Going to the Bathroom with Arthritis

Arthritis can make most daily activities more challenging but while many can be avoided or easily modified, others require more work and planning to deal with — like using the bathroom, which is something you have to do multiple times a day.

It’s not something people are always eager to talk about or acknowledge, but it’s important for those living with arthritis and chronic pain to know that many out there are struggling with issues related to using the bathroom. We hope this article will help provide some support and solutions.

Using the bathroom requires fine motor dexterity that many people with arthritis may lack due to stiff and swollen joints, especially in the fingers and wrists. Arthritis may also cause pain and loss of motion in areas such as the lower back, hips, and knees, which can make it harder to use the toilet, says occupational therapist Brittany Ferri, OTR/L, CCTP, founder of Simplicity of Health.

“All of our body parts need to work together to help keep us stable and provide us with the necessary range of movements that we need not just to get on and off the toilet but also to navigate the bathroom environment,” she explains.

Thankfully there are a lot of practical things you can do to help yourself use the bathroom more comfortably, more safely, and with greater peace of mind. We asked people with arthritis to tell us the biggest issues they face in the bathroom and then had experts help solve these problems.

Issue: How can I make using the toilet more comfortable?

Lowering yourself down onto the toilet, sitting for long periods of time, and standing back up after finishing your business can all be more difficult for someone with arthritis, says Lisa Nichole Folden, DPT, a physical therapist and founder of Healthy PhiT.

Use an adjustable-height commode

You can get a type of adjustable toilet that can either be used alone or fitted over your existing toilet. These allow you to customize the height to make it more comfortable, Dr. Folden says. “By raising the height of the toilet, your knees have a little less pressure on them so getting down to and up from the toilet will be easier,” she explains, adding that this is a far more affordable option than getting a custom toilet.

Engage your core

Having to sit down and get up from the toilet is often challenging for her arthritis patients, Ferri says. One simple trick she recommends to make the process easier is to engage your core muscles. “Activate your abdominals before standing up, as this will offload some of the weight from your legs and arms,” she explains, adding that it will help improve your balance and stability as well. Not sure what exactly that feels like? Your PT or OT will be more than happy to show you how to do it, she says.

Install a heated toilet seat

Sometimes it’s the little things that make the biggest difference. A heated toilet seat may sound like a luxury only for millionaires but for people with arthritis, it can make a big difference in reducing discomfort while sitting. “My dad installed a padded, heated toilet seat for me one day, after I complained about how much my back and hips hurt and I can’t even tell you how much more bearable it makes using the bathroom,” says Alex T., 25, who has ankylosing spondylitis and osteoarthritis of the spine.

Turn your toilet into a bidet

A warm spray of water can be an easier and more comfortable way to clean yourself after using the toilet, making a bidet — a plumbing fixture that uses water to wash your genitals — a genius solution for people with arthritis. Bidets are more common in other countries than in the U.S., so you may already have access to one but if you don’t you can purchase one and have it fitted to your existing toilet. “I was kind of grossed out at first when my doctor suggested using one but once I got used to it, it was amazing,” says Cleo M., 57, who has osteoarthritis. “I’m so spoiled now that I get upset when I have to use a regular toilet! It really saves my hands.”

Keep a button hook handy

Pulling pants down and up is half the battle and one way to make it simpler and less painful is to keep a button hook tool in every bathroom in your home and in your purse or bag for when you go out, Ferri says. If you get a multi-purpose dressing tool, it can help you do buttons, zippers, and hooks with ease.

Use a portable heater

People with arthritis are often more sensitive to cold than other folks and being cold can make your joints feel more stiff — definitely not a good situation in the bathroom. If you live in a cold climate, consider putting a portable heater in the area where your toilet is. “Having a heater in the toilet closet helps me relax,” Cleo says.

Issue: Toilet paper… help?

File toilet paper under the category of “things you never thought much about until you got arthritis.” But if you’re struggling to grip or pull the paper, change the roll, or use TP properly, know that you are not alone, Ferri says, adding that it’s a common complaint she hears from her patients.

Splurge on thicker toilet paper

Not all toilet paper is created equally and now is not the time to skimp with thin, cheap rolls, Ferri says. She suggests looking for the thickest toilet paper you can find, preferably with ridges, as this is easier to grab and hold. Plus you’ll need less of it so you won’t have to deal with wadding it up and risking getting your hands dirty.

