Wipes and Perineal Hygiene Done Gently

Principles

• Respect and consent. Explain what you are doing, ask permission, keep the person covered, and work in private. See dignity in intimate care: words, privacy and consent.
• Gentle, not scrubbing. Older skin is thin, dry and easily damaged.
• Front to back, always. Clean from the front (genitals) towards the back (anus), never the reverse, to avoid carrying bowel germs to the urethra and vagina, a major cause of urinary infections; see urinary tract infections in older adults: atypical signs.
• One wipe, one stroke. Use a clean part of the cloth or a fresh wipe for each stroke.
• Pat dry. Moisture left in folds invites rashes and fungus.
• Do it promptly after soiling, rather than leaving skin in contact with urine or stool.
• Hands and gloves. Wash hands, wear disposable gloves, and change them if they become soiled.
• Warm, not hot. Check water temperature on your wrist; see hot water and scald safety for older skin.

Water, cloths or wipes?

Warm water and a soft cloth is the gentlest and cheapest option, and often the best for sensitive skin and heavy soiling. Use a clean, soft cloth or disposable paper towel, and a basin or a bottle for rinsing. A small squeezable "peri bottle" or jug lets you pour warm water over the area while the person sits on a commode or lies on a pad, which reduces rubbing.

No-rinse skin cleansers (foams, sprays or lotions) designed for incontinence care can cleanse and condition without needing rinsing. They are useful in bed. Choose fragrance-free products with a skin-friendly pH.

Wipes are convenient, especially for outings, night changes and quick cleaning. Choose carefully:

• Alcohol-free, fragrance-free and preferably dye-free.
• Soft, thick and large, to reduce rubbing.
• Designed for adult skin and perineal care, with a skin-friendly pH.
• Free of strong preservatives and irritants such as certain parabens or methylisothiazolinone, if the person has sensitive skin or allergies; check labels, or ask the pharmacist.
• Avoid antibacterial wipes, and hand sanitiser wipes, for the skin of the perineum: they dry and irritate.
• Not a replacement for washing after heavy soiling.

Toilet paper alone is often too rough and not enough after heavy soiling; combine with water or wipes.

Important: do not flush wipes, even if labelled "flushable". They block pipes and septic tanks. Seal and bin them; see disposal, laundry and odour control.

Cleaning a woman

1. Position her comfortably, lying on her back with knees bent and apart, or seated on a commode or toilet, with a towel for modesty. 2. Wash hands and put on gloves. 3. Use a cloth or wipe to clean the skin of the groin folds first, wiping from the crease towards the centre. 4. Separate the labia gently with one hand (the outer lips) and wipe from front to back, down the middle, one stroke per wipe, then each side, using fresh wipes. Do not clean inside the vagina. Do not use douches, which upset natural balance. 5. Turn her onto her side to clean the anal area, wiping from the front towards the back, finishing at the anus, with clean wipes until clean. Clean the buttocks and skin folds. 6. Rinse if needed with warm water poured gently over the area. 7. Pat dry thoroughly, front to back. 8. Apply a thin layer of barrier cream if advised; see barrier creams and skin care under pads. 9. Fit a clean pad or product and cover; see how to change an adult diaper in bed. 10. Remove gloves, wash hands, and thank the person.

Postmenopausal women often have dry, thin, easily irritated tissues. Use water or a very gentle product, avoid soaps in the vagina, and tell the doctor about soreness, itching or burning; local treatment may help.

Cleaning a man

1. Position him lying on his back with knees bent, or seated, with a towel for modesty. 2. Wash hands and put on gloves. 3. Clean the groin creases from the crease inwards. 4. Clean the penis gently from the tip towards the base. If he is uncircumcised, gently draw back the foreskin only as far as it goes without force, clean beneath it, rinse, dry, and return the foreskin to its normal position afterwards. Leaving it retracted can cause swelling and pain (paraphimosis), an emergency. 5. Clean the scrotum and the skin folds underneath, lifting gently, and the inner thighs. 6. Turn him onto his side to clean the anal area, from front to back, with clean wipes until clean, including buttock folds. 7. Rinse, pat dry fully, including folds. 8. Apply barrier cream thinly if advised. 9. Position the penis downward in the brief, which helps channel urine into the absorbent area and prevents leakage at the waist. 10. Fit a clean product, remove gloves and wash hands.

