With the aging of the 77 million folks that comprise the Baby Boom generation, I have a feeling that I am not the only one using the more accommodating toilet in a public washroom! Many of us are noticing our stiffening joints, have had a back injury at some point in our lives, or maybe are sensing a need for a joint replacement surgery in the future. When there is a grab bar on the wall nearby, my observation from the occupational therapy clinic is that most folks tend to use it for light support.
My first reservation in noting this: If you find that you are using adaptive equipment, get busy on taking care of your health and joints TODAY. For example, strengthen your quads by practicing squatting without support if it is safe for you to do so instead of risking those muscles becoming weaker by pulling yourself up with your arms. My second reservation is that if you are truly benefitting from simple modifications in public places, consider adding them to your own living environment. A few changes may help you to use less effort in the bathroom (and save it for other activities), improve your body mechanics, and reduce the risk of falling in one of the most dangerous areas of your home.
In this 2-part blog, I will detail several options for improving the safety and ease of use of the toilet area of your bathroom.
Recommendations: Part 1
Whether it’s for a powder room or an “en suite,” some basic safety strategies go a long way to aid your independence. In part 1 we will look at the toilet as is. In part 2 we will look at the many uses of a simple piece of equipment that can help in the bathroom and in more places than you ever thought possible!
Optimal positioning for toileting has come full circle over the years. Like sitting in a desk chair, sitting with the hips/knees/ankles are at 90 degrees (think corner of a box) puts less strain on the low back and makes it easier to rise to a standing position. When the hips are lower than a person’s knees, it is harder to rise from sit to stand. However, too high of a toilet seat may decrease the relaxation needed for bowel elimination. A removable stool that can be stored out of the way such as a Squatty Potty may be the answer here.
So where is the balance? I suggest in general avoiding low toilets and either 1) attaching sturdy grab bars to the toilet itself (called a toilet safety frame) or 2) attaching grab bars to the adjacent walls (or side of a sink cabinet) for a secure hand-hold. Frames or grab bars next to your body, on both sides of the toilet allows for better support and body mechanics when sitting down and standing up. Additionally, place NO rug or mat underneath the legs of the toilet safety frame; the footers should come in direct contact with the floor.
Most folks will use the edge of the counter or sink when needing additional support. This awkward hand positioning often places significant strain on both the shoulder and finger joints. It’s also easy for your hand to slip while holding the smooth surfaces or scratch oneself on the rough underside of the counter as well.
Further, the sudden impact of sitting down too hard can place increased compression/pressure on the hips and spine exacerbating, even causing pain and injury. Never allow yourself to plop down onto a toilet seat! “Lift up” or “boost” devices exist to aid in self-lowering down or rising up from sitting on a toilet (and a chair too) if absolutely necessary. Think mechanical recliner lift chair and you have the idea of a device that is now available for toilets and commodes!
A raised toilet seat (or “toilet riser”) attaches to the toilet generally with a paddle that expands inside the inner rim of the toilet bowl. They are designed with and without attached “arms;” with arms provides the best “transfer” technique. Please avoid using a plastic toilet riser that does not have a tightening attachment as they tend to slide around on most toilets. It is almost impossible to achieve a secure attachment to the bowl without a tightening mechanism. While a “donut” shaped riser may be the least expensive option, this sliding motion of a loosely fitting riser creates an unstable, tippy surface upon which to sit and greatly increases the user’s risk to fall!
Also assess beforehand if the toilet bowl is round or oval as this will determine the exact design of toilet riser that will fit the best and tighten the most evenly, securely. There are different designs available for each type of toilet; consider and measure what is needed for all of the toilets in the home that the primary user is likely to use during the day and during the nighttime too.
Another option to improve toileting accessibility is to replace the toilet with a taller “ADA” (Americans with Disabilities Act) toilet: which is generally 19 inches from the floor. The only caveat is when there are shorter family members and grandchildren using this bathroom too . . . Try to be mindful of who else in the home will be using the bathroom as you make changes. However, never assume that the person needing the riser will just apply it every time they need it and remove it after each use. In my experience, this usually leads to non-compliance and increases the risk to fall when a person in need must repeatedly (day and night) move equipment around.
Alright. So know you know more about toileting accessibility than most people on the planet! And that is a good thing since you never know when you or a loved one will need to know this information. But wait, there’s more! In “Res and Rec: Toileting Accessibility Made Easy, Part 2,” we will discover how one of the most common piece of bathroom equipment you can find at a garage sale can save you money, effort, and prevent falls too. (See the Checklist for Used and Donated Bath Equipment before making your purchase.)
Please note that this information is intended to be a guide and not a replacement for an individual home safety assessment by an Occupational Therapist or Certified Age in Place Specialist.
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Take care, Julie, O.T.