Bladder and bowel problems need special attention.

        It is important to observe urine and feces for frequency, amount, color, and odor. Check whether urine is cloudy or clear, and observe the texture of feces. Report any problems or complaints.

        Urine is normally pale yellow and clear. Darker yellow usually indicates the need for more fluid. If you notice anything abnormal (e.g., color, odor, blood), report it.

        Bowel movements (BM) eliminate bodily waste (feces) through the anus. Frequency of bowel movements varies from person to person and is affected by age, disease, medications, diet, fluids, and activity. The general range is three times a day to three times a week. The NA must document each BM and recognize problems related to elimination. Any abnormal urine or feces should be reported before it is discarded. Report any complaints of pain or burning during elimination.

        Constipation is bowel movements that are infrequent and painful with hard feces. Treatment includes.

        Adjusting the diet, increasing fluids, and adding physical activity. If these measures are not effective, a suppository or enema may be ordered.

        Impaction is a serious form of constipation with inability to pass fecal matter. The resident may complain of pain in the abdomen or rectum. There may be an absence of bowel movements for several days, and small amounts of liquid may be seeping from the anus. Report any symptoms of impaction immediately.

        Diarrhea is watery stool. Causes include food irritations, medications, and infections. The urge to eliminate may happen suddenly. Keep a call light/ signal within easy reach of the resident, and respond promptly. Pay extra attention to hygiene, and encourage fluid intake to replace loss of fluids.

        Watch for anything unusual and any problems related to elimination. Report any concerns immediately. Elimination problems include the following:

Symptom	Problem
loose feces	Diarrhea
dark or ”tar” feces	Possible internal bleeding
hard feces	Constipation
small, infrequent feces	Possible impaction
dark or cloudy urine	Possible urinary tract infection
pain  or burning on urination	Possible infection
small, frequent amounts or urine	Possible infection

Bowel and Bladder Training

        Some clients lose bowel and bladder control. This condition is called incontinence. Causes include age, disease, immobility, physical restraints, and confusion. Training programs help clients regain control of elimination. Follow instructions carefully for clients who have training plans. Relearning bowel and bladder control takes time and patience.

        The goal of training is to establish regular patterns for elimination and to minimize or eliminate incontinence. Individual schedules are established. In order for training to be successful, instructions must be followed exactly. If training begins in the early stages of incontinence, the client may improve within six weeks. Others may take a year or more.

        All clients need to be offered frequent toileting. Some clients have “accidents” because they are embarrassed to ask for help with elimination needs. Failing to toilet clients who are continent is a form of abuse (forced incontinence). Not providing pericare after clients soil themselves is also abuse. Always be supportive and sensitive to the clients’ toileting needs.

        Some clients wear special briefs for incontinence. Learn to apply the briefs correctly. Improper use can cause skin problems. Change briefs whenever they are wet or soiled, and clean the skin thoroughly. Discard briefs according to procedures at the facility where you work.

        Observe what is happening when incontinence occurs. Sometimes incontinence increases with despair, excitement, anxiety, or isolation; residents are seldom incontinent at social events. Encourage social activities that are useful and interesting, and promote social interaction.

Bladder Retraining

        Keep accurate records of fluid intake, and record the time when the resident voids or wets. Provide toileting according to the individual ‘s  retraining schedule. Encourage adequate fluid intake. Unless the care plan states otherwise, provide fluids with meals and between meals. Cutting back on fluid does not decrease incontinence and may cause serious health problems.

        Assist with proper positioning. Males void more easily standing, and females void more easily sitting with feet firmly on the floor.

Bowel Retraining

        The goal of bowel retraining is to gain control of bowel movements and develop a pattern of elimination. Explain the training program to the resident and encourage cooperation.

        Follow each client’s care plan carefully. If allowed, teach exercises that strengthen abdominal muscles. Provide a regular eating schedule, and study eating habits. For residents who are able, encourage ambulation and physical activities.

        Find out whether there has been a change in diet, fluid intake, or physical activity. Ask how often and what time of day bowel movements occurred previously.

        Explain that every body system depends on water in order to function. Offer water and beverages through­ out the day (unless the care plan states otherwise). Establish a toileting schedule. Bowel evacuation often occurs about a half hour after breakfast. Be sure the resident has easy access to the toilet, or offer bedpans and assistance frequently. Provide privacy, allow sufficient time for toileting, and do whatever is necessary to ensure the resident’s comfort and safety.