Going to the toilet – a complex activity.
We all go to the toilet, in one way or another and the average person will urinate up to 7 times a day and pass faeces up to 3 times per day, it is a activity that most of us do without any thought or consideration of how we are going to achieve it.
Yet for people with physical, sensory or cognitive impairments it can become a challenge. This blog will look at the complexity of this activity and how the right toilet specification can have a life changing impact on going to the toilet and maintaining dignity.
Going to the toilet is a very complex task; to be able to go to the toilet you need to be able to:
- Know you need to go
- Know where the toilet is situated in the environment you are in
- Be able to physically access and use the toilet
- Have the ability to remove clothing
- Be able to transfer onto the toilet
- Have the sensation to then open your bowels or urinate
- Be able to access the toilet paper
- Use the toilet paper to wipe yourself
- Transfer off the toilet
- Put clothing back on
- Flush the toilet
- Wash your hands
- Go back to where you want to be
These are just some of the steps, however each step above could be broken down further to smaller components each of which the person using the toilets needs to be able to complete. For example to be able to wipe yourself after opening your bowels, you need to be able to place the paper in your hand, hold it, move your hand around to your bottom, use your senses to understand if you are wiping the correct area, vision to see if the toilet paper is now clean and therefore your bottom is and then be able to place it down the toilet.
As an occupational therapist we will often complete an activity analysis on how someone uses the toilet and this will give us an insight into what works and what difficulties our client has, from this assessment we will initially look at modifying the way someone carries out going to the toilet, then if this is not successful we will look at adaptive equipment and finally look at adapting the environment to support safe and independent use of the toilet.
Never assume you know how someone uses the toilet, make sure you observe the task, even if it is a dry run, you will be surprised and how many different ways there are to complete this task.
When adapting the environment, remember that space is critical to a successful outcome, however specifying the right toilet is just as important, areas to consider are,
* Height – the standard UK toilet is 400mm or 16inches height, this is quite low and a higher pan with seat might be required.
* Aperture – these do differ and you need a specific shape or diameter if you clients needs require it.
* Seat attachments – these come in plastic, metal or clip on, if you have a client doing a sliding transfer remember a metal attachment will be more resilient.
* Seat projection – this may be critical if using a toileting commode as you will need to get the chair far enough back to get the bottom over the toilet pan.
* Type of pan – do you need a close coupled, back to the wall or wall hung to meet your clients needs
* Flush – which side is this going on, is it a push, lever, hands free or remote flush
* Cleaning – will it be easy to clean for the client or who ever cleans it
* Functions – do you need a toilet that will wash or wash and dry, if this is the case can you client use the functions independently.
* Adherence to standards – remember that all products should meet WRAS approval
No one would choose to have to have assistance to go to the toilet if they had a choice, we would rather be able to go alone and complete the task in private away from another persons gaze or having to rely on someone to assist. It may require some time and expense to get the task and the environment right for a client to be independent, however never underestimate the dignity and joy of being able to access and use a toilet alone.