4 Elimination and Continence Care
Learn how to support safe, respectful toileting and continence care, recognize changes in urinary and bowel patterns, protect skin, and report concerns promptly.
Principles of care
is the passage of urine and stool. Care should support the person’s usual routine, privacy, dignity, comfort, and independence. is not an inevitable part of aging; report new or worsening changes rather than dismissing them.
Supporting safe toileting
Help the person use the toilet, commode, bedpan, urinal, or another prescribed aid according to their abilities and care plan. Ask about preferences, respond promptly to requests, and provide privacy while staying close enough to assist safely.
Before a transfer, clear the path, make needed mobility aids available, and ensure the person has stable footwear. Follow the care plan and your training for transfers. Do not rush or leave someone at risk of falling.
An individualized toileting schedule may help a person who has difficulty recognizing, communicating, or acting on the urge to go. Offer toileting at useful times, such as after meals or before sleep, and respond to requests without unnecessary delay. Encourage the person to take their time and use a comfortable, stable position. Do not force a schedule or restrict fluids to reduce toileting needs unless a qualified clinician directs this.
Urinary patterns and continence
Observe and report changes in the person’s usual urinary pattern, including new leakage, urgency, unusually frequent or infrequent urination, difficulty starting, pain, or trouble emptying the bladder. A may help a clinician identify patterns. can have different causes, so assessment can help determine appropriate treatment.
Support normal hydration according to the care plan. Do not recommend extra fluids or fluid restriction for a person with a condition such as heart or kidney failure unless directed by their clinician. For prescribed bladder training or pelvic-floor exercises, follow the clinician’s instructions rather than creating a plan independently.
Indwelling urinary catheters should be used only when clinically indicated and removed as soon as they are no longer needed. Perform hand hygiene before and after handling the device. Keep the drainage system closed, the tubing unkinked, and the bag below bladder level and off the floor.
Empty the bag using the approved procedure, without letting the outlet touch the collection container. Report leakage, blockage, disconnection, or other concerns. Catheter insertion and changes are performed only by trained, authorized personnel.
Bowel patterns and continence
Learn the person’s usual bowel pattern; there is no single correct frequency for everyone. Note changes in frequency, stool consistency, straining, pain, urgency, or accidental leakage. A bowel or stool diary can help reveal patterns.
may involve hard or difficult-to-pass stools, infrequent bowel movements, or a feeling of incomplete emptying. Loose stool can also contribute to bowel leakage, so leakage does not always mean diarrhea.
As allowed by the care plan, support fiber-containing foods, appropriate fluids, mobility, and unhurried toileting. A predictable opportunity to use the toilet after a meal may help some people. Do not give laxatives, enemas, or other treatments unless authorized by the care plan or a qualified clinician.
Hygiene, skin care, and observation
Use and follow the organization’s procedure, including gloves when contact with urine, stool, or contaminated items is possible. Explain what you are doing, protect privacy, and encourage the person to do whatever they can independently.
Clean the perineal area promptly after soiling, using gentle cleansing and drying. When providing care to a person with a vulva, wipe from front to back. Change wet or soiled clothing and absorbent products promptly. A barrier product may be used if included in the care plan.
Check for redness, irritation, broken skin, or pressure areas, and report concerns. Record and report relevant observations according to workplace policy, including timing and amount when required, urine or stool changes, pain, accidents, skin condition, and the person’s response to care. Describe observations rather than making a diagnosis.
When to report promptly
Follow emergency procedures and alert the appropriate clinician for inability to pass urine, visible blood in urine or stool, painful urination, new severe abdominal pain, vomiting, fever, or inability to pass gas with . A sudden significant change in also requires prompt attention.
Report new or worsening , persistent or diarrhea, and skin breakdown for assessment. Effective care is individualized, respectful, and safe: support timely and accessible toileting, observe and report changes, protect skin, and follow the care plan for hydration, treatments, and devices.