GI/GU: Assisting with urinary elimination

Urination is the process of expelling urine outside the body via the urethra. In the medical field, it’s also called voiding or micturition.

Your client might have problems with urinating, so it’s important that you recognize them and be able to assist them. Typically, this process starts when you decide to urinate, the brain sends a signal down to the bladder causing it to contract.

The sphincter relaxes, and the urine passes through the urethra and outside the body. The amount of urine a person passes depends on their age and size, but generally, an adult should pass around 2,200 ml to 2,700 ml per day.

If they pass under 300 ml per day, it’s called oliguria. If it’s less than 100ml per day, it’s called anuria.

Both often indicate a serious medical condition! Frequency of urination can also be an issue.

Needing to urinate more than once every 2-3 hours is called urinary frequency, and having to urinate often at night is called nocturia.

If there’s pain when urinating, it’s called dysuria. If they leak urine involuntarily, it’s called incontinence.

If they feel the urge to urinate but can’t, it’s urinary retention; if they feel sudden, strong urges, it's called urinary urgency.

Now typical urine can range from clear to a light yellow or an amber color, and it should be free of particles . A darker “tea” color could be due to dehydration but also other medical problems.

Red urine could be due to hematuria or blood in the urine, but some food, like beets, can also cause this. Now, some people might have trouble with urination simply because they are too weak or have other medical conditions that prevent them from getting to the bathroom or using the toilet, so whatever the cause, you’ll need to know how to assist people with voiding.

Now, before we go into each procedure, some common care tips include: Making sure the path to the toilet is lit before the client goes to the bathroom.

Answer call lights promptly, especially if they are elderly or have a history of incontinence. Keep note of their normal urinary habits, so you can recognize any changes.

Remember to close the room’s door and bedside curtain and respect their privacy. Warm bedpans and urinals are more comfortable; and close the curtain for privacy when using them.

A person might be too embarrassed to urinate when you’re there, so leaving the room or looking away might help, but stay nearby in case they need aid.

You might be asked to provide perineal care, or “peri-care,” where you clean the genitals and anal region. Use disposable cloth and wipe from the front to the back where the anus is located.

Finally, when you finish assisting, check their clothing, gown, and bedsheet to ensure they’re dry and not soiled. Let’s look at ways you can assist the client with urination.

If a biological female can’t get out of bed, we can use a bedpan. This device is also used for bowel movements for both biological male and female clients.

To use a bedpan for voiding, put on gloves, raise the bed to a comfortable level for you to work with, and lower the head of the bed so it’s flat.

Roll them onto their side in the lateral position and place down the bed protector. Move the gown, so the buttocks are exposed.

Ask them to bend their knees and place the bedpan firmly against their buttocks. Next, help roll them onto their back with the bedpan under the buttocks.

Tell them you’re ready and give them time to void. Some people have difficulty urinating in this position, so in these cases, you might need to help them into a sitting position.

For some clients, you can leave the room until they’re finished if they can hold the bedpan themselves. Before you leave, raise the side rails on one side of the bed to prevent falls and lower the bed to reduce the risk of injury.

Remember to remove gloves when you leave and put on a new pair when you come back. Provide tissue paper or paper towels if they are able to clean themselves; otherwise, you might be asked to assist in perineal care.

To remove the bedpan, ask them to push against the bed with their feet to lift their hips off the bed, so you can take the bedpan.

Put on the bedpan cover and remove the bed protector. Cover them back up with the gown.

Take the pan to the bathroom and empty the contents into a toilet. You might be asked to take a sample, measure their urine output, or leave it for a nurse to look at.

Take off your gloves, dispose of them safely, and wash your hands. Put on new gloves, return and help them wash their hands, and make sure they’re dry and comfortable.

Now, for biological males who can’t get out of bed, we can use a urinal which looks kind of like a plastic jug. The procedure can be done lying down, but it’s often helpful if they sit up at the edge of the bed, so ask them what position they prefer and help them into that position.

Put on the gloves like before and hand them the urinal if they can do this on their own. Otherwise, move their gown and help them insert their penis into the urinal.

Tilting it downwards can help avoid spills. Give them time to void completely; you might be asked to leave and come back when they’re done.

Once the urination is finished, take the urinal and close the cap. Make sure they are covered by their gown before taking the urinal to the bathroom for emptying.

Once again, you might be asked to gather samples, record information, or leave it for a nurse. Take off your gloves, dispose of them safely, and wash your hands.

Put on new gloves, return and help them wash their hands, and make sure they’re dry and comfortable.A bedside commode can be used by biological males and females with limited mobility but can still get out of the bed.

This device is like a chair with a built-in toilet seat and a removable waste container. To assist a client with using the commode, first put on gloves and then make sure the commode’s wheels are locked and the waste container is secure.

Fill the container partially with a small amount of warm water, so it will be easier to clean once the procedure is done.

Help the client walk to the commode and sit on the seat. They might need help undressing.

In some cases, you might be asked to leave the room but make sure they know to call for you once they finish. After they’re done, provide them with tissue paper or paper towels to clean themselves, or you might need to provide perineal care.

Help them wash their hands, and then dispose of the waste after recording the necessary information. There are a couple of things you should report to a nurse straight away.

First, if they have any new or worsening pain or difficulty urinating. Next, inform a nurse if you notice the urine is discolored, cloudy, or has an abnormal odor.

Sometimes a nurse could ask you to report the urine output. Also report if there’s a change from their normal voiding habits, like urgency, frequency, nocturia, or incontinence.

Finally, report any voiding accidents, like if they weren’t able to get to the bathroom in time. When you assist a client, document the date and time, anything atypical in the urine or voiding behavior, and the color, quantity and quality of urine.

All right, as a quick recap… Urination is the process of expelling urine from the body. It’s important for you to understand abnormal urination habits and recognize usual voiding behavior in your client.

For people who can not get out of bed to void, biological females use a bedpan, and biological males use a urinal.