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