Care Partner Series: Incontinence Management

by Guest Author

Mariah Mahotz, BSN, RN, OCN, Nurse Navigator at the Pacific Brain Tumor Center, reviews methods of incontinence management, safe handling if a family member is taking chemotherapy, and more. This is part of a “How To” series for our families, specifically focused on care partners.

What is incontinence?

Incontinence, or the inability to control urinary flow or bowel movement, is a common symptom of aging and cancer therapy. Over 75% of women over the age of 65 experience urinary incontinence (UI). Many cancer treatments, including chemotherapy, may affect bladder function by damaging the muscles and nerves used to control bladder flow.

Knowing the signs of incontinence is the first step to ensuring proper care for your loved one. Symptoms of UI include frequent urination at night, leakage, as well as a weak urine stream, or the feeling that the bladder is never empty, among others.

What is incontinence management?

Incontinence management, or the management of uncontrolled urine flow and bowel movement, is one of the most requested pieces of information for care partners looking after loved ones who have limited mobility from aging or from cancer treatment. While caring for a loved one who is incontinent, it is important to know how to keep them comfortable, but also keep yourself safe.

Before assisting your loved one with incontinence management, take the necessary steps to keep yourself self by wearing gloves. Specifically, if your loved one is undergoing oral chemotherapies, be sure to wear gloves to avoid coming into contact with these fluids which can be excreted through urine or sweat.

If at any time during incontinence management, you notice skin abnormalities on your loved one, such as redness or a new open wound, be sure to call your care team. Skin breakdown is quite common when caring for a bed-bound loved one and may require medical assistance. Skin breakdown occurs when the skin is deprived of regular blood flow, and can lead to open wounds and infection if left untreated.

Note: Many care partner supplies can be provided to you through insurance or your care provider. Be sure to contact your care team if you have any questions about obtaining supplies for the care of your loved one.

Watch Video

Proper Mechanics of Log Roll for a Bed-Bound Patient or Loved One

Logrolling, or the log roll, is a maneuver used to move your loved one without flexing the spinal column. Logrolling is used to change briefs, linens, and bedpans beneath your loved one. In this maneuver, your loved one’s legs are stretched and the head is held to immobilize the neck. Logrolling is best performed with two people to help hold your loved one, but it can be performed by one person if you do not have additional assistance.

Before beginning, identify if your loved has one side that is weaker than the other. If so, you will want to roll them so the dominant side is on top first. This allows your loved one to have a free dominant arm for support. For example, if your loved one has a weak left side, you will roll them to their left with their dominant right shoulder on top.

Incontinence management log roll — Mariah Mahotz, BSN, RN, OCN, Nurse Navigator
at the Pacific Brain Tumor Center.

NOTE: To avoid moving your loved one back and forth multiple times, plan to work as much as you can on one side before rolling your loved one to the other side.

Step 1: Place your feet firmly on the ground, shoulder-width apart, in a supportive stance. This will ensure that you are using your legs, not your lower back.

Step 2: Place your loved one’s dominant arm across their body, followed by their dominant leg, helping them to roll onto their non-dominant side. Once on their side, you will have full access to change a brief or place a bedpan beneath them.

Step 3: After you are done on the first side, carefully roll your loved one back to the center.

Step 4: Place your loved one’s non-dominant, or weaker arm around your neck, for support as you roll your loved one to the other side. Once on their side, you should have full access to the other side beneath your loved one to change a brief or place a bedpan.

Changing An Absorbent Brief for a Bed-Bound Patient or Loved One

If your loved one is bed-bound and in a brief, and you know that you will be changing them into a new brief, learn the steps to keep you and your loved one safe. Changing a brief may need to happen between six (6) to eight (8) times a day, depending on the condition of your loved one.

Note: Choosing the correct brief for your loved one depends on their mobility. Briefs, or adult diapers, come in all different shapes and sizes. Winged briefs are the most common option for those with limited mobility. Winged briefs have winged edges that can attach either side of the brief together at the hips. Pull-up briefs are options for more mobile patients. Pull-up briefs slide on and come off by ripping at the sides.

Step 1: Lay out your new linen (absorbent is best) over the bottom half of your loved one. Next, open up a new brief or adult diaper completely. Lay the brief on top of the new linen, in the position where it would be worn by the loved one.

Adult diapers for incontinence management

Step 2: Next, vertically roll up the linen with the brief inside of it and set it aside to use later.

Step 3: Once your new linens are prepared, undo the soiled brief on your loved one to begin removal. If your loved one needs to be cleaned, using disposable baby wipes is easiest. Be sure to clean your loved one by wiping the mess away from the urethra to avoid infection. Only use one wipe once. Once your loved one is clean, roll up the dirty brief and throw it away.

Step 4: You are now ready to roll your loved one. Using the proper roll mechanics detailed above, plant your feet firmly on the floor to support your back and roll your loved one to one side. You now will have access to remove the dirty linens below your loved one altogether. Roll these up and throw them away. If your loved one had a bowel movement, you could use this time to clean them. You can also use this time to apply any creams for skin breakdown or complete a wound dressing.

Step 5: Once your loved one is clean and all dirty linens are removed, vertically wedge the rolled-up clean linen and new brief you set aside (step 2) under the back of your loved one as they are still on their side. Next, guide your loved one back down so that they are laying on top of the new linen. Using the proper log rolling technique above, roll your loved one to the side to unroll your clean linens.

Step 6: With the new linens beneath them, secure the new brief on your loved one using the ties on each side of the brief (if you are using winged briefs).

Step 7: Place a pillow underneath one side of your loved one’s lower back to remove the pressure on the tailbone and prevent skin breakdown. Next, place their blanket back on so that they are ready to rest.

Managing Incontinence if Your Loved One Is Bed-Bound

If your loved one has limited mobility but is able to communicate with you when they are able to relieve themselves, knowing how to change a bedpan can save you and your loved much time and energy.

In addition to bedpans, urinals are also good options. Urinals are available for both males and females and may provide more accessible options for your loved one to urinate.

Bedpans are typically used for a bowel movement, while a urinal may be used for a loved one that is unable to get out of bed but can communicate with you when they need to relieve themselves.

If your loved one has limited mobility or they are not able to communicate when they need to relieve themselves, a bedpan and a urinal will not be good options to use for them. Instead, a brief and linen are best.

How to use a bedpan:

Step 1: Using the proper mechanics of the log roll technique illustrated above, roll your loved one to one side and place the bedpan underneath them with the flat side on their tailbone.

Step 2: Once they are done using the bedpan, gently log roll your loved to the side again and remove the bedpan for cleaning.

What is PureWick?

The PureWick system is a new incontinence management option for females and males. PureWick is an absorbent device that guides urinary flow to a suction canister via a plastic tube. It is placed over the female genitalia, helping to eliminate fluids from incontinence. PureWick is available via insurance and is best used for female patients.

What is a condom catheter?

A condom catheter is an option for males with urinary incontinence. It is a plastic device that is placed over the genitalia and connects to a tube with a leg bag to drain the urine. The condom catheter has a sticky surface that helps it to stay in place. It is one of the best options for males with urinary incontinence.