Providing Perineal Care: Basic Skills for CNAs

Certified Nursing Assistants (CNA) have an extensive set of skills. Providing perineal care is one of those skills that all CNAs must know, as it is essential to keeping a patient in good health. Those working with the elderly or with individuals who are disabled often must provide perineal care.

What Is Perineal Care?

Perineal care, also known as peri-care, involves cleaning the private areas of a patient. This practice is common in bedridden patients and those with incontinence. Since the perineal region is prone to infection, patients with these conditions must receive peri-care daily.

Where Is the Perineal Region?

The perineal region is located between the tailbone and the pubic arch. It is a diamond-shaped area between the anus and scrotum in males, and between the anus and vulva in females.

The Basics of Providing Perineal Care

Perineal care is needed for patients who urinate on the bed or require a bedpan. After urination, CNAs clean the patient’s perineal region to keep them comfortable and avoid infection. This practice is a common task for CNAs working in home care and may be performed while bathing a patient.

Remember that perineal care also means checking for signs of infections in the region every time you clean. Infections can appear as swelling, lesions, rashes, sores, or boils. If you notice any sign of infection, promptly call your supervisor.

Below are step-by-step instructions for providing perineal care:

Always wash and dry your hands before you start;
Put on gloves before cleaning;
Explain to the patient what you’ll be doing;
Spread the patient’s legs to reach the area;
Prepare a soft, warm washcloth;
Use the washcloth to clean the region from front to back. Always wash front to back to lessen the risk of infection;
Dry the region with a clean cloth;
Apply a cleansing lotion when necessary;
Dispose of your gloves;
Once finished, be sure to wash your hands with hot water and soap;
If the patient is bedridden, always put new sheets on the bed after you are finished cleaning.

For Female Patients

For female patients, separate the labia and then use downward strokes to clean the region. Use a new washcloth for each downward stroke, or a clean area of the same washcloth.

For Male Patients

For male patients, retract the foreskin (if necessary) and then use a washcloth in a circular motion from the top to the bottom of the penis, making sure to clean the testicles as well.

Infections and Conditions of Perineal Region To Look For

There are many infections and conditions CNAs must keep an eye out for when providing perineal care to patients. Symptoms can vary, but generally include pain, discomfort, changes in urination frequency or color, rash, swelling, or discharge.

Below are a few of the more common infections and conditions:

Urinary Tract Infections (UTIs) – UTIs can happen at any age, but are among the most common bacterial infections in older adults. CNAs should keep an eye out for an inability to hold urine, needing to urinate more than 8 times a day, pain or burning while urinating, cloudy or bloody urine, and trouble emptying the bladder. Post-menopausal women may also show non-specific symptoms such as abdominal pain, back pain, constipation, or chills.
Bladder infection – A bladder infection is a type of UTI. These infections can be serious in older adults, as the elastic bladder tissue may toughen and become less stretchy. CNAs should watch for the same symptoms as noted under UTIs.
Atrophic Vaginitis – Atrophic vaginitis is very common in post-menopausal women. The condition is due to declining levels of estrogen in a woman’s body. Symptoms of the condition include dryness, a feeling of pressure, itchy and yellow discharge, and urethral discomfort, among others.
Anorectal Disorders – Anorectal disorders are a group of medical disorders that range from benign to malignant. These disorders include hemorrhoids, anal fissures, and fecal incontinence,
Hemorrhoids – Hemorrhoids, also known as piles, are swollen veins in the lowest part of the rectum and anus. Symptoms of hemorrhoids can include painless rectal bleeding, pruritus, fecal soilage, perianal irritation, or mucus discharge.
Anorectal Abscess – An anorectal abscess occurs when a collection of pus develops near the anus. Symptoms include dull or aching pain with defecation, movement, sitting, or coughing.

Safety Tips

In order to negate the risk of infection, CNAs should adhere to the following safety recommendations when providing perineal care:

Always wash hands with soap and warm water before and aftercare;
Use an antiseptic soap, if possible;
Make sure to use a suitable water temperature when cleaning patients, preferably warm water;
Always wipe front to back;
Place a waterproof pad under the buttocks to absorb excess water;
Remember to position the patient so they’re comfortable;
If possible, use a new washcloth for each wipe. Otherwise, use a clean portion of the same washcloth for each wipe;
Cover the patient in a manner that avoids exposure as much as possible.