Toileting and Incontinence Care

Assisting with toileting is a fundamental CNA responsibility. Proper technique maintains patient dignity, promotes independence, and prevents complications such as skin breakdown and falls.

Toileting Equipment

Bedpan Use

Standard Bedpan Positioning:

1. Explain procedure and provide privacy
2. Raise bed to comfortable working height
3. Lower head of bed (if patient tolerates)
4. Put on gloves
5. Ask patient to bend knees and raise hips
6. Slide bedpan under buttocks (wide end toward back)
7. If patient cannot raise hips, roll to side and position pan
8. Raise head of bed for comfort
9. Provide call light and toilet paper
10. Leave patient for privacy (unless unsafe)
11. When finished, hold pan steady while patient raises hips
12. Wipe patient or provide assistance
13. Note characteristics of urine/stool
14. Empty, rinse, and clean bedpan
15. Provide hand hygiene for patient
16. Remove gloves, perform hand hygiene

Fracture Pan:

• Used for patients with hip fractures or back pain
• Place narrow/handle end under buttocks
• Requires less lifting by patient

Urinal Use

For Male Patients:

1. Provide privacy
2. Give urinal to patient or assist positioning
3. Ensure penis is inside opening
4. Leave patient with call light
5. When finished, cover urinal
6. Note amount and characteristics
7. Empty in toilet, rinse urinal
8. Provide hand hygiene for patient

Bedside Commode

Advantages:

• More natural sitting position than bedpan
• Easier for patients who can transfer
• Promotes independence
• Reduces risk of UTIs (better bladder emptying)

Transfer Procedure:

1. Position commode next to bed
2. Lock commode wheels (if present)
3. Assist patient to sitting at edge of bed
4. Apply gait belt
5. Assist to stand, pivot to commode
6. Lower patient to seat
7. Ensure patient is stable and comfortable
8. Provide call light and toilet paper
9. Step out for privacy if safe
10. Assist back to bed when finished

Understanding Incontinence

Incontinence is the inability to control urination (urinary) or bowel movements (fecal). It is not a normal part of aging—it has underlying causes.

Types of Urinary Incontinence:

Incontinence Care

Goals:

• Maintain skin integrity
• Preserve dignity
• Promote continence when possible
• Manage episodes effectively

Skin Care for Incontinence:

1. Clean skin immediately after each episode
2. Use gentle cleansers (avoid harsh soap)
3. Pat dry—don't rub
4. Apply barrier cream as ordered
5. Change briefs/pads promptly
6. Check skin frequently for breakdown

Bladder Training Programs:

Incontinence Products

Documentation

Record and report:

• Time of voiding/bowel movement
• Amount (measured if on I&O)
• Characteristics (color, odor, consistency)
• Skin condition
• Patient's ability to feel urge
• Episodes of incontinence