Elimination of menstrual waste

Procreation, or the ability to produce offspring, is an essential function of living beings if they are to remain a viable species. Reproduction is dependent on the female producing ova (eggs) for the male to fertilize with sperm. The production and release of the eggs occurs in monthly cycles, which commence around the age of 11–13 years and cease when the woman reaches the menopause, most frequently around the age of 50. The secretion of the hormones oestrogen and progesterone influences this cycle, though a number of other factors, such as diet, stress, medication and contraceptive devices, can also influence an individual’s pattern.

The female reproductive system consists of two ovaries, responsible for releasing the eggs, and two Fallopian tubes that carry the eggs to the uterus. The uterus is a hollow, pear-shaped muscular organ, which retains the egg prior to fertilization.

Uterine and ovarian cycles are usually referred to as the menstrual cycle. The first day of bleeding in a non-pregnant, fertile woman, when blood, secretions and the top layer of the endometrium is shed, is generally considered day 1 of the cycle. The menstrual cycle usually lasts about 28 days, but bleeding only occurs for 4–5 of these days. Ovulation, when the egg or ovum is released from the ovary, usually occurs on or about day 14.

The factors that affect elimination may be:
• physical arising from alteration in the structure, function or processes of the urinary, gastro-intestinal or associated bodily systems
• psychological such as intellect, anxiety and stress
• sociocultural, for example different words used for elimination and products of elimination, different rituals surrounding elimination (such as clean hand for eating/dirty hand for cleansing), fasting and other dietary restrictions
• environmental including poor food storage, personal hygiene and toileting facilities
• politico-economic, for example lack of finances for a healthy high-fibre diet, political influences on availability of certain foods and genetically modified products.

The remainder of this chapter gives the common terminology associated with the activity of eliminating; points to consider when assessing an individual’s ability to eliminate; how to assist clients to eliminate; how to apply a nappy; care of an indwelling urinary catheter; monitoring urinary output; bowel actions and vomit; and how to collect specimens of urine and faeces. The chapter concludes with references and further reading.