Author: Manning

Toileting plans
The aims of a toileting plan is to help you know when to take the person you support to the toilet. These set times are in the plan because this is when the person is most likely to pass urine or open their bowels. A toileting plan is designed for the person by a continence professional such as a continence nurse advisor. You can help by reporting what you see, as well as any changes, to your supervisor or the person who wrote the plan.

The person’s care plan should be followed carefully, as it will give information about what the person can do for themselves and what they need help with. This helps them to be as independent as possible and gives them the right aids, support and environment when they need them.

Following a toileting plan

You should follow toileting plans carefully. Get help if the person you support:
- refuses or resists going to the toilet at the scheduled time
- refuses or resists sitting on the toilet when you take them
- doesn’t pass urine or bowel motions when you take them to the toilet
- wets or soils themselves between toileting times.
Toileting plans are designed specifically for each individual. If you aren’t sure about how to follow the person’s toileting plan, ask your supervisor or a continence professional. They may need to review and update the care plan if the person’s needs have changed.

Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.
March 19, 2025
How to fill out a bowel diary
Important

A bowel diary is a record of when a person passes bowel motions. Some people need help to fill out a bowel diary.

Bowel diaries are usually filled out as part of a continence assessment. It’s important to fill out the bowel diary carefully, so it provides useful information for the health care professional. A bowel diary should be kept over seven days and nights.

What equipment do you need?

You will need:
- a pen
- a printed bowel diary
- a printed copy of the Bristol Stool Chart
- disposable gloves
Put this equipment in or near the toilet, so the diary can be filled out each time the person passes a bowel motion.

How do you fill out the diary?

Wait until the person needs to go to the toilet and give them the help they need.
1. Put on disposable gloves.
2. When the person finishes passing a bowel motion, help them with wiping if needed. Don’t throw the toilet paper into the toilet bowl straight away, as you may not be able to see the bowel motion in the toilet bowl.
3. Do not flush the toilet straight away.
4. Look at the bowel motion in the toilet bowl and compare it to the Bristol Stool Chart.
5. Record the type of bowel motion in the bowel diary.
6. Flush the toilet.
7. Take off your gloves and wash your hands.
8. Complete the bowel diary by writing down the time, date, amount and any other information asked for in the diary.
Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.
March 19, 2025
How to fill out a bladder diary
Important

A bladder diary is a record of when a person normally passes urine. Some people may need help to fill out a bladder diary.

Bladder diaries are usually filled out as part of a continence assessment. It’s important to fill out the bladder diary carefully, so that it provides useful information to the health care professional A bladder diary should be kept over three days and nights.

What equipment do you need?

You will need:
- a pen
- a printed bladder diary – one page for each 24-hour period
- a collection container, e.g. an empty and clean ice-cream container
- a measuring jug
- disposable gloves.
Put all this equipment in or near the toilet, so the diary can be filled out each time the person passes urine.

How do you fill out the diary?

Wait until the person wants to go to the toilet and give them the help they need.
1. Put on disposable gloves.
2. Put the collection container in the toilet bowel before the person sits on the toilet.
3. After the person passes urine, throw any toilet paper or wipes into the toilet bowel, not the container.
4. Pour the urine into a measuring jug.
5. Write on the bladder diary how many millilitres of urine are in the container.
6. Empty the urine into the toilet and flush.
7. Rinse out the container and jug with water and leave to dry.
8. Take off gloves and wash your hands.
9. Complete the bladder diary entry by writing down the time and any other information asked for on the diary.
Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.
March 19, 2025
Following a continence care plan
Important

Always read a person’s care plan and make sure you understand what you need to do to help them. If you don’t understand the plan, or the person you support refuses to follow it, talk to your supervisor, as the plan may need to be explained to you or be reviewed.

What is a continence care plan?

A continence care plan:
- explains what help the person needs to use the toilet to pass urine or faeces
- gives information about how to manage any leaking of urine and faeces.
A continence care plan is worked out to meet the needs of each person. Don’t use another person’s care plan.

How do you use the plan?

When you are supporting the person, you need to:
- read the goals of the plan
- follow all the instructions in the plan exactly as they are written
- make sure you are using the right behavioural management strategies
- make sure you are using the right toilet and continence aids
- look at the type and amount of food and drinks the person should have
- make sure you’ve read the plan before providing care. Check it again each time it’s reviewed or updated in case the plan has changed.
What do you do if the plan isn’t working?

