A Guide to Incontinence Care

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Introduction

Incontinence is the inability to control urination and/or bowel movements. These changes can be uncomfortable to talk about, but managing incontinence can prevent discomfort and skin problems. Your care team will help you get needed supplies and equipment and offer help specific to your situation.

What You Can Do

  • Routinely offer assistance in getting to the bathroom.
  • Ask the person if they need to use the urinal, bedside commode or bedpan every few hours. Keep these items close by.
  • Use disposable briefs, pads, shields and/or protective bed pads (chux) to contain body waste.
  • Check for wetness every couple hours.
  • Change soiled briefs, pads and linens as soon as possible to prevent skin irritation and breakdown.
  • Clean the genital are with soap free cleansers or soft wipes after each incontinent episode. Gently dry well. Apply a barrier cream to protect skin.
  • If taking diuretics which increase urine output, ask your nurse or physician about scheduling them early in the day to prevent the need to urinate frequently during the night.
  • Ask your nurse or hospice aide about ordering a bedside commode or elevated toilet seat to make using the toilet easier and safer.

Call Your Nurse If You Notice

  • Difficulty urinating, especially when associated with abdominal or bladder pain
  • Burning, pressure or pain when urinating
  • Bloody or cloudy urine

As disease or illness advance and a person begins to eat and drink less, it is normal for urine to become darker and more concentrated. It will change from amber to brown and be scant in amount. This is an expected change at the end of life as a person’s body begins to shut down and will cause the person no pain or discomfort. Bowel movements also often decrease in amount and frequency.

 

Let your hospice care team know if incontinence, urinary pain or changes in pattern or frequency occur. They are available to help you with information and support.

Using a Bedside Commode

A bedside commode is a portable toilet that can be placed wherever it’s most convenient.

  • Position the commode at an angle to the chair or bed.
  • Disposable pads or newspaper can be placed under the commode to protect flooring.
  • Place a small amount of mild soapy water or scented disinfectant in the disposal bucket to aid in disposal and clean up after use.
  • Make sure tissue or toilet paper is handy. Offer supplies for washing up genital area and/or hands after use.
  • Remember to use gloves when assisting in washing and when disposing waste.
  • Wash your hands after removing gloves.

Assisting with Using a Bedpan

  • Wash hands and put on gloves.
  • If the person you care for is in a hospital bed, lower the head of the bed.
  • Have them roll onto one side; if applicable, make sure side rails are up on that side.
  • A little powder or cornstarch sprinkled onto the lip of the pan helps it side under the person receiving your care.
  • Place bedpan against buttocks with small end of pan toward the small of the back.
  • Help them roll onto their back, bedpan will be underneath them.
  • Raise the head of the bed or assist the person to as close to a sitting position as tolerable. Assist them in bending their knees and planting their feet on the bed.
  • Remember to leave them some toilet paper.
  • Provide privacy but stay nearby.
  • When removing bedpan, lower head of bed, and place one hand on the mattress near the bottom of the bedpan and push down on the mattress.
  • With the other hand hold the pan level and pull the pan from under the person as you ask them to lift slightly.
  • If they are unable to lift up, help them turn over slightly, in the direction away from you as you slide the bedpan form under them.
  • Assist with washing thoroughly, drying, and applying lotion or cream.

Urinary Catheter Care

A urinary catheter drains urine continuously from the bladder through a plastic tube and into a collection bag. The catheter is held inside the bladder by a small balloon filled with sterile saline. The catheter eliminates the need to use a bedpan or toilet for urination, but a bedpan is still needed for a bowel movement. The following tips can provide comfort and help to prevent bladder infections.

  • Wash your hands with soap and water before and after handling the catheter, tube or bag.
  • Keep the bag below the level of the bladder at all times.
  • Check to be sure there are no kinks or loops in the tubing and that the person is not lying on the tubing.
  • Don’t pull or tug on the catheter tubing.
  • Wash around the catheter entry site with soap and water twice each day and after each bowel movement.
  • Do not use powder around the catheter entry site.

Emptying the Catheter Bag

The collection bag should be emptied as often as needed or at least every 12 hours.

Leg bags should be emptied every 3-4 hours.

 

Supplies: Gloves, container to collect urine, alcohol swab

  • Wash your hands and put on gloves.
  • Remove the drainage tube from its sleeve, and point it into the container.
  • Unclamp the drainage tube. Try not to touch the end of the tube to any surface
  • when emptying the collection bag.
  • Let the urine drain into a container.
  • Reclamp the tube.
  • Clean the tip of the drainage tube with an alcohol swab.
  • Reinsert the tip of the drainage tube into the sleeve.

Urinary Catheter Questions and Concerns

Many people have questions and concerns about urinary catheters. Some of these concerns and what you can do are listed below.

 

Concern:

After catheter insertion, the person feels mild burning or a need to urinate. This is a common feeling and will diminish.

What you can do:

  • Try deep breathing, relaxation exercises or diversion activities, such as watching TV or visiting with family and friends.
  • Call your nurse if these symptoms persist more than a day.

Concern:

The urine in the collection bag is dark or amber colored. This can be caused by some medicines, some illnesses or not taking in much fluid.

What you can do:

  • Encourage and increase the fluids you offer if the person can tolerate the increased intake.
  • Let your nurse know, especially if there is any increased discomfort and ask her to discuss reasons for this.

Concern:

No urine has drained into the tubing or bag.

What you can do:

  • Be sure the tubing is not caught under the person, kinked, or looped. Straighten the catheter tubing.
  • Change the person’s position. Help them roll onto their side or sit up if able.
  • Check to be sure the bag is below the level of the bladder.
  • Check for wetness (leaking) around the catheter entry site.
  • Check to see if the person feels pressure or pain in the lower abdomen.
  • Call your nurse if there is leaking, pain or pressure or if you have tried all of the above and you still see little or no urine in the bag 6 to 8 hours after you emptied it.

 

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