Background

Toileting and toilet hygiene are activities of daily living (ADLs) that everyone does frequently throughout the day—usually without much thought. But for an individual with a disability or limited mobility, these tasks can be difficult to safely complete by themselves and will mostly likely require assistance from their occupational therapy (OT) practitioner, other adaptive devices, and caregivers. Some individuals who have a severe disability may be bedridden and require extra assistance to perform the ADL while lying in bed.

The two videos in this section demonstrate the following skills that the OP practitioner can use to assist their clients to perform ADLs: transferring from a wheelchair or walker to a toilet while following precautions, getting dressed and managing briefs, performing perianal and perineal hygiene, and using adaptive equipment. Other skills demonstrated are donning and doffing briefs while in bed and using adaptive equipment properly.

You will also make some connections to previously learned skills that will facilitate better toileting skills and that build upon the information you learned in the “Introduction to Transfers and Mobility” in Physical Dysfunction I and Modalities I.

First, in Modalities I, you learned to functionally transfer your client using correct body mechanics and suitable adaptive devices. This is very important when performing a toileting intervention with your client, and it ensures both you, your client, or caregiver stay safe without injury. Second, in Functional Anatomy, you learned about the nervous system and how it affects muscles, body parts, and their motor control functions. You also learned about cognition, which is important to know to discern your patient’s abilities to follow commands and to understand what is happening to them, all of which affect the transfer type and adaptive equipment that you choose to use.

Assisting with and Adaptive Equipment for Toileting

This video describes how the OT practitioner can assist their client to transfer from a wheelchair to a toilet using a walker and how their client can use adaptive equipment for perianal hygiene.

Assisting with and Adaptive Equipment for Toileting Video Transcript

Assisting with and Adaptive Equipment for Toileting Tips

• Managing Toilet Transfers
  • When transferring your client from the wheelchair to the toilet using a walker, keep in mind the following:
    • Generally, toilet transfer assists require more assistance than standard transfers.
    • Note your client’s weight-bearing precautions.
    • Use a gait belt to help your client transfer.
    • Know and follow the universal precautions.

• Managing Adaptive Equipment
  • Always make sure that the adaptive equipment is secured correctly.
    • The Toilet Seat Riser
      • Clamp it on to the toilet by turning a fastener knob.
      • It provides a four-inch rise and grab-bar handles.
    • The Toilet Safety Frame
      • Bolt it onto the toilet seat.
      • It provides handles to assist with the transfer.
    • The Bedside Commode
      • Adjust or eliminate the removable bucket.
      • It can be placed over the toilet to elevate the toilet’s surface height.

• Managing Clothing and Briefs
  • Make sure that the side of the brief with tabs goes in the back. The side with non-tabs goes in the front.
    • Donning a brief while your client is seated on the toilet.
      • Slip the brief between the client’s legs.
      • Secure the brief’s tabs at the legs.
      • Have your client bring their pants up to their thighs while seated and spread their legs wide to keep them up.
      • Have your client stand up and bring the briefs up.
      • Adjust the tabs so the brief fits properly.
      • Doff the brief the same way in reverse.

• Managing Perianal Hygiene
  • Make sure that you always keep the following in mind:
    • Train your client to wipe from front to back.
    • Use universal precautions and wear disposable gloves.
    • Use the following possible adaptive equipment as needed.
      • Alligator clips
        • Alligator clips prevent your client’s pants from falling to the ground.
        • Clip the alligator clips to your client’s shirt and pants. There is a string in between the clips and clothing.
      • Tongs
        • Tongs assist your client to perform perianal hygiene.
        • Train your client to use tongs if they have a hard time reaching their bottom
      • Bottom Buddy
        • Train your client to use a bottom buddy to assist with reaching around to perform perianal hygiene.
        • Open the thumb catch, and insert toilet paper into the catch.
      • Bidet
        • The bidet is a French-style toilet that sprays warm water on your client’s bottom after they use the toilet.
        • Train your client to use the bidet to perform perianal hygiene.

Bed Level Toileting

This video explains how the OT practitioner can manage toileting for their client who is lying in bed. Skills include donning and doffing briefs, completing perineal hygiene, and using adaptive equipment such as a bedpan.

Bed Level Toileting Video Transcript

Bed-Level Toileting Tips

• Managing a Brief
  • To Don a Brief: Use a rolling technique. Log roll your client to one side. Roll one side of the brief to your client’s midline. Place the brief’s rolled edge under the body. Reverse log roll your client to their other side, and unroll the brief to make it flat on the bed.
  • To Doff a Brief: Undo the brief’s tabs. Roll the brief from your client’s front toward the back. Secure the rolled front under your client’s legs. Log roll your client, and continue to roll up the brief into a self-contained unit for easy disposal.

• Managing Perineal Hygiene
  • Have all the cleaning supplies and a trash can within your reach before you begin cleaning. Always clean the patient from front to back to avoid infection. Clean as you go, taking advantage of the opportunity to clean using the different positions your client is in from log rolling.

• Managing Adaptive Equipment
  • To Place a Bed Pan: While your client is lying down in bed, log roll them to bring down their pants. Place the high end of the bedpan under them and towards their legs. Position the bedpan to catch stool or urine. Keep in mind that using the bedpan can be more comfortable for your client when the head of the bed is set up at a slightly higher angle. When your client is finished, lay them flat and log roll them to one side. Be careful to hold the bedpan securely in one hand to keep it level so as not to spill the contents. Empty and sanitize the pan.
  • To Place a Urinal: Urinals can be used to allow your client to urinate while in bed. Male and female urinals are designed differently.  For males, place the penis inside of the urinal and position the urinal so that it doesn’t spill. For females, place the urinal so that it covers the urethra and is positioned so that it doesn’t spill.

 Resources

• • • • ○ #1 Pivot Transfer: Wheelchair to Toilet – My Shepherd Connection By Shepherd Center
      • ○ #2: Nursing Bedpan Management, by Tammy J. Toney-Butler; Gwendolyn Gaston, CCBY
      • ○ #3: How to Change Disposable Briefs, by Drugs.com, Multiple Licenses