Rulings on Purification for the Sick

All praise be to Allah, the Lord of the Worlds, and may peace an blessings of Allah be upon the noblest of the Prophets and Messengers, our Prophet, Muhammad and upon all his family and Companions. As for what follows:

Verily, Allah, the Most Glorified, Most High has legislated purification for every prayer, because the elimination of impurity and the removal of pollution - whether on the body, the clothes or the place of prayer - are two of the conditions of the prayer. So when the Muslim wishes to pray, he must perform the well known ablution (Wudhu') to purify himself from minor impurity, or make Ghusl if the impurity is of the major kind. And before making ablution, Istinja' must be performed with water, or Istijmar by the one who has urinated or defecated in order that the purification and cleansing be complete. What follows is an explanation of some of the rulings related to this.

Istinja' with water is obligatory every time something is discharged from the bowel and bladder, such as urine or feces. But it is not necessary for the sleeper or one who passes gas to perform Istinja'. He is only required to perform ablution, because Istinja' is only prescribed for the removal of pollution, and there is no pollution in this situation.

Istijmar is performed using stones, or another material in its place (such as wood, paper etc.) It must consist of three clean stones, as is proved by the Hadith of the Prophet which states that he said:
"Whoever performs Istijmar, let him make it Witr (i.e. use an odd number of stones)."

And he also said:
If any of you goes to defecate, he should take with him three stones, for they will be sufficient for him.

Muslim narrated that he forbade Istijmar with less than three stones. It is not permissible to make Istijmar with animal droppings, bones or food or anything which contains some forbidden material. It is preferred for a person to perform Istijmar with stones, or the like such as tissues etc. After which, he should use water, because the stones remove the essence of the pollution, but the water purifies the area and is therefore more thorough. A person has the choice of Istinja' with water, or Istijmar with stones or the like. It is reported on the authority of Anas, may Allah be pleased with him, that he said:

"The Prophet entered the toilet and I and a young boy like me carried materials, including water and an 'Anazah and he would perform Istinja' with the water."

It is reported on the authority of 'A'ishah, may Allah be pleased with her, that she said to a group of women: "Order your husbands to clean themselves following defecation with water, for I am too embarrassed to do so, and the Prophet used to do so." At-Tirmithi said that it is authentic.

If a person wishes to use only one of them (i.e. stones or water), it is preferred to choose water, because it cleans the area, removing the essence and the traces and it is more thorough in cleansing. If he chooses only to use stones, he should content himself with three, if it cleanses the area, but if it is not enough, he may use four or five (or more) until he has cleaned the area, but it is better to finish with an odd number, based upon the saying of the Prophet:

"Whoever performs Istijmar, let him make it Witr.

It is not permissible to make Istijmar with the right hand, according to the Hadith of Salman, may Allah be pleased with him, in which he said: "The Messenger of Allah forbade us from performing Istinja' with the right hand." And he said:

"None of you should hold his penis in his right hand while he is urinating, nor should he wipe himself with his right hand after answering the call of nature.

But if his left hand has been cut off, or is broken or there is some disease in it, he may use his right hand, and there is no objection to that.

Because the Islamic law is based upon facility and ease, Allah, the Most Glorified, Most High has lightened the burden of worship on those who have some excuse, according to the excuse. He, the Most High says:
And (He) has not laid upon you in religion any hardship.

And He says:
And Allah intends for you ease, and He does not want to make things difficult for you.

And He says:
So keep your duty to Allah and fear Him as much as you can.

And the Prophet said:
"If I order you to do something, do it as much as you can.

And he said:
Verily, the religion is ease.

If a sick person is unable to cleanse himself of minor impurity with water by making ablution, or he is unable to purify himself of major impurity by making Ghusl, due to weakness, or fear of making his illness worse, or delaying his recovery, he may perform Tayammum.

This is done by striking his hands in clean dust once, then wiping his face with the palms of his hands and his fingers slowly, based upon the Words of Him, the Most High:
And if you are ill, or on a journey, or one of you comes after answering the call of nature, or you have been in contact with women (by sexual relations) and you find no water, then perform Tayammum with clean earth and rub therewith your faces and hands.

The ruling on those who are unable to use water is the same as that of those who are unable to find water, according to the words of the Prophet:

"Deeds by intentions, and every person shall have what he intended.

A sick person may fall into one of a number of categories:

If his illness is a simple one and he does not fear to use water, such as an ailment from which there is no fear that using water will delay his recovery, or increase his pain, or cause any infection, such as a headache, toothache, and the like, or he is able to use warm water without harm, then it is not allowed for him to make Tayammum. Because the permission to perform it is in order to prevent harm, and there is no fear of harm to him, and because he can find water, therefore he must use it.

If he is suffering from an illness which he fears may, should he use water, cause his death or harm one of his organs, or which may lead to some illness which might cause his death or harm one of his organs, or cause the loss of some faculty, then it is permissible for him to perform Tayammum, based upon the Words of Him, the Most High:
And do not kill yourselves (nor kill one another). Surely, Allah is Most Merciful to you.!!

If he is suffering from some illness which makes him unable to move, and he finds no one to bring him water, it is permissible for him to perform Tayammum.

Anyone suffering from a wound, an ulcer or fracture, or any illness which will be exacerbated by using water, and who becomes Junub is allowed to perform Tayammum, based upon the above evidences. If he is able to wash the healthy areas of his body, he must do so and make Tayammum for the rest.

A sick person who is in a place in which he finds neither water nor dust, or anyone who can bring him either one of them, may pray in whatever condition he is in, and he is not allowed to delay the prayer, as Allah, the Most High says:
So keep your duty to Allah and fear Him as much as you can.

An invalid afflicted with incontinence of urine, who is not cured by his treatment, must make ablution for every prayer after the start of its prescribed time, wash off any urine that has affected his body, and wear a clean garment for his prayer, if this is not a burden on him. But if it is, he is excused from it, based upon Allah's Words:
And (He) has not laid upon you in religion any hardship.

And His Words:
Allah intends for you ease, and He does not want to make things difficult for you.

And the words of the Prophet:
If I order you to do something, do it as much as you are able.

He must try to the best of his ability to prevent the spread of urine to his clothes, or his body, or the place in which he will pray. And everything that invalidates ablution also invalidates Tayammum, and in addition, the ability to use water or its presence. And Allah knows best.

Source:
Ibn Baz
Fatawa Islamiyah, Vol. 2 Pages 17-18-19-20-21-22-23