Carry disposable wipes

Flushable toilet wipes are a good option for people who have a difficult time managing a roll of toilet paper or who are worried about not being able to access toilet paper in public bathrooms, Ferri says. Keep a package near the toilet and tucked in your bag so you never have to worry about doing the toilet shuffle with your pants around your ankles.

Use a gripper

If your hands and fingers are too limited to pinch toilet paper consider using a tool instead, Ferri says. Grabber tools come in multiple lengths and some are even collapsible, making them easy and convenient to store or keep in your purse. You can hold the handle with your whole hand making it less stressful — on your joints and your pride — to grab the thin paper.

Issue: What if I can’t make it in time?

People with arthritis are at a higher risk for incontinence, thanks to a combination of mobility problems and direct effects of the disease, according to the Continence Foundation of Australia. It can be hard to unzip or unbutton in time. And what’s more, gastroinestinal issues, including irritable bowel syndrome (IBS) and inflammatory bowel diseases (Crohn’s disease and ulcerative colitis) tend to be more common in people with inflammatory arthritis or related conditions like fibromyalgia. These can make you need to go to the bathroom suddenly.

Use protection

Wearing incontinence underwear — either the disposable kind or the reusable fabric variety — can go a long way in giving peace of mind when it comes to bladder control. They come in many shapes, styles, and materials to fit every need. The real hurdle to these isn’t necessarily comfort but pride, says Amina F., 30, who has rheumatoid arthritis. “I recently had two hip replacements and going to the bathroom was hard on a good day. I couldn’t run to the toilet even if I wanted to, so wearing incontinence undies helps a lot,” she says. “At first I was really embarrassed that I needed them but they’re very discreet and no one notices them. The only issue is if I need to change it in a public restroom because you have to get almost totally undressed and then you have to carry it out to a garbage can. On those days I wear incontinence pads instead.”

Think through your clothing choices

“Pants buttons are often difficult for people with arthritis when they have poor finger motion or strength,” Ferri says. She recommends wearing elastic-waist pants or pants with snaps instead of traditional buttons as they are easier to get on and off, especially if you’re in a rush. And for those who prefer pants with traditional buttons? “Try looping an elastic around the button, through the button hole, and back around the button to help pants stay on,” she says.

Treat constipation

Constipation is a surprisingly common source of bathroom urgency and incontinence as the bowel puts pressure on the bladder, according to the CFA. Arthritis can lead to constipation through the disease itself (being less physically active due to pain and fatigue can increase constipation) or as a side effect of some medications. Treating your constipation through medication or dietary changes can help ease bathroom woes.

Practice targeted exercises

Pelvic floor exercises, including Kegels, can help tighten up the muscles that help you be able to hold in urine longer and buy you more time to get to the bathroom, Ferri says. There are several different types of these exercises so ask your physical therapist which ones will be the most beneficial to you. “I do Kegels at red traffic lights until they turn green; it’s easy to remember and I do think it helps,” Amina says.

Issue: How can I make my bathroom safer?

Safety should be a top concern for people with arthritis, Ferri says. Bathrooms can have slippery tile floors, rugs that slide, puddles of water, things to step over, and other hazards.

Schedule regular bathroom breaks

Using the bathroom can sometimes feel like an emergency but waiting to the last minute and rushing can lead to injuries. It’s worth taking your time, Ferri says. This means not only moving slowly to get to the bathroom but also budgeting time in your schedule for bathroom breaks. Head to the restroom before you feel an extreme urgency and take regular breaks, she says.

Sit down the right way

Once you’re in the bathroom, it’s even more important to take your time and use good form, Ferri says. “Move slowly to stand in front of the toilet, turn around, and carefully sit,” she explains. It may sound obvious but you’d be surprised at how many people just drop onto the toilet which can be painful and cause injury, she adds.

Install grab bars

Make your bathroom as arthritis-friendly as possible by installing grab bars on the walls near the toilet or using portable grab bars that get stored next to the toilet, Ferri says. Having something to hold on to will help stabilize your body and take some stress off painful or stiff joints, she explains.

Plug in a motion-activated night light

You may have your bathroom routine down in the daytime but add darkness and a good dose of sleepiness and your risk for falls and injuries goes way up, Ferri says. A quick and easy solution is to get a plug-in motion-activated night light. This saves you from fumbling for the light switch in the dark and from the glaring brightness of an overhead light.

Issue: How do I get over my fear of public restrooms?

