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
The first thing you need is the right kind of sling, one called a "split leg", "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
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
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 straps, 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
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
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 easily.
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 up.
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 restriction is to avoid thin fabric that will tear easily.
Alteration instructions here; How to Adapt Your Slacks