Education Category: Care Plans

What is a toileting plan?

A toileting plan is a document that has instructions on how to help the person you support reach and use the toilet at a set time. To be effective, all the people who support them must follow the plan.

Regular and prompted toileting helps to set up a toileting routine. The goal is not to change toileting functions, but to improve continence by helping the person reach and use the toilet at the best times for them. This means they are less likely to experience incontinence.

How are toileting plans made?

A detailed continence assessment is done before a continence nurse advisor or other health care professional writes the toileting plan. This is to make sure the person’s individual needs are included in the plan. Click here for more information about Continence assessments.

The plan:

• will be specific to the person and include exactly what help the person needs, including any aids, such as continence pads
• may include specific times the person needs to be helped to the toilet
• can include the behaviours to look for that tell you the person needs to use the toilet.

You should always read, understand and follow the care plan, as it tells you what the person needs.

A toileting plan may need to be reviewed by a continence nurse advisor or other health care professional if it doesn’t seem to be working. You should speak to your supervisor or care coordinator to organise a review.

Who can help?

A continence nurse advisor can:

• work out the person’s needs
• design a plan specifically for them
• review plans if they are not working or if the person’s needs have changed.

Other health care professionals, including an occupational therapist, physiotherapist, behavioural psychologist and the person’s general practitioner (GP), can also help with toileting plans.

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

What is a bowel diary?

A bowel diary is a record of when the person normally passes bowel motions. It’s often used to collect information as part of a continence assessment. A bowel diary may also be used at different times during a continence treatment plan to see if the plan is working.

It is important to fill out the diary carefully, so that the information can be used to plan the person’s continence care.

Important

The person should be involved in managing their bowel diary as much as possible. Work out what things they can do, for example, looking at the bowel motions and choosing what number it is on the Bristol Stool Chart.

What information does a bowel diary collect?

The bowel diary shows:

• how many times a person passes a bowel motion
• the type of faeces the person passes each time – this can be identified using the Bristol Stool Chart
• whether the person is soiled before they get to the toilet (faecal incontinence)
• whether the person felt the need to go at the scheduled time
• if the person wears a continence pad, how many times it needs to be changed
• whether the continence pad is already soiled when the person gets to the toilet
• if the bowel motions change with the food and fluids the person is having when compared to a food or fluid intake diary (a record of what food and drinks the person has in the same time period).

How do you fill out a bowel diary?

A bowel diary is usually kept for seven days in a row. It should be filled out using the person’s normal routine.

Every bowel motion is recorded during the time you are asked to fill out the diary.

If the person is out or flushes the toilet before you see the bowel motion, note on the diary the date, time and that the person passed a bowel motion but that it wasn’t seen.

Other things to think about:

• If the person has a commode, they can use that instead of the toilet, as the pan will catch the bowel motions. Some people don’t like to use the commode during the day, however, and you need to respect that even if it’s easier for you.
• You may be asked to record the food and fluids the person consumes during the time the diary is kept. The diary may have room to write this down, or you may need to write it on a separate diary. This can be kept in the kitchen so that the time, as well as the type and amount of food and liquid can be written down as the person has it.

Remember that for the information to be useful, you need to fill in the diary as carefully as possible.

If you have any problems filling out the bowel diary, ask the person who wants to diary for help.

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

Extra Resources

• Bowel diary

What is a bladder diary?

A bladder diary is a record of when the person normally passes urine. It’s often used to collect information as part of a continence assessment. A bladder diary may also be used at different times during a continence treatment plan to see if the plan is working.

It’s important to fill out the diary carefully, so that the information can be used to plan the person’s continence care.

Important

The person should be involved in managing their bladder diary as much as possible. Work out what things they can do, for example, writing down the amount of urine passed on the bladder diary after you measure it, or tipping the urine from the container into the toilet.

What information does a bladder diary collect?

A bladder diary shows:

• how many times the person empties their bladder during the day and overnight
• the total amount of urine the person passes every 24 hours
• whether the person is wet before they get to the toilet (urinary incontinence)
• whether the person felt the need to go to the scheduled time
• if the person wears a continence pad, how many times a day it needs to be changed
• whether the amount of fluid they drink is less or more than the amount of urine the person passes, when compared to a fluid intake diary (a record of what drinks the person has in the same time period).

How do you fill out a bladder diary?

A bladder diary is usually kept for three days. It should be filled out using the person’s normal routine.

The diary:

• is kept for three full days
• can be kept for three separate 24-hour periods, or for three days and nights in a row.

