After a spinal cord injury (SCI), the process of using a toilet to relieve yourself changes dramatically. The majority of SCI survivors lose their ability to control their bladders or bowels.
In fact, the National Spinal Cord Injury Statistical Center (NSCISC) estimates that there are about 17,700 new cases each year in which someone survives a spinal cord injury. Of those individuals, research shows:
“More than 80% of these individuals exhibit at least some degree of bladder dysfunction... In a large cohort study of patients with neurogenic bladder, 40% attended a urology clinic visit over 1 year, 33% were hospitalized, and 15% were in a nursing home. UTIs were responsible for more than 20% of all 1-year hospitalizations.
However, having a spinal cord injury doesn't have to preclude you from living and functioning independently.
Individuals with lower spinal cord injuries (such as those affecting the sacral spine, lumbar spinal cord, or thoracic spinal cord regions) tend to retain more upper body mobility and strength, which helps them maneuver a restroom and transfer to and from a toilet with greater independence. For individuals with injuries impacting higher areas of the spine, however, they may require the help of a personal care assistant (PCA) to assist with planned restroom breaks.
What are some of the ways that you can remain independent while using various parts of the restroom?
1. Practice Wheelchair to Toilet Transfers to Gain Confidence
When you have a spinal cord injury and need to use a toilet (whether at home or out and about), it’s critical that you can do so confidently. Having this ability requires practice for many spinal cord injury survivors — particularly those with newer SCIs. They will practice transferring on and off toilets in a variety of situations and bathroom conditions. Some of these conditions can include practicing:
- In small, cramped stalls and spacious restrooms;
- With and without handrails; and
- With and without an assistive toilet seat.
Performing a Wheelchair Transfer Without Technology
Transferring without the aid of any assistive devices is a multi-step process:
- Position your wheelchair in front of the toilet.
- Verify the toilet is clean and stable; wipe it with toilet paper and press down to check its stability with both hands (preferably with toilet paper to keep your hands from directly contacting the seat).
- Shift your body to the edge of your wheelchair seat.
- Using your leading hand, lift each leg independently and set each food on the floor.
- Keep your trailing hand low on the wheelchair arm to anchor yourself while transferring by pushing down (not sideways). Pushing at the wrong angle on a wet surface can cause the wheelchair to move and result in you falling to the floor.
- Place your leading hand on the toilet seat or a handrail that is easily within reach. Push down and use it to support your weight as you lift and swing to rotate your hips and body into a sitting position on the toilet seat.
- Reposition your body and legs (one at a time) once seated.
- Because you’ll be seated for several minutes, be sure to lean forward or side to side, using the handrails or toilet seat for balance, to avoid the development of pressure sores and allow blood flow.
Using Assistive Technology for a Wheelchair to Toilet Transfer
When it comes to assistance using the toilet, some people turn to electronic solutions to help. These types of technologies can include the use of 1) functional electrical stimulation (FES) to stimulate paralyzed muscles to cause contractions and help them regain some muscle control, or 2) slings and lifts that can be used to transfer you from a bed or wheelchair to the toilet.
Another option for performing a wheelchair to toilet transfer is to use a wheelchair transfer board, or what is also known as a sliding board. There is a wide variety of wheelchair transfer boards on the market — they can be made of plastic or wood; they can be smooth or textured, and may have a flat or curved design.
To use the wheelchair transfer board, place one half of the device on the toilet seat. Maneuver your body toward the edge of your wheelchair seat and place the other half of the board on the seat next to you. Lifting and sliding your body along the board, use the material to guide your body into position on the toilet seat.
2. Use a Catheter to Help You Enjoy Greater Freedom
Using catheters, which once used to be a cumbersome, frustrating, and messy process has improved by leaps and bounds thanks to the growth and development of medical technologies. These technologies transformed the catheterization process into a simple and convenient way for spinal cord injury survivors and others with physical disabilities to deal with incontinence.
Catheters are integral to an effective bladder management program. However, there are many types of catheters that you can use, including (but not limited to):
- Intermittent catheters,
- Indwelling catheters (also known as a Foley catheter),
- Suprapubic catheters (which require surgery),
- Mitrofanoff catheters (which require surgery), and
- Condom catheters (for men only)
For women who opt to use an intermittent catheter, you can use a knee spreader with a built-in mirror to assist with self-catheterization. This tool can help make it easier to insert an indwelling catheter independently.
3. Maintain a Regular Bladder and Bowel Management Schedule
After a spinal cord injury, regular bladder management and bowel management are imperative to staying healthy. These programs aim to minimize complications and provide a way to take care of base bodily functions in a way that matches your lifestyle.
Part of this process is to set and maintain a regular bladder and bowel management schedule a few times a day to ensure that you are expelling waste from your body. This can be done through:
- The use of laxatives,
- Bowel management surgery and enemas, and
- Employing digital stimulation (also known as “dil”).
4. Check for Wheelchair-Accessible Accommodations
When traveling by yourself or with a loved one, something you can do to make your life easier is to check for hotels with ADA-compliant rooms. Accessible accommodations are becoming more common, and they typically cost no more than a standard hotel room. However, they typically feature spacious bathrooms with wall grab bars for the toilet and bathtub areas. Some of the more modern rooms even use roll-in showers in lieu of bathtubs.
5. Exercise to Maintain Both Your Upper Strength and Mobility
While this is not a direct “bathroom tip,” it is a factor that affects your ability to use the restroom independently. In general, it’s important for people with spinal cord injuries to exercise to maintain muscle strength, development, and to avoid atrophy. However, building and maintaining strength is also integral to your ability to perform a toilet transfer easily and efficiently.
To learn more about how spinal cord injuries affect your bladder, bowel, and sexual functions, click on the link below to download our free guide.
