Caregiving: Bedpans, Portable Commodes, and Other Options
For someone with limited mobility, the journey from the bed to the bathroom can seem like a cross-country trek. And even if she can reach the destination, she may not be able to sit down on the toilet. In this situation, many caregivers have turned to an unappealing but convenient option: The bedpan.
Bedpans are a good choice only if your relative can tell you when she needs it, and if someone is always around to help. When appropriate, bedpans can make your relative's life more comfortable and your life a little easier.
What equipment do I need?
There are a few things to consider when choosing a bedpan. If you expect to need it for a long period of time, it's worthwhile to consider different options. Disposable bedpans or bedpan liners can make cleanup easier. If your relative is unable to lift her hips -- perhaps because of a hip fracture -- select an ergonomic design that can easily slide into place.
You'll also need a small wash basin to hold warm water, disposable gloves, toilet tissue or wipes, washcloths, soap for hand washing, powder or cornstarch, and absorbent padding for the bed.
What are the next steps?
After gathering your supplies, wash your hands so they are clean and warm. Put on the disposable gloves.
If the bedpan is metal, warm it with tap water and dry it.
Spread an extra layer of absorbent padding on the bed -- even if there's a plastic or rubber sheet on the mattress.
Dust a little powder or cornstarch on the bedpan seat to make it easier to place and adjust.
Fold the bedclothes down and to the side to avoid soiling. If needed, use a drape or sheet for warmth and privacy.
How do I use a bedpan?
Place the bedpan on the bed near her hips with the open end facing the foot of the bed.
If possible, help her to a sitting position. (Sitting can make it easier to eliminate.) Have her flex her knees slightly, and then support her back while you slide the bedpan and the absorbent pads into position.
If sitting is impossible, help her roll onto one side. Position the absorbent padding. Place the bedpan against her buttocks, and move it gently in place as you help her roll into position.
Take a moment to ask her if she's comfortable.
When women use the bedpan, a wick made of toilet paper will guide the urine stream and help avoid spills.
Privacy is important, but if your relative is weak, don't risk a fall: Stay in the room. Under no circumstance should you leave the bedpan in place for extended periods of time. It's not only uncomfortable, but also sitting for a long time on a hard surface can cause a pressure sore. Consult with your health-care provider if constipation or urine retention is a problem.
If she's able to clean herself, provide her with toilet paper, but you may have to assist with wiping.
If she's in a sitting position, support her as she lifts her buttocks slightly, allowing you to slide the bedpan out of the way.
If she's on her side, help her gently roll away from the bedpan. Use one hand to keep the pan from spilling.
As needed, use a warm, wet washcloth to clean the buttocks area. Dry the area thoroughly before putting her clothes back on, and be alert for any skin irritation, rashes, or sores. If you notice these or any other problems developing, consult your health-care provider.
What are some other toileting options?
Adult diapers (Incontinence pads)
In the later stages of dementia, people may be unable to stay continent because of changes caused by the disease. Caregivers should always respond to an accident with calm understanding and love, as it is not the loved one's fault: Scolding is uncalled-for and will only lower self-esteem. You may want to use diapers at night or other times, combined with a rubber sheet on the mattress underneath the cotton ones. Help maintain your loved one's dignity by checking the sheets regularly for wetness and changing them as needed.
If someone is confined to bed but able to sit or stand up, a portable urinal may allow him to relieve himself without depending on a caregiver. They have a secure airtight cover and are even used "by truck drivers who need to make a deadline," according to one ad for the product. Urinals are designed for both men and women, and more mobile patients may prefer to use one instead of a bedpan when the situation calls. If you're assisting someone, place a protective layer under her hips and let her position the urinal if she's able. A sheet or drape can provide some much-needed privacy.
For people recovering from injuries or surgery, a portable or "bedside" commode may be a good option. This inexpensive option is basically a lightweight metal and plastic chair with a removable toilet bowl, and can be found online and at any medical-supply store. Some have a padded seat that you can use to convert to a shower seat as well. Two cautions: If the chair has wheels, make sure to lock them before use. Also, be sure that you buy a portable commode that can support the patient's weight. (Certain types will hold up to 1,000 pounds.)
If your loved one cannot use a bedpan or diapers, and can't stand up to use a bedside commode, her doctor may insert a urinary catheter. Used to drain urine, it consists of a thin, rubber tube that enters the urethra and goes into the bladder, where it is held in place by a small balloon. The opposite end of the tube is connected to a collection bag. Proper hygiene and care of the catheter is crucial for avoiding bladder and kidney infections, so be sure to get detailed instructions from the doctor or nurse.
Call the doctor immediately if you notice any of these signs of possible infection: pain in the pelvis or lower abdomen, pain at the insertion site, changes in the urine's color or consistency, blood in the urine, pus drainage or foul odor at the insertion site, or fever above 100 degrees F. Also alert the doctor if you observe little or no urine flowing into the bag over four hours, or if two hours pass with little or no urine flow, but the patient complains of a full bladder.
Because people with advanced Alzheimer's or other forms of dementia may not be able to complain of pain or fever resulting from an infection, adult diapers may be a better option.
Reusable bedpans, urinals, and bedside commodes need to be washed after every use. Empty waste into the toilet. Rinse immediately with cool water. Dispose of soiled protective pads and wipes.
Take time to thoroughly wash your hands. Then use a warm, soapy washcloth to wash your relative's hands.
Clean the bedpan with soap and hot water. Allow the pan to air dry.
Ready all equipment for the next use.
Boise State University, Nursing Assistant Handout.
Pennsylvania Department of Aging, A Guide for Family Caregivers of Older Pennsylvanians.
Penn State Gerontology Center. Elimination of Bodily Wastes. caregiverpa.psu.edu/manual/text/55-11-elim.htm
American Medical Association Family Medical Guide, Third Edition. Managing a bedpan. p. 791-792.
Cincinnati Childrens Hospital. Cast Care: Use of Bedpans /Diapers http://www.cincinnatichildrens.org/health/info/orthopaedics/home/hip-spica.htm
Nursing Assistant Education. Preventing Pressure Ulcers.
Caregiving Guide: Techniques and Points to Ponder. Region Nine Area Agency on Aging, Mankato, MN. http://www.rndc.org/rosemanual.pdf
Induscom. Biodegradable Products.
University of Pittsburgh Medical Center. http://patienteducation.upmc.com/Pdf/UrinaryCatheterCare.pdf
Biorelief.com. Uriwell personal toilet. http://www.biorelief.com/uriwell_personal_toilet_b.htm
American Discount Home Medical Equipment. Bedside commodes. http://www.home-med-equip.com/commode/