Toileting Advice and Adaptations
For any potty training or continence programme to be successful, the first priority is to make sure the individual feels secure. Secondly, comfort and safety are vital. For ordinary toileting (not including ACE or other bowel irrigation procedures), toileting time should not exceed 10 minutes.
In practice, this means that when using a toilet:
• feet should be supported on either the floor or a footrest.
• a comfortable toilet seat should be provided, and if necessary a padding on the seat that does not “stick” to the skin.
• the individual should be able to maintain good sitting balance for the necessary period of time.
• assistance should be within easy calling distance, and the person should only be left alone for short periods and/ or have access to an alarm.
Where good sitting balance is not possible, the child or adult should be supported by either a toilet/potty chair and appropriate rails, for which they have been individually assessed in the situation in which it is to be used. Provision of side and front hand rails can increase stability, safety and independence. Wherever possible, the simplest solution should be tried first.
An assessment should be undertaken by either the child’s or adult’s own occupational therapist; or a referral should be made to the appropriate agency. This would be the case for any equipment or adaptations which may assist with successful toileting.
Health & Safety
All carers who may be involved in assisting in any toilet training or continence care need to be fully aware of safety precautions; and trained in the correct positioning and movement of both chair and individual. This should include both voluntary and employed carers.
Many toilet/shower chairs have parts, including removable seat and castors that are necessary, but can be hazardous. Therefore all equipment should be checked regularly.
Moving and handling guidelines and regulations require that many service users and their carers use hoists. LOLER (Lifting Operations and Lifting Equipment Regulations) governs the use and care of all lifting equipment: existing, second hand, leased or new. LOLER states that all equipment and accessories used to lift people must be serviced every 6 months.
There is a vast array of equipment available to assist with toileting and continence, and to encourage independence. Wherever possible they should be tried out in situ, in the presence of an occupational therapist. If an item is to be purchased privately, because of the waiting list for assessment, it should at least be viewed, before costly provision is made.
Most areas now have Disabled Living Centres where members of the public can receive professional advice from occupational therapists and view or try out equipment. Often an appointment is required. It is essential that the limitations of the service user’s own bathroom or toilet, be made clear and taken into consideration. For example, most shower chairs require as much doorway width as a wheelchair and will need to be stored somewhere when not in use.