Train travel and toilets

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This week we heard about Anne Wafula Strike in the news – not being able to access the toilet on a long train journey.

The fear of not finding a usable toilet (and risk urinating in your underwear or damaging your bladder and kidneys) is very real. It leaves disabled people choosing the more dignified option – to not make any long journeys by train or car. This leads to major life restrictions around work, health care, leisure and socialising or seeing family.

Until 6 years ago, I had never been on a train. I then had to get into London for specialist hospital services so we started using trains. With my husband, we carefully choose our stations – they have to be 

  1. staffed – to set up ramps to get on and off . (Not all stations have staff present.)
  2. Step free access to the platform. (Some stations have no access to platforms or only access to some platforms in one direction).

It is here we bring into the equation – where will I be able to use the loo along the way.

Where are the usable toilets?

Our main route has been from Tonbridge to London Bridge and Maidstone to Victoria. From the moment I last use the loo at home, the clock starts ticking. I won’t drink anything that day to reduce the need for the loo.

Around an hour has passed and I’m at the station. The toilet door opens straight onto the platform – so my husband who lifts me out of my chair to/from the loo will have to slink out whilst I use it (without exposing me to people on the platform). He will then have to loiter and listen out for me to call him back in. He will get some funny looks – but that’s ‘normal’ for us. It’s not a private affair. 

There is no hoist – so he will have to lift/drag me to the seat. On the plus side it’s clean and has all 3 of the standard set of support rails to cling on to. 

I can’t travel by train to London with my personal assistants as they can only use a hoist to lift me and there are no rail stations with hoist equipped toilets on my route or at my destination. 

On the train

On the train, I need to get assistance into the accessible carriage. This is where the accessible toilet is located. However, on the way home we are sometimes just put in the doorway area because not all trains have accessible carriages or are too full at rush hour. They have no access to the toilets. Staff just want to get people on trains or are they see the accessible coach is a long way away – so they try to board you into the nearest coach with no wheelchair space. 


I can’t use the toilets on trains because my small powerchair won’t fit and there is no space for my husband to lift me. They don’t have hoists. You can see here that if my chair was next to the loo – my husband would not fit in at all. Alas I haven’t mastered levitation.

I often see they are out of order. If I needed the loo I’d have to get staff to cancel the ramp at my destination- and make new arrangements for me to get off at another station –  and back on another train after using the loo. As I’ve just said, stations might be no go areas because they are not step free or staffed.

If it is possible to get off at another station, what if the toilet on that station isn’t usable? Not every toilet has the ‘standard’ space, suppport rails etc. Take this one for example.


We were a few hours on a train for a day out at Ely. My husband had worked out we could use the toilet at the station. He’d even seen a picture on the station’s website. However, we headed straight for the loo only to find the support rail was not standard / too far away from the toilet to hold on to. I would have fallen on the floor. I had heart failure because we were in a new place with no idea where to find a toilet. 


On our way back from Ely to Kings Cross the same problem but thankfully on the left hand side (I need a right hand side rail as it’s the only way I can lean). For someone else this won’t be usable. This toilet is also higher than the recommended standard for safe and manageable transfers from a wheelchair. 

Trains and stations – will they ever be accessible?

I haven’t heard that newly refurbished stations like London Bridge or Cross Rail will have made any improvements to accessing toilets at stations across London. No toilets with larger spaces or hoists being put in. No refurbishing or auditing of current toilets to ensure all access features are present and correctly positioned or offer better privacy.  

I’ve been part of consultations on toilet provision on new trains. The designs did not involve larger spaces or better layouts for wheelchair users. 

There is never a guarantee the toilet will be in working order – but if all stations had improved, usable wheelchair accessible toilets on all platforms, we could at least get off the train at the next staffed station and be confident that I could pee into the loo and not into my knickers. 

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All about support / grab rails

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Taken from our guide (see links page) we look at the importance of support rails in accessible toilets. AD M is approved document M of the U.K. Building Regulations.

It is possible to have many layouts to allow for the provided dimensions and fixture configurations in AD M.
 

The general layout of a unisex accessible toilet is to have horizontal grab rails to both the left and right side of the toilet [AD M: S 5.8].

Heights, lengths and distance from the toilet / sink / mirror etc must be precise as described in AD M.
Vertical rails must also be provided in specific places.

How many rails do people need?

74% of disabled/older people use handrails. They can be used to pull/push up with or simply to lean on for stability.

41% of powered wheelchair users prefer the right side, 30% the left and the rest had no preference in a 2005 study.

Some people need a rail both sides and on the back wall.  The rails needs to be the right height, length, distance from the toilet/sink, thickness and colour.

An accessible toilet must  have at least 5 support rails with additional ones if the toilet is located some distance from the wall. 


Barriers introduced

As can be seen above, support rails can infringe on the transfer space and cause problems for some wheelchair users.

Solutions

  1. Assess your toilet – do they have the full complement of support rails and are they in the right place and the right length / height? 
  2. Mix it up – the standard suggests that if you provide more than one unisex toilet, a choice of layouts for left and right hand transfer should be provided. 
  3. The smaller the space, the more grab rails will get in the way for powered wheelchair users and carers – re-consider your design space. 
  4. Provide Changing Places toilets in addition to existing accessible toilets. The larger spaces to the left and right of a central toilet offer more transfer option angles for people who use powered wheelchairs, large walkers/ frames, or need carers to assist them.

Choosing an over toilet chair / commode

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For the last few months I’ve been searching for a solution to sitting on the toilet whilst on holiday. In my particular case, my hips splay outwards and I have to sit on a very specifically shaped toilet seat. If I don’t, I have so much pain that I can’t go or balance. There are many different shapes of toilet seat – hole aperture differs in shape and size, the bevel of the seat can be highly ridged, a gentle curve or totally flat. I have low muscle tone, hip contractures, poor balance and my hips dislocate. My husband also has to manually lift me to transfer.  All in all, I struggle when sitting on most toilets.

