Toilet Hygiene and the Use of Bidets for ppl w/ ALS/MND

ALS is a debilitating disease that can cause weakness throughout the body, impairing function with all day to day tasks.  In my seven years of working at the ALS clinic as an Occupational Therapist, most people with ALS (PALS) are more than willing to discuss difficulties they are having with dressing, walking, opening containers, opening doors, hand writing and a host of other daily activities. 

The activity of going to the bathroom is rarely discussed, as most of us were taught from a young age that this is a basic human function that should be kept private.  PALS rarely (unless prompted) discuss activities involved with going to the bathroom especially in terms of being able to manage their clothing and being able to perform toileting hygiene and cleaning.   In most cases this is probably an accurate and acceptable social norm; however what do you do if your hand and arm strength is greatly diminished?  An activity that was once a basic human function performed on a daily basis can turn into an extremely difficult task.  The consequences of this task not being performed effectively and correctly can lead to embarrassment and needlessly exaggerate functional deficits associated with ALS.  Even if a PALS has help with toileting hygiene, he or she may feel uncomfortable with this loss of independence. 

The bidet is a good solution for those PALS with loss of hand and arm function, who need assistance with toilet hygiene.  Bidets come in many different forms and at many different price points.  I have not heard any patient regret their decision to use a bidet at home to increase independence with toileting.    Some patients have been extremely happy with regaining a level of independence with such a private activity of daily living. 

Most bidets are sold as part of a toilet seat.  This bidet/toilet seat will be installed in place of your current toilet seat.  Bidets usually cannot be used in conjunction with a 3 in 1 commode or raised toilet seat.  If you are having difficulty standing up from the toilet, you may want to install a new ADA compliant toilet.  The ADA (Americans with Disability Act) height recommendation for toilets is 17 to 19 inches (floor to seat).  Depending on your ability to use your arms, you may also want to install a grab bar along one or both sides of the toilet at 33 to 36 inches high.  This can help most PALS with sit to stand toilet transfers and prolong independence with toileting.  Doing this can be helpful even if you need assistance from a caregiver with getting onto and up from a toilet. 

 

Most of the bidets I recommend do not come from a medical supply store and are not necessarily marketed exclusively to people who have disabilities.  For instance, the brand Toto is a Japanese manufacturer of toilets that are marketed as luxury items.  I believe that products made by these types of companies have a higher level of quality and are actually less expensive than products exclusively made for people with disabilities.

Bidets also have different functions that can be beneficial.    One of the major functions I would look for when purchasing a bidet is hands free use.  If you already have limited hand function, you don’t want to have to operate buttons or a remote control to use your bidet.  This defeats the purpose of hands free toilet hygiene.  There are many bidet options that come with sensors that activate the bidet system through shifting your weight on the toilet seat.  This ensures hands free hygiene and makes it so the bidet system cannot accidently be activated otherwise. 

Another function I would look for when purchasing a bidet is a drying mechanism that is also operated in a hands free function.  A bidet uses sprayed water to clean a person so you are going to need to be dried after using it.  Many bidets come with a blow dryer function to meet this need. 

There are other functions that you may or may not find helpful.  There are automatic toilet lid openers, self cleaning nozzles, heated seats, and massage functions.  Outside of the automatic seat, the other functions may or may not be needed. 

After reading this article, if you have any questions you can contact me at scott.rushanan@uphs.upenn.edu  I hope you found this article helpful.  I’ve attached some links to company websites that sell types of bidet systems discussed in this article. 

 http://www.totousa.com/Washlet/WashletS400.aspx

http://www.eganmedical.com/Clean-Butt-Bidet-Spa-p/mscp-cb-7500r.htm

http://www.us.kohler.com/onlinecatalog/detail.jsp?item=14426102&section=2&category=14&retail=false

Authors: Scott Rushanan, MS, OTR/L and Michelle Lewis, DPT, PT