To work out which one of these timing options to use and when:

• think about what will work better for the person:
  • if you notice that their pattern of passing urine changes over the week, it may be better to do three different days
  • if their pattern of passing urine is the same most of the time, keep the diary for three days in a row
• think about when the person will be home during the recording period. It’s harder to record the results when the person is out, so it’s best to keep the diary when they will be at home, e.g if they are at a day centre during the week, keep the diary on the weekend when they are home.

Other things to think about:

• If the person has a commode, they can use that instead of the toilet, as the pan will catch the urine. Some people don’t like to use the commode during the day, however, and you need to respect that even if it’s easier for you.
• You may be also asked to record the fluids the person drinks during the time the diary is kept. The diary may have room to write this down, or you may need to write it on a separate diary. This can be kept in the kitchen so that the time, as well as the type and amount of fluid can be written down as the person has it.

Remember that for the information to be useful, you need to fill out the diary as carefully as possible.

If you have any problems filling out the bladder diary, ask the person who wants the diary for help.

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

Extra Resources

• Bladder diary

What is a continence care plan?

A continence care plan is a document that tells everybody supporting a person what help they need to use the toilet. The plan also sets goals to be achieved.

An individualised care plan is written after the toileting habits and needs of the person have been assessed in a continence assessment. Information for the assessment comes from:

• the workers who support the person
• the person’s general practitioner (GP) or other health care professional, such as a physiotherapist or occupational therapist
• the person’s family and friends
• the person themselves.

For more information on continence assessments, go to Continence assessments.

How long does the plan last?

All continence care plans need to be reviewed regularly to make sure any changes are not missed. The plan should also be reviewed whenever the person’s health or needs change, or if the plan stops working.

How do you know if the plan isn’t working?

The plan isn’t working if the person:

• won’t let you take them to the toilet at the times in the plan
• won’t wear the continence pads or pants that are recommended in the plan
• is wet or soiled before they get to the toilet
• is suddenly wetting or soiling themselves when they weren’t before
• has a change in their health
• isn’t able to move around on their own as easily as before.

If the plan isn’t working, the person’s GP, a continence nurse advisor or other health care professional will need to review it.

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

What is a continence assessment?

A continence assessment is a detailed assessment:

• of how the person’s bladder and bowel are working
• of any issues the person has getting to, or using, the toilet
• to work out if the person has incontinence and what type of incontinence they have.

This helps the health care professional to find out what’s causing the continence issues and what’s the best way to treat it.

There are many different things that can cause problems with passing urine and faeces. Some people can be cured with the right treatment. For other people, the problem may not be able to be cured but can be better managed.

A continence assessment may not be finished in a single visit. Information may need to be gathered about the person’s health, symptoms, normal bladder and bowel habits, and what help they need. This information will need to be collected by everybody who helps to support the person. This includes the person themselves, their family, support workers, their general practitioner (GP) or other health care professional, such a physiotherapist and occupational therapist.

Once all the information is collected, the person doing the assessment can diagnose the issues and write a continence care plan.

What information is collected?

The information collected for a continence assessment can include:

• the continence goals the person would like to achieve
• the person’s current bladder and bowel habits
• what issues they have passing urine or faeces or both
• what aids they need to use the toilet
• what continence products they currently use
• how much help they need to use the toilet
• any other health issues or conditions
• information about previous illnesses or operations
• what medicines they take
• how much and what type of food and drinks they regularly consume
• what their home environment is like
• a physical examination, if the person agrees
• if there is already a continence care plan in place. If so, how well the current plan works.

How can you help with a continence assessment?

• Talk to the assessor about what you know about the person’s bladder and bowel habits, especially if the person is unable to speak for themselves.
• If possible, arrange for the family to be present with the person during the assessment.
• Provide a private and quiet space for the assessment visits.
• Complete bladder and bowel diaries if needed.
• Collect any other information the assessor needs between visits.
• Tell the assessor any other information that you think might be helpful.

Who does continence assessments?

Everyone involved in supporting the person, including the person themselves, provides information to help complete the assessment.

A health care professional with extra training and knowledge about normal bladder and bowel function, as well as the management of incontinence, completes the detailed assessment.

This could be:

• a continence nurse advisor
• the person’s GP
• a physiotherapist who specialises in bladder and bowel health.

Call the National Continence Helpline 18OO 33 OO 66 for information on local continence services who can help.

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

Extra Resources

• Bladder diary
• Bowel diary