Using The Toilet With: An Injury

The reality is that for many families helping a loved one through an injury recovery, some assistance is necessary. But how can the process of using the toilet with an injury be made a bit easier? In this guide we’ll cover some key elements to toilet use that will provide a better experience for the individual.

Clearing the path to the toilet

Before even considering how the toilet itself can be better prepared for use by someone in the midst of physical rehabilitation, it’s important to make sure that the path into the bathroom is unimpeded. With bowel motions often calling at a moment’s notice, any difficulty in getting to the toilet combined with a slower pace of movement can cause accidents. While accidents are sometimes hard to avoid, the access to the bathroom and right up to the toilet can save precious seconds to at least reduce these somewhat.

A clear path to the bathroom starts in the areas where the individual spends time – bedroom, living area, kitchen – all spaces and doorways should be able to be moved through with assistive equipment such as wheelchairs, crutches etc. Once in the hallway area, there should be no objects left on the floor that require manoeuvring around. Anything like this left out can catch on legs or wheels and slow the individual’s movement down. Or worse, it can create an accident.

Entrance to the bathroom

Once at the bathroom, the path to the toilet should be clear of free standing fixtures like towel racks, stools and cleaning items. The threshold should be kept well maintained with any loose carpet, nails or skirting fixed ASAP. There should be ample room to move through the doorway safely with equipment and a carer in tow. Practising this access without needing to use the toilet is often a good idea to make sure everyone is comfortable with the approach.

Bathroom floor

The bathroom floor itself needs to be both clear of items and cleaned regularly. Items that can create hazards for someone with an injury trying to access the toilet include dirty laundry, towels that have slipped off the rack and bathmats that aren’t hung up. The floor itself should be mopped and cleaned with a good household floor cleaning agent on a reasonably regular basis. Ensure that after the mopping, the floor is dried completely before attempting to access.

Getting the seated position high and comfortable

It’s the same challenge that an elderly person or someone with lifelong mobility impairment may have with the toilet; the movement of crouching down to a standard toilet height when legs and / or back mobility is reduced or non-existent can make toileting impractical. The occupational therapist may determine that for the toilet, a heightened seating position is required. This will help the user mount the toilet easier and faster. When in a hurry, undressing and getting situated on the toilet quickly can mean the difference between a good and messy experience.

There are a number of ways that toilet seat height can be adjusted::

• A replacement toilet seat that is thick and achieves a moderate level of height adjustment.
• A fixture that is attached onto the toilet that provides a significant lift in seated position.
• A custom toilet affixed high and accessible specifically for a long term mobility need. For a cost, there are height-adjustable toilet bowls available, not to mention self-clean toilet options.
• A bathroom mobility chair system that can be positioned atop a regular toilet. The user can be seated in the chair before even entering the bathroom, placed over the toilet, with no transferring or awkward movements at all. The same system may be used for bathing, further removing risky movements.

Establishing Arm Supports For Stability

It’s not just the backside and back that need support during toilet use. For many, the physical impairment they’re recovering from causes issues with their balance and stability. Core strength is required to sit upright with no help, a function that many are often lacking especially early on in their journey of recovery.

For that reason, arm supports are often a good idea to aid personal privacy during toilet use – these may hold the user in place without any personal input, or the arm rests can be actively held and used to keep a central position. How these are used will ultimately depend on the level of personal mobility at the time. Good arm supports should be affixed to the toilet or equipment strongly enough that they can support the full body weight of the user.

Is Neck And Back Support Required?

This is a matter for your occupational and physical therapist to determine. While it may not be the case for the duration of the rehabilitation, neck and back support might be a priority early on in the process. For these users, a more sophisticated support solution will be required. A simple toilet riser is not going to meet these needs.

In these instances, a proper full function bathroom mobility system is going to be the better choice. These systems offer a range of modifications and accessories that allow neck support rests, different back support and elements like fastening belts to keep in position. With a more appropriate and advanced equipment solution, the reliance upon the carer or individual can be reduced.

Planning a Toilet Use Process With An OT or PT

There is a different plan for each person going through physical rehabilitation, because the level and type of impairment can be so variable, as can the individual’s own wishes.

Whatever the way forward, planning this with the occupational or physical therapist should be the first port of call. They’re able to assess all these variables and design a solution in concert with the individual that best meets their needs.

The process will cover everything from access to use to clean up, so everyone knows what’s happening. If the current toileting process isn’t working, the OT or PT will be able to help design a better way forward. In the situation of someone gradually building back mobility, OTs need to continually refine the plan to enable more independence by the individual.

Transferring Onto And Off The Toilet

One of the more risky parts of the toilet use process is the act of getting onto and off of the toilet. Manual transfers from wheelchair to toilet and back to wheelchair can put both the individual and their carer at risk of injury with a heavy, awkward weight distribution occurring during transfer.

Even the most qualified, experienced home carers can experience injury or accident when relying solely on personal strength and ability to transfer someone to and from the toilet. Add in the slippery bathroom environment and it’s easy to imagine why manual transfers can be such an issue for all involved.

It’s this part of the bathroom process that makes a full bathroom mobility transfer solution so valuable. The lack of personal mobility can be compensated for by a chair that can allow the individual to remain seated for the entirety of their bathroom use – and that includes bathing and drying off too, also reducing the risk of injury to carer and user.

Combining Toilet Use And Bathing

While toilet use can occur at any time of day, it’s common for a bathroom routine to include both toilet and shower at once – either out of habit in our daily routine or required to clean up. Again, a proper transfer system can maintain the users’ personal safety through this process, saving the carer time and effort as well.

Assistance When It’s Required, Independence When It’s Possible

While most daily tasks we’d prefer doing ourselves, this desire for independence is felt mostly in times of privacy such as toilet use. While we’re unable to provide any specific guidance for individual cases, our team and wider OT/PT community tend to engage our equipment in order to provide a baseline level of support and function that empowers independence vs. replaces it.

What this means is that the assistance of equipment and a carer is ideally designed around making the toilet process as comfortable and dignified as possible. We design products that allow the user to take back some of the control over bathing and toileting. For someone with a physical injury, the equipment should be able to provide the assistance at the most severe period of impairment, and continue to be a practical option when the individual can conduct some of the process themselves.

The same tends to go for family or support people – they may start out by providing positional and cleaning help on the toilet, and gradually reduce their input as the individual builds up strength and coordination to do these tasks themselves.