CARE OF THE PERINEUM
Perineal care defined as clean the perineum from the cleanest to the less clean area, the urethral orifice to the anal orifice
Perineal care includes the external genitalia and surrounding area. During perineal care, clean the area around the urinary meatus before cleaning the area around the anus
Purpose
- To prevent sepsis
- To remove discharges and prevent bad odor
- To relieve itching
- To promote healing of stitches
- To promote comfort
Washing a Woman’s Perineum
Fill the basin with clean warm water. Fold the towel in hair. Ask or help the woman to lift her buttocks. Put the towel under the buttocks. Ask the woman to bend her knees and spread her legs. With a soapy washcloth in one hand, separate the labia (“lips” of the vagina) with the other hand. Wash the labia from front to back. Do not touch the anus with the washcloth. Germs from the anus could get into the vagina and cause an infection
Rinse the washcloth and remove the soap from the perineum. It is important to remove all the soap because it can irritate the skin. Dry the area with a dry towel. Do not put powder on the perineum because the powder may harden
Wash the anus next. Ask the woman to turn onto her side so that she is facing away from you. Ask her to rise up her top leg. This will let you see and clean the skin around the anus. Slide the towel under the woman’s buttocks. Use toilet paper or a paper towel to remove BM that may be on the skin. You need to wet the toilet paper or paper towel if the BM has dried. Throw the toilet paper or paper towel away in a trash bag. Wash, rinse, and dry the anal area.
Washing a Man’s Perineum
Empty the dirty water into the sink. Fill the basin with clean warm water. Ask or help the man to lie on his back. Fold the towel in half and put in under the man’s buttocks. Ask the man to bend his knees slightly and spread his legs. Hold the penis with one hand. With the other hand, wash the tip of the penis with a soapy washcloth. Rinse the washcloth and remove the soap from the penis
If the man has a foreskin, gently push it back. The foreskin is the skin that covers the rounded end of the penis. Wash the end of the penis. Rinse the washcloth and remove the soap from the end of the penis
Using a soapy washcloth, wash the rest of the penis and the scrotum. The scrotum is the bag of skin that hangs under the penis. Rinse and dry well
The anus should be washed next. Ask the man to turn onto his side with the top leg raised. This will let you see and clean the anal area easier. Fold the towel in half and put it under the man’s buttocks. Use toilet paper or a paper towel to remove BM that may be on the skin. You may need to wet the toilet paper or paper towel if the BM has dried. Throw the toilet paper or paper towel away in a trash bag. Wash, rinse and dry the anal area
Perineum Care for Special Group of Patients
- Unable to do self-care or bedridden patients
- After surgery on the genitourinary system
- Patients with indwelling catheters
- Patients with excessive vaginal discharges
- Postpartum patients
- Incontinence of urine and stool
- Genitourinary tract infections
Preliminary Assessment
Check
- Doctors order for any specific instruction
- Assess the condition of the perineal skin-itching, irritation, ulcers, edema, drainage, etc
- Assess the need and frequency of care
- Assess the self-care ability of the patients
- Mental state to follow instructions
- Articles available in the patients unit
Preparation of the Patient and the Environment
- Explain the sequence of the procedure
- Provide privacy
- Arranged the needed articles at the bed side
- Place the Mackintosh under the buttocks, over the draw sheet
- Place a clean bedpan on the bed on your working side
- Unite the pads – if any, and observe the discharges its color, odor, amount, etc
Equipment
A tray containing:
- Mackintosh
- A jug with warm water or antiseptic solution
- Wet cotton balls or rag pieces in a bowl
- Gauze or rag pieces in a container
- Long artery forceps in the kidney tray
- Paper bag
- Clean (personal and bed linen) dressing pads, etc. as needed
- Soap, soap dish, towel and wash cloth of the patient is able to do himself
- Bed pain
Procedure
- Wash hands thoroughly to prevent cross infection
- Pour water over the perineum to wash off the discharges from the perineal area
- Hold the swabs with forceps and clean from above downwards towards the anal canal
- Use one swab for one swabbing
Clean the perineum from the midline outward in the following order – vulva, the labia minora on both sides, inside of the labia majora on both sides (start cleaning from more clean area to less clean area)
Clean the perineal region and the anus thoroughly
- Remove the bed pan by supporting the hip. Turn the patient to one side and dry the buttocks with a dry rag pieces
After Care
- Apply the medicine and pad if necessary
- Remove the Mackintosh if an extra one is used
- Change the linen if necessary
- Provide comfortable position to the patient
- Clean the articles and replace it in a proper place
- Wash hands thoroughly
- Record and report the procedure in a nurses record sheet
