Family Caregiver – Toileting the Wheelchair Patient at Home

My husband uses a catheter only on road trips, not around the house. He is generally continent, generally. I keep an ear pealed for his call and hope I get him to wherever he needs to be to answer nature’s call.

* A urinal is kept alongside the bed on his night table for use during the night. He sometimes feels confident enough to use the urinal himself without waking me. That’s okay when it works. Lately he uses the urinal, replaces it onto his night table without my assistance, and then a couple hours later tries to use it again when there is still urine in it from the previous use. You can guess what happens… I’ve started placing reusable bed pads on the floor against the bed and draped down the side of the bed to catch accidental spills. You can never have too many bed pads.

* I have considered having him use an external catheter at bed time. I know of a family where the husband does use a Texas catheter at night. That man is apparently not as fidgety as my husband. I’m afraid the way my husband tosses and turns as part of the Parkinson’s disease, he would be wrapped in the tubing and the collection bag would be useless. So the urinal is our only choice for now. And a couple reusable bed pads on the bed. You may have luck with the catheter, or absorbent underwear. My husband will not wear the underwear at all.

* A urinal is in the bathroom for when he’s not able to stand at the toilet. One in the basement for when he’s working around the workshop, one near the kitchen table for sudden urges that don’t make it to the bathroom. A urinal is kept in the basket of his scooter, kept under cover in an unobtrusive cloth bag. With a box of tissues packed alongside.

* Boxes of pop-up facial tissues are everywhere for use with the urinal, or wiping noses.

* A box of disposable latex gloves is kept at the toilet for use as needed.

* Adapting clothing helps with dressing and toileting. Try to keep the male patient in pants that are loose around the waist and hips and have a long fly zipper. Try to eliminate underwear. I have changed the zipper in his slacks to be extra long, extending all the way to the crotch seam. Zippers can be added to legs to get over braces. Zippers can open a tight neckline. Velcro can be used instead of zippers. A seamstress may be able to fix/adapt clothing to make dressing and functioning easier. My experience is with a male patient. I cannot imagine how a woman copes with incontinence comfortably.

* To protect the wheelchair seat from wetting accidents, small absorbent seat pads, like a miniature bed pad, can be used. Lacking the special pads, a layer of folded hand towels will help.

* A reusable, waterproof bed pad and a bed pad with handles can be helpful to protect bedding from wetting accidents and to move the patient around the bed. If the bed pad has handles it is easier to grasp the handles than to grab a fist full of cloth to reposition the patient. A bed pad with handles can also be used to protect a recliner and helps to position the patient.

* If you use a bed pad for repositioning the patient, to pull him up towards the head of the bed, remember that when you pull the bed pad up, the bedding is now exposed without protection. You will want to have a second absorbent bed pad in place under the pad that will be used for repositioning, so that when it is pulled towards the head of the bed, there will still be protection under the patient. I use a total of 5 bed pads in various positions on the bed, including the one with handles. Plus the one I lay on the floor.

* My husband uses a male oriented, split front toilet seat. It helps him to position himself so he can use the toilet properly. When he sits for any length of time I place a pillow or two behind him since this type seat has no lid to lean back onto. I make sure the pillows are “old” in case they get soiled or fall into the toilet.

* There are grab bars around the perimeter of the bathroom. When I roll his wheelchair into the bathroom he can grab hold of the bars along the wall to assist in getting himself up and onto the toilet. I stand behind and help him up holding him under the arms until he is standing,or as close to standing as he is able. I then stand off to one side and pull the wheelchair out of the bathroom so it is behind me and then, stepping into position behind him again, I am able to help him onto the toilet, or to stand if he is up to trying. On days when he is not as strong, he will use the urinal while seated in the wheelchair, or I will use the gait belt to transfer him to the toilet.

* Heavy duty grab bars were installed on each side of the toilet for him to hold onto when standing at the toilet or when lowering onto and getting up from the toilet. They work really well. We had them professionally installed during some other modification work. They are almost 2″ in diameter, jut out from the wall on both sides of the toilet, and swing up out of the way when not needed. VERY handy for when I have to climb around him to get into the bathroom, as for his morning wash-up. I wheel him in first then I have to get around to be in front of him. I have to squeeze between the sink and his wheelchair. To do this, the grab bars must be up to allow clearance for me to get through. Once I get around front of the wheelchair, if he decides to use the toilet, I step out of the way as best I can, and I lower the bars down. My husband says our bathroom is the size of a postage stamp. It’s a little larger than that, but not much – 6 ft. x 8 ft. We had the bathroom door frame enlarged too, so his wheelchair would fit through the opening.

Caring for my husband these 13 years has given me a genuine understanding and sympathy for other caregivers and their individual situations. I am always looking for a better, easier way to help him through the day. If he’s happy then we’re both happy.