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Many really heavy people are nervous about using the toilet in case they break it and injure themselves. A traditional ceramic pan will take a load of about 20 stone, but there is now a heavy-duty toilet surround, (shown left) which will convert any standard toilet into a facility that can be used safely by people weighing up to 444 kg (70 stone).
Most configurations of grab rails in the toilet are not sufficient for the needs of obese patients, as they do not extend far enough forwards, and may not be sufficiently supportive. A sturdy floor-mounted support in front of the toilet may be more helpful, as the user can then lean forwards and use both hands to pull themselves up.
Provisions for assistance in this area also include extra-wide commode chairs (right). This Carmina chair from ArjoHuntleigh has a number of features to help make hygiene routines easier for both the user and carer. The adjustable footrest provides a comfortable and safe sitting position, and good access for transfers using different types of passive lifters. Push poles assist caregivers when manoeuvring the chair, and can be used by those people who have some mobility to support themselves when sitting down and standing up. The poles fold away to facilitate sideways transfers.
The adjustable backrest with four different seating depths provides extra support for individual needs, as well as allowing integration with most toilets.
A tip-up seat makes it easier to clean and disinfect, and provides good access to the commode container. The Carmina has a safe working load of 320 kg (50 stone)
This is part of the Independent Living Focus on bariatric care. You can sign up for the free monthly email round-up here
Personal cleansing after using the toilet may be especially difficult: a specialist unit that combines a bidet and warm air drying with the WC may be the solution to maintaining patient dignity and privacy in this area. The heavy-duty automatic shower toilet shown here is combined with an electronically controlled toilet lift which raises and lowers the user in a safely supported seated position. It is suitable for individuals who way up to 47 stone (300 kg), and has an ergonomic seat specifically designed for bariatric users.
Pressure management is also important: chronic digestive problems may involve extended periods seated on the toilet, and obesity is one of the risk factors for development of pressure sores, so it is good practice to extend pressure relief measures to this area. A padded seat can help.
Bariatric bathroom support
Many suppliers of grab rails include heavy duty supports in their range, to accommodate the needs of heavier users. Plastic rails, with a tubular aluminium core for added strength, are a good choice in the bathroom, as they don’t require earthing. Rails with five fixing points give more support than those with the more usual three.
When installing a grab rail, it is always important to choose the right kind of fixings for the wall it is being attached to – if it must support the weight of somebody of 20 stone or more, this is clearly paramount. Many internal walls are constructed from plasterboard mounted on a timber frame, known as stud work. You would not be able to get sufficient fixing points in a standard timber frame to support a heavy duty rail, so in this case, it would be safest to fix the rail to a backboard on the other side of the wall.
For users weighing up to 55 stone (350 kg), a carer propelled shower/commode chair manufactured from wider diameter tubing for extra strength, with robust twin castors that make manoeuvring easier, even with a maximum load. Armrests and heavy duty footrests lift up out of the way, to facilitate side transfers.
To accommodate the largest users, a very generously proportioned shower enclosure, or a wet room, are ideal. A heavy duty former or level access tray, with a slip-resistant surface will suit both ambulant users and those in a chair. If you choose a wall-mounted shower chair, remember that the weight it can safely support will depend as much on the quality of the fixings and the wall it is attached to, as the chair itself.
An effective solution for users who have severely limited mobility is a bariatric shower trolley. The unit shown here can safely transport a load of 63 stone (400 kg), and is height adjustable, so that it can be moved to a safe working height for carers. The base is high enough to accommodate a mobile hoist, if the user is transferred from bed to trolley using a sling. Waterproof padded cushions form a comfortable base and sides. For transfers, the sides drop down level with the base. This type of trolley is suitable for wound care, as well as washing.
To help support heavier users to bathe independently, the bariatric bathboard shown here is made from smooth reinforced plastic, with stainless steel fittings. Adjustable brackets with a serrated face and rubber buffers help secure the board in place, while rubber pads under the slats help prevent the bath board slipping on the rim of the bath. It can accommodate users weighing up to 30 stone (190 kg).
Steps of two, four or six inches (50, 100 or 150 mm), which also come with a support rail on one or both sides, also contribute to enabling a bariatric bather to access the bath safely. They are particularly helpful where the user is short in stature, or the edge of the bath is rather high.
For individuals who don’t have enough mobility in their hips and knees to lift their legs into the bath, either a walk-in tub or a bath with a powered lifter can enable them to continue enjoying the pleasure and therapeutic benefits of a soak in hot water. You can see more in our assisted bathing and walk-in bathsections.