Kate asks….a simple question about toilets

Hi Kate, I have been working on this subject recently as part of my r and d into improving assistive devices in personal hygiene for the elderly. Every millimetre lower the toilet is, more easily facilitates evacuation of the bowels. Toilet seat risers should be illegal. Within days of being made to use one of these a close relation of mine was soiling her bed at night because her bowels don't empty properly when perched instead of squatting.

Perhaps we should discuss this in a wider fashion than throwing out generalisations like "risers should be illegal"! The human body is designed so that bowel evacuation is facilitated when the pelvis is lowered and gravity can assist, i.e. when the hip joints are lower than the knee joints. This is well demonstrated in other cultures when you meet loos that are holes in the floor with footprints, and in many countries where people (including the elderly) squat to void with no problems. However if you flex the knees more than 60 degrees then you lose most of the power for your quadriceps to extend from that position, so if you are in our "sitting" society and therefore weak in that area you have difficulty getting up. Knee extensor muscles can be strengthened up until the 8th decade, but bowel control is not so reversible.
Unfortunately many people recommending raises don't realise that by raising the seat they may be creating bowel problems, so the raises always need to be removable and Andy needs to explain politely why the raise is not helping his relation (with his evidence base to hand).

Philippa's invitation to discuss this in a wider fashion is most welcome. The cheap plastic toilet riser cost the local care services about a fiver. After 3 weeks of dealing with the stress and strain of her soiling her bed, her elderly husband could no longer cope and she went into care at a cost of around £650 per week. I set about creating a device that would enable her to come home, it is nearly ready to undergo clinical trials, but it is not yet available. It is a well known powered riser adapted to interface with an electronic bidet toilet seat and can even incorporate the odour free cassette waste storage system developped for use in luxury caravans, motorhomes and yachts worldwide. Yes, it will cost a fortune, but nowhere near the £30,000 per year that a care home costs. (And you'll be able to rent them for around £120 per month for as long as needed.)
It will sit you down and lift you up again gently and it will wash and dry you after going to the toilet all at the touch of a button. With that help, her husband believes he can cope.
How's that for starting a wider discussion?

Andy - I agree that that bowel function can be compromised when raising the toilet height but not in all cases and maybe the 'professionals' should have looked at what was causing the bowel problems with the lady in your case study rather than resorting to nursing care.

Culturally we are a nation that sit to evacuate our bowels and most of us do this without any problems, however we have increasing problems with clients who can not raise from the toilet due to weakness in their quadriceps, by having slightly higher toilets to start with would this eliminate the need for raisers without complex and expensive equipment to assist?

2 things occur to me:
1. Fit a suitable grab rail, if possible, so that both arms and legs can be used to stand up.
2. If a raised seat is necessary fit two boxes (children's toilet stands?) at 10 o'clock and 2 o'clock by the toilet pedestal. Then the knee height relative to the hips can be restored by lifting each foot onto its box. Boxes fixed to something like a pedestal mat to stop them moving. Afterwards return feet to the floor to aid standing.