“My biggest issue with going out is my fear of having to use a public restroom and getting stuck in an embarrassing situation,” says Philip P., 70, who has osteoarthritis in his back and knees and gout. “I’m slow, unstable, I need a walker, and my hands shake so sometimes it’s a big mess. I’d rather just stay home than have to ask someone for help in the toilet.”

Look for a family bathroom

Many public places have single-room unisex or family bathrooms, which are generally much larger and offer more privacy than regular bathrooms. Discovering family bathrooms and changing rooms has been Philip’s saving grace. “I’ll even call ahead to see if the store or restaurant has one,” he says. “It’s worth it.”

Use the accessible stall

The next best thing to a family bathroom is using the larger stalls marked for people with disabilities, Ferri says. These stalls are larger, giving you more room to maneuver a cane or walker, and have grab bars to help you sit and stand.

Don’t be afraid to put your hands on the toilet seat

Okay, it’s gross and most of us prefer to not touch toilet seats but when it comes to standing and sitting safely in public stalls where there are no grab bars it’s better than trying to go hands-free and risking a bad fall, Ferri says. “Use your hands to feel for objects behind you to help orient you and stabilize your descent,” she says. And when you’re done just make sure to wash your hands thoroughly with soap (lots of soap!) and water.

Remember that everyone’s more worried about their own bodies than yours

Being in public can feel like you’re on a stage, especially if something is going wrong, but the truth is that people are more worried about what they’re doing than what’s going on in your stall, Dr. Folden says. Try to relax, take your time, and take comfort that other people probably aren’t paying any attention to you at all.

Issue: How do I deal with my period during an arthritis flare-up?

Peeling the sticky backing off maxi pads, pushing a tampon applicator, removing a tampon, washing delicate areas — as if feminine hygiene isn’t tricky enough, arthritis can add a whole new level of difficulty to being a menstruating woman.

Be prepared

“Preparation is everything when it comes to bathroom care,” Ferri says. She recommends keeping all the supplies you need in a basket or drawer close enough to reach from the toilet so you don’t have to scramble to get what you need.

Consider different birth control

Having fewer, or even no, periods can be a good option for managing your menstrual care while having a chronic illness, says Sherry Ross, MD, ob-gyn and author of She-Ology. “IUDs [intrauterine devices] are a great contraceptive for women in many different situations because once they’re inserted they don’t require any ongoing care for the life of the device,” she explains. They’re particularly great for women with arthritis because the kind that provide a low dose of hormones, like Mirena and Skyla, can significantly lighten your period or even eliminate it, she says. Or you can take continuous birth control pills to reduce or stop your period, she adds. Talk to your doctor about what options would be best for, you given your medical history, symptoms, and treatment plan.

Try a flex cup

Menstrual cups are reusable, cost effective, environmentally friendly, provide excellent protection — and can feel impossible to use if you have pain or limited motion in your hands and fingers, Dr. Ross says. The problem is that the cups work by creating suction inside the vagina and to remove them you need to break that seal, something that can be difficult even for people without arthritis, she says. Thankfully there are options. “The Flex cup is my holy grail for my period,” says Angelique M., 32, who has rheumatoid arthritis. “It has a little ring at the bottom that you can hook your finger through and pull instead of a ‘stem’ or ‘string’ like other cups, which makes it so much easier to use.”

Try period underwear

Knixwear, Thinx, and other companies now make underwear specifically designed to be worn as protection during your period and these can be a great option for women who have a hard time dealing with traditional feminine care products, Dr. Ross says. “These panties eliminate the need for standard menstrual products by absorbing blood into a special waterproof lining built into the underwear,” she says.

Use maxi pads without wings

Pads are preferable over tampons for many women with arthritis as they require less dexterity to use, Ferri says. Just make sure you choose the right kind. “I prefer to use the biggest maxi pads without wings because they are easier to grip and remove,” says Stephanie S., 40, who has rheumatoid arthritis. Not only is the backing easier to peel off but putting them in and taking them out is a lot easier when you don’t have to worry about thin, sticky “wings” getting in your way, she explains.

Use flushable wipes

Cleaning up your lady parts during your period can take extra work so make it easier on yourself by using flushable wet wipes, Ferri says. These can be easier to grab out of the package than toilet paper and they’ll get you cleaner, faster.

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Keep Reading

Interview with Brittany Ferri, OTR/L, CCTP, occupational therapist and founder of Simplicity of Health

Interview with  Lisa Nichole Folden, DPT, a physical therapist and founder of Healthy PhiT

Interview with Sherry Ross, MD, ob-gyn and author of She-Ology

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