Sometimes a plan that was working well, suddenly doesn’t anymore. Reasons for this can include:
- the person refuses to go to the toilet or use continence aids recommended
- the person has had a change in their diet or fluid intake
- the person is sick or has an ongoing health issue
- other people who support the person have not been following the plan
- the person’s continence issues have changed
- the aids are not working anymore.
If you don’t know the reason why the plan isn’t working, or if the person’s health or needs have changed, the plan may need to be reviewed by their general practitioner (GP), a continence nurse advisor or other health care professional.

Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.
March 19, 2025
Continence assessement

Why is a continence assessment important?

There are many different types of incontinence, so treatment and management plans can be very different. A continence assessment is done to find out the type of incontinence a person is experiencing. It helps the health care professional to write a personalised treatment and management plan for the person.

As part of a continence assessment, you may need to provide a record of the continence management issues experienced by the person you support. This can be done by completing a bladder diary or bowel diary as part of the person’s assessment. The health care professional may also ask for a copy of the person’s medicines.

It is important to fill out any documents and follow any instructions carefully. If you don’t understand what you need to do to help collect information for a continence assessment, ask you supervisor or care coordinator.

Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.

March 19, 2025
Unstable on the toilet
Important

It’s important to help the person you support sit on the toilet correctly because:
- an incorrect toileting position can make it hard for the person to pass urine or bowel motions.
- an unstable position can cause the person to fall off the toilet and hurt themselves.
How should a person sit on the toilet?

The diagram below shows you how a person should sit on the toileting.

Why is it important to sit on the toilet correctly?

It’s important because it helps to relax the pelvic floor muscles, which opens the ano-rectal angle and allows the faeces to pass quickly and easily.

How can you help?

Check the person’s care plan to make sure that any recommended aids are used. These can include:
- an over-toilet frame or raised toilet seat
- a foot stool.
What if the person is unstable on the toilet?

Check the care plan and make sure that you are following it.
- If the person seems unstable, don’t leave them alone on the toilet.
- Check that they are sitting correctly on the toilet seat. You may need to help them stand up and sit down again to get them into the right position.
- Check that any toileting aids are being used and are suitable for the person.
- If the person is still unstable, speak to your supervisor about getting an occupational therapist or physiotherapist to look at what toileting aids may be needed for safety and correct positioning.
Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.
March 19, 2025
Fluid intake
Important

Dehydration means that the person you support doesn’t have enough fluid in their body. It is a very serious problem that can happen quickly and make them ill.

How do you know if the person is drinking enough fluid?

Keep track of how much they are drinking. For most people, drinking 1-1.5 litres (6-8 glasses) of fluid a day is enough. However, some health conditions require people to drink less or more fluid. Don’t assume the person knows when they are thirsty or that they will ask for a drink.

When the person uses the toilet, compare the urine colour to the hydration chart. If their urine is:
- clear or light yellow – they are drinking enough
- yellow – give some more fluid
- dark yellow or orange – give some more fluids, and check with a health care professional if it doesn’t improve
- very dark yellow or brown – the person needs to see a health care professional straight away.
Check the person’s care or mealtime plan for any special needs. These can include:
- thickened fluid
- fluid restrictions
- preferred hot or cold drinks at certain times
- a favourite cup or bottle to drink from.
What can you do if they are not drinking enough?
1. Offer small amounts of fluid regularly (e.g. with meals or when giving medication) rather than a few big drinks.
2. Put fluids where the person can easily reach them, if safe.
3. Don’t rush – sit with them and encourage them. Lift the drink to their mouth if needed.
4. Remember that some foods are also a good way of getting fluid. These include:
  - soup
  - jelly
  - ice cream, yoghurt, smoothies
  - watermelon.
5. When you go out, regularly offer them a water bottle.
6. If the person is active or the weather is hot, they might need more fluids.
7. If the person has a percutaneous endoscopic gastrostomy (PEG) tube, make sure you follow their feeding plan.
8. In cold weather, they may prefer hot drinks such as hot chocolate, herbal tea or soup.
Checklist

If the person is not drinking much fluid, check to see if:
- their mouth and gums are dry or have any painful areas
- they can swallow properly
- that they like what you are giving them to drink.
If you don’t know what to do or are worried, talk to your supervisor, care coordinator or ask for help from a health care professional.

Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.
March 19, 2025
Unable to hold bowel motions
What is faecal incontinence?

Faecal incontinence is when someone can’t control their bowel motions or wind (farts, flatus) from their anus. People with faecal incontinence aren’t able to hold on when they feel the need to pass a bowel motion, which means they have to go to the toilet as soon as they feel the urge to go.

Faecal incontinence can:
- be severe with major accidents, or minor with only their underwear getting smeared
- include diarrhoea, constipation, wind and bloating
- happen everyday or only occasionally
- keep a person house-bound, or restricted to places where they feel they could cope with an accident
- affect a person’s work, social and sex life.
What can you do to help a person with faecal incontinence?
- If they have a toileting or bowel management plan, make sure you follow it.
- People with faecal incontinence may need to see their general practitioner (GP) or other health care professional to find out why they have this condition and what they can do to treat it.
Try to find our why the person has faecal incontinence
- Check for any changes to their diet or routine:
  - Have they changed what they eat?
  - Does their diet include enough fibre? Arrange a dietitian appointment if you’re not sure.
  - Are they drinking less than usual?
- Have they started any new medicines? Don’t change the medicines, but tell their GP if they get faecal incontinence.
- If they have been prescribed any medicines for faecal incontinence by a GP or nurse practitioner, make sure they have taken them. Their health care professional may need to review the medicines.
- Talk about their care with your supervisor.
Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.
March 19, 2025
Lumps around the anus
Important

Lumps around the anus are not normal. A number of different things can cause them. It’s important that the person sees their general practitioner (GP) or other health care professional if you notice lumps, any signs of bleeding from the anus, or any sudden change in how often the person passes bowel motions.

What should you do if you see or feel lumps around the anus?
- Put on some non-latex gloves. Have a look at the lumps and see how big they are. Do not touch the lumps. Remember to ask permission first and let the person know what you are doing and why.
- You need to work out if something has changed or become worse, so you can let the GP know.
- Ask the person (or other support workers or their family) if:
  - they know about the lumps, and if they do, how long they have been there
  - the lumps are painful
  - they have haemorrhoids
  - they have talked about the lumps with their GP.
How should you support someone with lumps around their anus?

If the person has lumps around their anus:
- Check their care plan to see if it has any toileting instructions.
- Use wet wipes rather than toilet paper after they use the toilet. Pat rather than rub the skin clean. Be very gentle so you don’t cause pain or bleeding.
- Check the skin between the buttocks and around the anus. If there is a rash, talk to their GP, your supervisor or their care coordinator.
- Don’t leave the person sitting for a long time on the toilet or a hard surface, as this can make the lumps worse.
- If the person is straining or pushing to pass a bowel motion, arrange for a review by their GP, a continence nurse advisor or a disability nurse advisor.
- Check that the person has cotton underwear, as they are usually more comfortable.
If the person you support has a spinal injury above T6, make sure you know the signs and symptoms of autonomic dysreflexia.

Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.
March 19, 2025
Loose bowel motions
What is diarrhoea?

Diarrhoea is a watery, soft or mushy bowel motion. Sometimes there can also be stomach cramps or pain and a sick feeling.

People with diarrhoea may find it hard to hold on to their bowel motions and need to rush to the toilet multiple times per day. Diarrhoea can cause dehydration, as well as malnutrition if it lasts for a long time.

What should you do if the person you support has diarrhoea?
- Discuss the person’s care with your supervisor. You may need to arrange for a visit to their general practitioner (GP).
- Organise suitable continence pads, if required. When pads are soiled, they need to be changed quickly to protect the skin from the watery bowel motion. The skin needs to be cleaned well.
- If the person has limited mobility, make sure any mobility aids are used and check if their needs have changed.
- Check for any changes to the person’s diet or routine:
  - Have they changed what they eat?
  - Does their diet have enough fibre? Arrange a dietitian appointment if you’re not sure.
  - Are they drinking less than usual?
  - Have they started any new medicines? Don’t change their medicines but tell their GP if they get diarrhoea.
- If the person has been prescribed medicines to treat diarrhoea by a GP or nurse practitioner, make sure they have taken them. The medicines might need to be reviewed by a health care professional.
People experiencing continued problems with loose bowel motions or diarrhoea should see their GP or other health care professional for investigation and treatment.

Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.
March 19, 2025