¶ Introduction
Toileting refers to the act of having a bowel movement or urinating into a suitable receptacle.
¶ Types of Toilets
| Term | Definition |
|---|---|
| Bedpan | A shallow container used to urinate or defecate while in bed. |
| Commode | A portable toilet, often resembling a chair, often with a removable container for waste. |
| Flush Toilet | A plumbing fixture that disposes of human waste by using water to flush it through a drainpipe to a sewer or septic system. |
| Outhouse | A simple, non-flushing toilet typically located outside a building, usually consisting of a pit covered by a small structure for privacy. |
| Urine Bottle | A portable container used for urination. |
Standard toilet fitted with safety rails
Wheeled tilt shower commode, front view.
Wheeled tilt shower commode, side view, upright.
¶ Getting to the Toilet
Flush toilets are typically mounted near walls; this necessitates either a turn or backward movement in order to reach them before sitting down. These maneuvers are difficult and potentially unsafe for an individual with significant ALS disease progression.
Grab bars and transfer poles may be used to provide support while walking backward to a toilet if the individual retains a moderate amount of lower limb strength.
Wheeled over-the-toilet commodes may be used to complete the journey to the toilet if the layout of the bathroom permits. Care should be taken to avoid ramming the commode into the toilet tank, as it may cause it to crack and leak water.
¶ Examples
The following examples are in order of greatest independence, followed by least independence.
¶ Minor or zero disability
- Walk to the toilet
- Carefully turn around when in front of it
- Slowly sit down upon the toilet
¶ Moderate disability with walking and standing
- Walk as close to the toilet as possible with a walker
- Use a wall-mounted grab-bar for support to turn around
- Slowly sit down upon the toilet, which has been fitted with a toilet seat riser or commode to increase its height
¶ Significant disability with walking and standing
- Using a patient lift, transfer to a wheeled over-the-toilet commode
- Have an assistant push the commode over top of the toilet bowl
- Align the commode carefully, and set the brakes
¶ Seat Height
Toilets come in different seating heights. While there are height measurements that are quite common, toilets may be installed at any height.
Ideally, a person's knees would be higher than their hips when sitting on a toilet. Such a position helps with evacuation.
Lower limb weakness necessitates the use of a toilet with a higher seating position, as low seating positions require significant strength to stand up from. Further disease progression will require ever-higher seating heights, until it becomes impractical to stand independently from any height.
Toilet seat risers or over-the-toilet commodes (with or without wheels) can be used to increase the seating height of a flush toilet.
Toilet safety rails may be useful if the toilet itself already has a relatively high seating position. Guests and other individuals in the home may be more comfortable using a toilet fitted with safety rails as opposed to a toilet seat riser.
¶ Alternate Methods of Toileting
When it is not possible or practical to get to a toilet due to disability or incontinence, the patient may use a combination of briefs and a catheter, or a bedpan and urine bottle.
¶ Anal Hygiene
¶ Toilet Paper
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¶ Bidets
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¶ Waste Disposal
Human waste that is not being disposed of in a flush toilet will need to be disposed of according to the regulations of the municipal waste program. Some jurisdictions require signing up for a diaper removal program, which may have associated fees and require periodic renewal.
The waste disposal container should be at least 10 gallons (38L) in size if it is to be collected weekly.