Hesperian Health Guides
Passing urine and stool
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Some women with disabilities do not have complete control over when they pass urine or stool. This is especially common for women whose disability affects their muscles in the lower body, such as paralysis from polio or a spinal cord injury.
If you cannot wash your genitals by yourself, ask a family member or helper to help you keep your genital area clean and dry. If you need to wear cloth or nappies (diapers) to catch urine or stool, change them often to prevent rashes, infections and sores.
When you go outside, if possible take an extra change of clothing with you. Then, if you lose control of your bladder or bowel and soil your clothes, you will be able to change and avoid being embarrassed, and also avoid getting an infection.
If you pass urine often or leak urine, try the squeezing exercise to help strengthen weak muscles. This exercise can also help keep your muscles strong so you will be less likely to leak urine when you are older.
The squeezing exercise
First practice while you are passing urine. As the urine comes out, stop it by tightly squeezing the muscles in your vagina. Count to 10, then relax the muscles to let the urine come out. Repeat this several times whenever you pass urine.
Once you know how, practice the squeezing exercise at other times during the day. No one will know. Try to practice at least 4 times a day, squeezing your muscles 5 to 10 times each time.
Some women may need surgery to help control leaking urine. If your urine leaks a lot and this exercise does not help, get advice from a health worker trained in women’s health. The squeezing exercise is good for all women to do every day. It helps keep muscles strong and can prevent problems later in life.
Emptying the bladder
If your disability makes you unable to pass urine without assistance, you will need another way to empty your bladder. Some women can urinate and empty the bladder if they:
- tap their belly over the bladder, right below the belly button (navel, umbilicus) and above the pubic bone.
- push down with their hands on the lower belly, over the bladder.
- put a fist over the lower belly and gently press it by bending the upper body forward.
- strain to push urine out by making the stomach muscles tight.
You should use these methods only if the urine comes out easily with gentle pressure. If your muscles do not relax and let the urine out, pushing on your bladder can force the urine back into the kidneys and damage them.
If none of these methods work, you will need to use a rubber or plastic tube called a catheter. Do not use a catheter unless it is the only way you can pass urine. Even careful use of a catheter can cause infection of the bladder and kidneys.
Using a standard catheter
A catheter is a flexible rubber tube used for draining urine out of the bladder. Many women who need to use one put a clean or sterile catheter into the bladder every 4 to 6 hours to empty it. The more liquid a woman drinks during the day, the more often she needs to use the catheter.
Some women do not drink much water because they do not want to use the catheter very often. But this can cause other problems. If you do not drink enough liquid, you can get an infection in your bladder or kidneys, or have difficulty passing stool (constipation).
It is important not to let your bladder get too full. This can cause dysreflexia, and can also cause the urine to go back up into the kidneys and damage them.
Many women learn to use a catheter while they are sitting on a toilet or pot. Women can also use a catheter in a wheelchair, emptying the urine into a toilet or a bottle. Experiment with what works for you. It takes practice to learn how to use a catheter when you are sitting, but many women find using a catheter makes it easier for them to do their daily activities. For most women, the best catheter size to use is a 16. A very small woman may find a size 14 fits better.
A person using a catheter is more likely to get a urinary infection than someone who does not. This usually happens because the catheter is not clean enough and germs get into the bladder. Cleaning your catheter carefully is the best way to prevent a urinary infection. Always wash your hands with mild soap and clean or boiled water before you touch the catheter, and wash it before and after using it. Keep the catheter in a clean place when you are not using it.
Water is injected into the balloon here.
Urine drains out here.
|A ‘Foley’ (indwelling) catheter has a small balloon near the tip. The catheter is made this way so it will stay inside the bladder for long periods of time. The balloon is filled with water when it is inside the bladder, so it will not slip out. 5cc of water is usually enough to hold the Foley catheter inside. If it comes out, increase the amount of water to 12cc or 15cc.|
How to put in a catheter
Boil the catheter (and any syringe or tool you may be using) for 20 minutes. Or at least wash them well in water that has been boiled and cooled, and keep them clean.
Carefully wash theskin around the
genitals with mild
soap and clean water. Take care to clean the area where urine comes out and the folds of skin around it (the vulva). If you do not have mild soap, use only clean water. Strong soap can harm your skin.
Wash your hands. After washing, touch only things that are very clean.
If you can, sit where your genitals are not touching anything, like the front of a chair, or on a clean toilet seat. If you have to sit on the ground or another solid surface, put clean cloths under and around the genitals.
If you have to touch anything, wash your hands again with mild soap and water.
Cover the catheter with a sterile, water-based lubricant (not oil or petroleum jelly). This helps protect the soft skin of the genitals and urine tube (urethra). If you do not have any lubricant, make sure the catheter is still wet from the water you boiled it in or cleaned it with, and be extra gentle when you put it in.
If you put the catheter in by yourself, use a mirror to help you see where the urinary opening is, and use your pointing (index) finger and third finger to hold the skin around the vagina open. The urinary opening is below the clitoris almost at the opening to the vagina (see page 78). After you have done this a few times, you will know where the opening is and you will not need to use a mirror.
Then, with your middle finger, touch below your clitoris. You will feel a sort of small dent or dimple, and right below that is the urinary opening. Keep your middle finger just above that spot, and with your other hand, hold the clean catheter 4 to 5 inches from the end, touch the tip to just below the end of your middle finger, and gently guide the catheter into the opening until urine starts to come out. Be very careful not to touch the tip of the catheter with your fingers or hands.
Make sure the catheter is in a downward position so that the urine can come out.
You will know if the catheter goes into the vagina instead of the urinary opening because it will go in easily, but no urine will come out. Also, when you remove it, the catheter will have discharge (mucus from the vagina) in it. Rinse the catheter in clean water, and try again. If you do get a bladder or kidney infection, talk with a health worker. You may have an infection in your vagina.