5 Urinary and Bowel Elimination

Supporting toileting and continence

Support elimination in a way that is safe, comfortable, and as independent as possible. Incontinence is not an inevitable part of aging, and a change in bladder or bowel habits may have a treatable cause. Follow the person’s care plan and workplace procedures; report concerns rather than diagnosing or changing treatment yourself.

Ask about and use the person’s preferred words and routines. Offer help promptly when requested, and follow any individualized or scheduled toileting plan. Do not rush or shame the person, or assume that needing assistance means they are incontinent.

Keep the route to the toilet clear and well lit. Place prescribed mobility aids, a call bell, urinal, or commode within reach. Follow the person’s transfer and mobility plan, request help when needed, and do not leave someone at risk of falling unsupported.

Explain each step and obtain consent. Protect privacy by closing the door or curtain and exposing only the area being cleaned. Stay nearby or supervise according to the person’s safety needs.

Support usual fluid intake, meals, and activity as permitted by the care plan. Do not restrict fluids or introduce laxatives or other treatments unless directed. Arthritis or other mobility difficulties can make timely bathroom access harder, and constipation can contribute to urinary or bowel symptoms.

Assisting with elimination

1. Perform hand hygiene and use gloves when contact with urine, stool, or contaminated items is expected. Gather needed supplies before beginning.

2. Help the person transfer to the toilet, commode, or bedpan using the approved technique and equipment. Provide clothing assistance and time, and allow the person to do as much as they safely can.

3. Offer toilet tissue and help with cleaning as needed. For perineal care, clean gently from front to back, use a mild or facility-approved cleanser, and pat dry. Change soiled clothing, pads, and linens promptly. Assist the person with handwashing afterward.

4. Dispose of waste and clean equipment according to workplace procedures. Remove gloves safely and perform hand hygiene.

Protecting skin integrity

Urine and stool left against the skin can cause irritation and breakdown. Clean and dry the skin promptly after soiling; avoid vigorous rubbing and products that are irritating or contain alcohol.

Apply a prescribed or approved moisture barrier as directed, but continue to clean the skin after each episode. Observe the buttocks, groin, and perineal area for persistent redness, rash, pain, open areas, or other changes, and report them.

Observing and reporting changes

Record and report information according to the care plan, including how often the person urinates or has bowel movements; changes in amount, urgency, control, or usual pattern; stool consistency; difficulty or pain; and associated symptoms. Report new leakage, constipation, diarrhea, or difficulty urinating rather than treating these changes as a normal part of aging.

Promptly report painful or burning urination, blood in urine or stool, fever or chills, lower abdominal or back pain, new confusion or a marked change in condition, and skin breakdown.

Sudden inability to urinate—especially with lower abdominal pain or swelling—needs urgent clinical attention. Constipation with severe persistent abdominal pain, vomiting, inability to pass gas, or rectal bleeding also needs urgent clinical attention. Follow emergency procedures for severe symptoms.