One of the most frustrating problems presented by ALS is using the toilet. For men, finding
someone strong enough to lift them is a problem. For females, this is a hassle faced several
times a day. The most frequently recommended solution is a lift system such as a Hoyer lift or
ceiling track lift. Either type eliminates the need to lift the patient and that is a big help,
but information on this equipment focuses on lifting and transfer ease. Nobody mentions getting
your pants down! No one tells you that in order to use a sling lift for toileting, you have to
give up wearing slacks and underwear! Well, I refuse to sit around bare-assed under a
drafty skirt or lap blanket waiting for a call of nature! With a bit of experimenting, I've
found a way to dress normally and still use my lift.
The brand of lift you get doesn't make as much difference as the type of sling you use
with it. Despite what lift manufactures want you to believe, most slings will work just fine on
most brands of lifts.
The first thing you need is the right kind of sling, one called a "hygiene" or
"toileting" sling, NOT a "transfer" or "commode" sling.
Commode slings simply have a hole under your bottom. Hygiene/toileting slings are open
underneath your bottom and all the way up to your waist in the back. The key feature I wanted in
a sling was that it be easy to put on and take off while I was in my wheelchair. I did not want
to have to sit on it all day. Besides being a red flag for the fashion police if I wanted to go
out, it could also contribute to pressure sores. These pictures show the difference between a
usable toileting sling which can easily put on and removed while seated in a wheelchair, and a
commode sling which cannot.
Dress for Success
A feature I needed was to be able to get my slacks down and back up without a big hassle.
Some manufacturers of toileting/hygiene slings say your caregiver may be able to get your slacks
down and back up again while you are in the sling but none guarantee it. We found that with some
heavy tugging we could get them down, but getting them back up was a major effort and soon
abandoned. That led me to try adaptive clothing.
At first I tried slacks that have zippers at both sides. When unzipped, the backside of the
slacks drops down like a trap door and can be pulled forward out of the way before you are
lowered down onto the toilet. Lifting the flap back up before sitting requires a couple seconds
of standing with only one armed support. Getting the zippers re-zipped once back in the chair
required dexterity and hand strength and frustrated my helpers. Side zip pants would still be
the best choice if you ever have to stand up in public however.
A much better solution are slacks with an open back. They are far easier to get on in bed or
in a wheelchair. As weird as they sound, they look like ordinary slacks when you are sitting in
them. Of course you can't wear underwear with them. I just put a hand towel on the
wheelchair seat instead. They can be put on while you are lying in bed or sitting in your chair
or on the toilet. Just have your helper put your feet in, pull them up to your thighs, lift your
knees and pull them up and tuck them under, and snap the waist band in back.
When you transfer to the toilet -- by standing or in a sling -- you don't have to do
anything with them. Just transfer to the toilet and go! No removing, pulling, unzipping,
unsnapping, un-velcro-ing needed. There is plenty of open space underneath -- just move the
flaps to the outside of the toilet or bedpan. Back to your chair, remove the sling, do a quick
fanny check of your sides to make certain there isn't a revealing gap, and you are on your
way. A pit stop with the help of a caregiver who is familiar with the process takes less than 10
minutes --even with me on a ventilator now!
How to Use a Toileting Sling
A sling takes practice to get on properly. You really can't slide down through it as you
are lifted, but your position can be adjusted to get you sitting fairly upright. If you think of
it as being like the seat on a kids swing where your weight is on your upper thighs rather than
your butt, the mechanics of positioning it make more sense. My husband was ready to throw the
sling out when it didn't work the first time. I had to insist that we take the time to try
different loops on the straps, cross the leg staps, and get the leg straps further up under my
thighs. Hope you have a little more patience!
Place the sling behind the patients back with the lower edge of the sling at the level of
the waist band. If a wheelchair seat belt is used, unbuckle it.
If you wear side-zip slacks, unzip them.
Bring the leg straps forward and under the leg, lifting each knee to get the straps up high
under the thigh. This is the key to a safe, comfortable transfer! If you slide
butt down to far through the sling, it is probably because the leg straps need to be moved
further up under your thighs.
Fasten sling safety belt. (Actually, we ditched the belt. With the back rest and leg straps
correctly positioned, I don't slide down and can't tip out. I am no daredevil -- I
wouldn't use it that way if I didn't feel safe!)
Bring the lift bar over the patient and lower it. Hook the loops of the straps over the
hooks on the bar. Each strap has a series of three loops. By choosing higher or lower loop you
can adjust whether you sit upright or lean back. I find it more comfortable (and dignified!) to
cross the leg straps in front of me to keep my knees together.
If the patient is to be moved sideways to the toilet, remove the armrest on that side.
Recheck to make sure none of the loops have slipped off the hooks and begin lifting. After
making sure the patient is not slipping down through the sling (indicating that the straps need
to be moved up higher under the thighs), move the patient over the toilet.
If you wear side-zip slacks, grab the back waist band of the slacks and pull it down and
forward while lowering the patient onto the toilet. For women there is no need to pull down the
front of the slacks.
When the patient is finished, recheck to make sure none of the loops have slipped off the
hooks and begin lifting. When the patient is a few inches above the toilet, wiping can be done
Lower the patient back into the wheelchair. If you use side-zip slacks, grab the back waist
band of the slacks and hold it back up in place while lowering the patient back into the
wheelchair. Remove the sling, zip slacks, etc.
Purchasing a Toileting/Hygiene Sling
Although there are several manufacturers of the right type of sling, you may find they will
not sell you the one you want unless you have their same brand of lift. This is no doubt
explained as a liability issue, but the truth is that nearly all slings will fit nearly all
lifts. The most common incompatibility is that the sling has four or six straps and the bar
(sometimes called the carriage) of the lift only has two hooks. As long as the straps of the
sling have loops so you can select the length you need, you should be able to be positioned
upright or at a comfortable angle even with just two hooks.
The easiest way to buy is to select a brand of sling sold by general medical supply web
sites. There you can purchase over the Internet without having to speak to anyone. Just put one
in your shopping cart and pay for it.
If you really want a sling sold only by a lift company, be prepared to lie! Read their web
site and decide which model of their lifts you are going to claim to have. If they ask for the
serial number, try "Oh, I don't have it yet! I just know it will be the model 700M. My
brother-in-law is supposed to be going to get it but I don't how soon that will be."
(Everyone can relate to the undependable brother-in-law story.) If they want to send a sales rep
out to "make certain it is the sling that will best suit your needs”, hang
Finding a Sling
Google "hygiene sling" to get started. Invacare and Hoyer are good brands sold at many
websites. Prices on the same sling vary widely among suppliers. Once you find the brand and
model you like, do a web search for the name and model number for the best price on it.
Links to Clothing
The two main suppliers for open back slacks are Silverts and Buck and
Buck.com/. Fabrics and colors are limited. You will find that adapting your own slacks or
having it done allows you complete control over fabric, color, fit, and style. Jeans, shorts,
men's or women's! My only restiction is to avoid thin fabric that will tear easily. Alteration
instructions here; How to Adapt Your Slacks