If a catheter is present, clean the skin around it with soap and water daily as the nurse advises, moving away from the body; see catheter care basics for families.

After a bowel movement

• Remove as much stool as possible gently with toilet paper or a wipe, into the toilet or a bag.
• Use warm water and several wipes, clean from front to back, until the skin is clean, then rinse.
• Do not scrub stuck stool. Soften with a barrier oil or warm water, and wipe gently. Use a wet cloth rather than dry paper.
• Check skin for redness or damage; see incontinence-associated skin damage: prevention and care.

Drying and protecting

• Pat dry with a soft towel, dedicated to this use, or let air dry for a minute.
• Make sure folds are dry: the groin, under the abdomen, between the buttocks.
• Use a thin layer of barrier cream if advised.
• Avoid talcum powder, which clumps and may irritate.
• Choose breathable underwear or pads, and cotton clothing.
• Change products promptly and avoid leaving the person in a wet product.

Frequency

• After every episode of wetting or soiling, or at each product change.
• At least once or twice a day as part of a general wash, in the morning and evening.
• Not excessively: overwashing and over-wiping with strong products can dry and irritate the skin. Use water for light cleaning, and stronger methods only when needed.

Products and habits to avoid

• Perfumed or alcohol-based wipes, intimate washes, feminine hygiene sprays, and harsh soaps.
• Antiseptic liquids such as strong disinfectants in the bath water, unless prescribed.
• Scrubbing with rough cloths, loofahs or brushes.
• Hot water.
• Cleaning from back to front.
• Re-using wipes or cloths.
• Flushing wipes.
• Sharing towels and cloths between people.
• Douching or cleaning inside the vagina.
• Home remedies on sore skin.
• Plastic or synthetic underwear that traps moisture.

Special situations

• Skin tears and fragile skin: use the gentlest method, pat only, and ask a nurse for advice.
• People with arthritis or limited reach: a long-handled wiping aid, a bidet-style spray or a handheld shower may help them stay independent; see handheld shower guide. A bidet attachment or hand-held water spray is common in India and is excellent for cleaning, provided that water is warm and gentle and the person can dry well.
• Squat toilets and Indian-style toilets: water use is the norm; encourage washing with a mug or a spray, and drying with a clean cloth or tissue.
• People with dementia: explain slowly, one step at a time, with a calm voice; avoid rushing; distract with music; see incontinence and dementia: routines and reassurance.
• Bedridden people: see personal hygiene for a bedridden parent and bed bath step by step.
• Diarrhoea: clean very gently and often, protect the skin with a barrier, and see a doctor; see diarrhoea and dehydration in seniors.
• Cultural and religious needs: some families prefer water cleaning and same-gender carers; ask and respect preferences; see caring with religion and culture in mind.
• Hot, humid weather: more frequent washing and drying; see summer heat and bedridden care.

Warning signs

Call the doctor or nurse for:

• Redness, soreness, blisters, cracks or broken skin that does not improve.
• A rash with small red spots at the edges, suggesting a fungal infection.
• Itching, burning or a foul discharge.
• A smelly or cloudy urine, burning on passing urine, frequent urination or new confusion; see urinary tract infections in older adults: atypical signs.
• Blood in urine or stool.
• Swelling or pain in the genital area, including a foreskin that cannot be returned (an emergency).
• Fever or feeling unwell.

Call 112 for fever with confusion, severe pain, heavy bleeding, or no urine for many hours.

When to ask a professional

Ask a nurse to demonstrate how to clean and check the skin, and to recommend products. Ask a doctor about any rash, discharge, pain or urinary symptoms. Ask a pharmacist for fragrance-free options. Ask a continence adviser for a plan if skin keeps breaking down.