5. Keeping clean after using the toilet or being incontinent

Key points

For some people, this is a really tough part of caring.
Try to help the person to do as much as they can for themselves.
Men and women have different cleaning needs.

Helping someone to stay clean (wiping or washing) after using the toilet or being incontinent can be difficult for all sorts of reasons. The person you are helping might not be able to stand or sit easily or they might not want your help. Plus, you might be managing the needs of someone of the opposite sex for the first time. Also, whilst some carers do not find these tasks difficult, many find them emotionally very tough to do, particularly in the beginning.

“I think if anything we became closer. It was a massive privilege to help her.”

Daughter-in-law

“It really upset me but it’s part of life now, don’t even think about it.”

Husband

General points for personal cleaning tasks

Help the person to keep doing as much as they can for themselves. This might vary from day to day.
Pee and poo can both damage skin, lead to soreness and smell if not thoroughly removed.

Communication is really important and not always easy. Try to keep sentences short and clear. Don’t rush and give the person time to tell you what they want, or watch their body language for clues.
Try to avoid uncomfortable sensations such as sudden cold water or rough material on sensitive areas.
Don’t forget to gently clean under nails.
Don’t forget about yourself. For example, if your back hurts from supporting the person or bending to wipe, ask to speak to an Occupational Therapist. It’s your choice whether to wear disposable gloves. If you do, you still need to wash your hands with soap and water afterwards.

“I don’t do anything unless I can see skin getting red. I just use toilet paper to clean her up and in the morning she gets a full wash.”

Husband

Wiping after using the toilet

The person might be able to wipe with your help, for example you pass toilet paper and make sure it is flushed away.
Use toilet paper and, if needed, wet wipes. If you use wet wipes, gently pat the skin dry after use. Most wipes will block the toilet if flushed. Wipes should be put in the household bin (put them in a nappy sack first if needed).
It is important to check the skin is clean and dry to avoid itchiness or soreness.
Use barrier creams or sprays (ask your pharmacist for advice on brands) as extra protection if you see any redness. Report any broken skin to your healthcare professional.

“I certainly never envisaged wiping his bottom. You just don’t, do you? I can remember that the first time I had to deal with a dirty bottom I was doing it in tears.”

Wife

Cleaning up pee or poo after incontinence

Make sure you have all the equipment that you need before you start (for example bowl or basin of warm water, soap or skin cleanser, disposal bags, cloths or wipes, towels, clean clothes, new continence pad).
Use simple spoken prompts to guide the person where possible.
Remove any continence products (for example, a pad) and put in a bag for disposal (nappy sacks are useful). Remove any dirty clothing for washing.
With poo, try to remove within the used continence pad (if using one) or remove using toilet paper (and flush in the toilet), or use disposable dry wipes.
Wash any areas where pee or poo have touched the skin with warm water (with a gentle, non-perfumed soap or skin cleanser if needed). You can either use a cloth which can be washed at a high temperature or disposable wipes.
Try to avoid unpleasant sensations such as sudden cold water or rough material on sensitive areas.
Gently dry skin with a soft towel. Use barrier creams or sprays (ask your pharmacist for advice) as extra protection for any redness. Report any broken skin to your healthcare professional.
If applying barrier creams (or other ointments) to protect the skin they might reduce the absorbency of incontinence pads. Help avoid this by applying only a thin layer.
Once cleaning is finished, help the person to wash their hands and wash yours too.

“Many men didn’t get involved with doing their children necessarily. And they don’t know. They’re not a woman, what are the things you’ve got to be careful about?”

Husband

Caring for a man

The penis should be washed every day. If the person you’re caring for has a foreskin, this should be pulled back gently to wash underneath and then replaced after cleaning. This helps to avoid a build-up of secretions which can lead to smell, soreness or infections.
The base of the penis and testicles should also be washed daily.

Caring for a woman

Try to wipe from front to back - from the genitals back towards the back passage (anus). This might help stop bacteria from the back passage causing an infection.
The outside of a woman’s genitals (vulva) should be washed at least once per day and after an episode of incontinence with warm water. It is not necessary to clean inside the vagina.

Thoughts from carers

It can be helpful to connect personal care with something positive. Different ideas work for different people. Some carers put on music or sing. Some finish care with a spritz of perfume or favourite hand cream.
If you struggle to cope with unpleasant smells, you can try:
- Putting a few drops of essential oil in petroleum jelly (for example, Vaseline) and dab inside nostrils.
- Humming can make it difficult to smell.
- Breathing through your mouth can also help.
Many carers say that it took time to get used to providing personal hygiene care. Many do adapt but, for others, it is something that they are not able to do.

“My brother was over and he’d always said there’s no way I could clean her up. But he happened to be there and he did.”

Daughter