Imagine being invited out for lunch and knowing that, before you can say yes, you need to research the toilet.

Not the menu. Not the parking. But whether the toilet is somewhere you can manage.

For a person living with bowel symptoms, the social outing may involve a great deal of preparation before anyone meets at the café. There may be a route to plan, supplies to pack and an alternative to find in case the usual toilet is unavailable. By the time lunch begins, part of the work of participating has already happened.

As occupational therapists, we need to ask about that work.

Crohn’s disease, IBS and diverticulitis are different conditions. People’s symptoms and treatment needs vary. What brings them into our housing and equipment practice is the effect on everyday occupations: working, studying, caring for a family, getting dressed or spending time with friends.

Looking below the surface

“Independent with toileting” can conceal quite a lot.

Someone may manage without another person’s hands-on help, yet need painful reaching, repeated attempts or a rest afterwards. They may have arranged everything at home to make the routine possible. In an unfamiliar bathroom, those carefully worked-out solutions disappear.

It is a little like looking at an iceberg. We see the completed task above the waterline. The planning and effort underneath need a conversation to become visible.

A useful question is: “What have you stopped doing so that you can keep managing this?”

The answer might be lunch with colleagues. Or a train journey. Or staying long enough to watch a grandchild’s football match. These are the occupations our recommendations need to account for.

What the environment is asking

Before choosing equipment, we need to understand the demand. Is the difficulty reaching to cleanse? Standing from the toilet? Managing fastenings quickly? Getting access when the toilet is occupied?

Those problems lead us in different directions. A wash and dry toilet may be worth trialling for an assessed hygiene difficulty. A change to seat height needs consideration of the whole transfer and sitting position. An occupational health assessed arrangement for classroom cover may help a teacher whose main difficulty is leaving when they need to.

Sometimes the most useful change is small. Sometimes the room needs substantial work. The size of the intervention should follow the problem we have understood.

Pain or changing bowel symptoms may also need medical review. Our assessment should connect with that care, rather than assume an adaptation will deal with the cause.

What happens afterwards

Installation is a point in the process. Review tells us whether the recommendation was useful.

Can the person complete the difficult step comfortably? Can they operate and maintain the equipment, with support if needed? Does the arrangement work on a more difficult day? And what has become possible beyond the bathroom?

For me, that last question keeps the occupation in occupational therapy. A bathroom assessment may begin with movement, reach and space. Its purpose might be to help someone accept an invitation without the toilet deciding for them.

When the bathroom decides whether you go out

Looking below the surface

What the environment is asking

What happens afterwards

Further reading