Continence Care Foundations — Canada

The kidneys produce urine, which travels through the ureters to the bladder for storage and leaves through the urethra. Bladder muscles, nerves and sphincters coordinate storage and emptying. The bowel absorbs nutrients and water and moves remaining waste toward the rectum for elimination. Continence also depends on recognizing the need to go and reaching suitable facilities.

Incontinence is unintentional leakage; retention means difficulty emptying the bladder. Constipation may involve hard stools, straining or a change from the person’s usual pattern. Leakage does not prove the bladder is empty, and loose stool can sometimes occur around impacted stool. Support the individual plan for fluids, food, movement and toileting. Report new changes rather than assuming they are an inevitable part of aging or independently starting a bowel treatment.

Practice: Fictional practice: A person leaks urine but also reports difficulty emptying their bladder. Explain why leakage alone cannot rule out retention and identify the clinical concern to report.

Ask how the person prefers to be helped and explain each step before intimate care. Offer privacy with doors or curtains while maintaining the supervision required by the safety plan. Keep the person covered as much as possible, use respectful adult language and respond promptly to requests for the toilet. Do not discuss continence difficulties where others can overhear.

Encourage the person to manage the parts they can, such as clothing or hygiene, with equipment and assistance already assessed as suitable. Make the call device accessible and agree how they will request help. A toileting schedule should reflect the care plan and personal needs, not staff convenience. If help is declined, explore the concern, respect the person and seek appropriate support; do not use humiliation or force.

Practice: Fictional practice: Amira wants privacy but needs assistance to stand. Describe how to agree a safe way to summon help without leaving her to transfer alone.

A stoma is a surgically created opening that allows waste to leave the body by a different route. A colostomy brings part of the large bowel to the abdominal surface; an ileostomy uses the small bowel. A urostomy diverts urine. A pouching system commonly collects the output. Some ostomies are temporary and others permanent.

Reasons may include cancer treatment, inflammatory bowel disease, injury or a congenital condition. The type affects output and care requirements, so do not assume every pouch is for stool or use the same routine for everyone. Ask about the person’s usual self-care and follow the individualized plan. Leakage, skin damage or an unexpected change in output needs reporting to the responsible nurse or ostomy specialist. This introduction does not authorize irrigation, appliance fitting or other procedures without training and local authorization.

Practice: Fictional practice: A new colleague calls every abdominal pouch a colostomy. Explain the difference between a bowel ostomy and a urostomy without making assumptions about a particular resident.

Equipment may include an accessible toilet, raised toilet seat, bedside commode, bedpan, urinal and appropriately fitted absorbent products. A commode can reduce the distance to a toilet; a urinal or bedpan may support someone unable to access it safely. Absorbent products contain leakage but do not replace assessment, timely toileting or skin care. Catheter and ostomy systems serve particular clinical needs.

Use the equipment specified after assessment. Check stability, cleanliness, condition and the transfer plan before use. Place supplies and the call device within reach and ensure clothing can be managed safely. An aid that suits one person may create a fall or pressure risk for another. Do not improvise lifts, substitute an unassessed device or use a catheter simply to reduce staff workload.

Practice: Fictional practice: A person cannot safely walk the usual distance at night. List an equipment option for assessment and the transfer and privacy questions that must be resolved.

Continence care can expose workers and others to urine, stool and contaminated equipment. Assess the task, perform hand hygiene and use appropriate gloves and other protective equipment when exposure is anticipated. Gloves do not replace hand hygiene. Separate clean supplies from used items, clean equipment through the approved process and dispose of waste according to site instructions.

Help with prompt, gentle cleansing and drying after leakage, following the skin-care plan. Report redness, broken skin or pain; do not scrub fragile skin or introduce unapproved products. Keep the route to the toilet clear and follow the transfer plan. Inability to pass urine with pain, blood, fever with flank pain or severe deterioration needs prompt clinical escalation. Do not diagnose infection from urine smell alone or reduce prescribed fluids merely to avoid wet clothing.

Practice: Fictional practice: A colleague proposes giving fewer permitted drinks to reduce pad changes. Explain the concern and propose support that follows the care plan.

An indwelling urinary catheter drains the bladder through tubing into a collection bag. Follow the prescribed care instructions, maintain the closed system and keep the bag below bladder level and off the floor. Check for tubing that is kinked, compressed or pulling; secure it as instructed. Routine hygiene and hand hygiene reduce contamination risk.

Only trained, authorized staff should carry out the assigned care. When emptying is within your role, use the approved method and avoid contaminating the outlet. Record measured output as directed. Report absent drainage, new pain, leakage, bleeding or signs of illness promptly. Do not disconnect, flush, replace or remove a catheter on your own initiative. A sudden painful failure to drain needs urgent assessment; do not wait for a routine recording time. The need for the catheter should be reviewed by the clinical team.

Practice: Fictional practice: During a transfer you notice the drainage bag above bladder level. Identify the positioning concern and explain what to report if urine is not draining despite routine checks.

Confirm the ordered test, person’s identifiers and laboratory instructions before collecting. Explain the process, obtain agreement, provide privacy and use the specified container. For a requested clean-catch midstream urine sample, follow the supplied cleaning instructions, start urinating into the toilet and collect the middle portion without touching the container’s inner surface. Other urine tests may require different methods.

For a stool sample, use a clean collection receptacle and prevent contamination by urine or toilet water. Transfer only the amount directed into the correct laboratory container; do not discard preservatives or substitute a household jar. Close securely, label with the required identifiers and collection time, and arrange storage and transport exactly as instructed. Report contamination or labelling errors. Catheter sampling requires a separate authorized technique; an old drainage-bag sample is not a substitute for a prescribed collection method.

Practice: Fictional practice: A stool specimen falls into toilet water before collection. Explain why it must not be labelled as an uncontaminated sample and identify who supplies recollection instructions.

A bladder diary may record toileting times, measured urine volumes, leakage and relevant symptoms. A bowel chart may record frequency, stool consistency using the approved chart, discomfort and assistance. Catheter or ostomy records may include output and observations specified in the plan. These records help the team compare patterns and evaluate care; they do not independently establish a diagnosis.

Write factual, timely entries using the required units and your own identity. Distinguish measured amounts from estimates and record care offered, provided or declined respectfully. Include who was notified about a concern and the response, rather than assuming a completed chart communicates urgency. Use approved confidential systems, not personal messaging or photographs. For example, record the person’s reported burning and the time of escalation instead of writing an unsupported diagnosis of urinary infection.

Practice: Fictional practice: At 10:15 a person reports burning when urinating. Draft a factual entry with the reported symptom and notification, without claiming a diagnosis or inventing a urine volume.