So, the solution was to take a portable over the toilet chair that meets specific criteria:

  • low enough to transfer
  • adjustable to cope with different heights of toilet
  • a contoured seat (wide round aperture with no cut away – i.e. not horseshoe shaped)
  • arms that moved completely out the way to transfer and were height adjustable
  • removable foot rests / foot plates with no brackets sticking out to trip over.
  • portable to take on holiday
  • stable (I lean a lot to one side because of scoliosis)

So… how hard could this be out of the thousands of models available to purchase.

It turns out, it was impossible. I bought the closest thing I could find and my husband modified it (I found a suitable seat in Homebase and my husband did some engineering to attach it to the frame).

This blog shows some of the huge variations in shower/over toilet chairs that are available and some of their pros and cons. I hope you find it useful – please ask if you have any questions.

To view a range of models and descriptions – see my pinterest board for a range of examples of toilet chairs, seats and hygiene products.

Types of over the toilet chairs for adults.

Basic_Commode_ChairThis is a basic design. A flat seat, round aperture and rigid frame.

Footplates are often fixed or just have flip up feet parts – so tripping or catching them when transferring can be a problem. Some have fixed arms that are not removable and are a fixed height – so they might not go over the toilet at all. This one does not fold away – few come apart for transporting on holiday or folding when not in use.

Hospitals tend to have basic ones like this. I find them unbearably painful! They range from around £50-100

 

Assistant_Propelled_Freeway_T40

This is an example of the Freeway range of chairs. You can see that this chair has a padded seat. Many of these types have a choice of seat type.

A Horseshoe seat has a gap in the front or rear of the seat (and sometimes the side).

An aperture seat is a ‘donut’ with varying length and width of the hole (some are keyhole shaped, others are round or more oblong). The type of hole can make a huge difference to comfort – as can the depth of padding.

Most seats are flat – so if you need one that is sloping forward that might be hard to find. Some specialist seats offer backward tilt or ’tilt in space’ function – more about that later.

These types vary in how adjustable they are – simple things like how angled the footplates are can also make a difference to stability if moving in the chair. You can see the angle on this chair has the footplates a lot more out in front – which makes the chair longer to manoeuvre into bathrooms and over the toilet.

When you look underneath the chair, you can see it is totally free to go over the toilet – no bars or snagging parts. Note how the back is straight up, vertically aligned to the back castors – meaning you can get right back over the pan and won’t be peeing on the floor!

chilterninvadexThe chair on the left is from Chiltern Invadex. You can see the horseshoe type seat. Note how small the armrests are.

This is a common problem if you really need to lean on them (or rest arms on them). They are often hard plastic, uncomfortable and so small your arm falls over the side, which can mean you could fall sideways to some extent.

Consider how much you need to grab onto the arms and whether you need one that is padded or has a good width.

Arms also reach forward and are longer in some models more than others. This might be important in being able to stand, adjust your sitting position, grip etc. These are £4-600 and can have headrests, belts and other accessories.

 

 

Freeway_shower_chair

This is an example of a chair that has a high support back/head rest and also tilts backwards. Some have manual tilt and others are powered. You can expect to pay £1000-3000 pounds for these.

One thing with these is that you may need to use them with a commode pan because when tilted, they don’t usually fit over the toilet.

 

 

 

EtacThis is an Etac chair. The design is uncluttered and the footrest slides back under the seat. You can see the depth of padding and contoured seat.

A feature of this one is the gap at the back of the horseshoe seat – ideal if you have coccyx pain or pressure sores, or need someone to reach under to wipe.

Different chairs come with different backs. Some are flat canvas, others are hard plastic. This is a bit different in that it’s curved. However, if you have a spinal deformity this might be a problem and cause you to become sore or not Etac chair retails for around £560

 

Self_Propelled_Freeway_T50

 

Chairs can be pushed by an assistant (four small wheels or castors, each with brakes), self propelled (large wheels in the front or rear), or static. This is the Freeway T50 which retails for around £460

 

 

 

 

A note on height adjustment

If you want a chair to role over the toilet, for travelling, it is worth noting the following:

  • toilet pans in the UK vary in height. The lowest (floor to seat) are usually 39-46 cm and the high ones are 48-52cm

High_toilet

Toilet chairs vary in how much clearance they need to go over the toilet.

This can add another 4-6cm to the height, plus the height of any padded seat on your toilet chair. You could end up with a height that is impossible to transfer to or reach, unless you use a hoist.

  • toilet chairs may come in a range of fixed heights – so you could go on holiday and find the height you have chosen does not go over the pan.
  • the chair I chose, came with adjustable heights to alter without tools.
  • If the chair raises up – do the footplates also raise up (many do not so you may not reach them if you have short legs).
  • If you go with a set height the gap between the seat and pan might cause splash out.
  • Check if the model will go over any bidet/hygiene toilet – not all do.
  • The seat height might be adjustable – but are the armrests fixed?
  • The wider the arms are, if you have them at a certain height they could hit the fixed grab rails on toilet walls.

 

What did I choose?

I went for this one – the Invacare Ocean. I went for the wider spaced arms XL version. You can see how we modified it as I couldn’t use the seat it came with.

Invacare_Ocean

No modifications – the Invacare Ocean

I don’t need the heigh adjustable foot plates so we took them off. This was the bathroom in our room at the Future Inn in Plymouth. It’s a robust chair which does come apart for storage/travelling and we bought the carry bag accessory. However, we are not convinced it will fit in the bag as the back is wider than the XL version in the brochure. We took it already assembled (it arrives flat packed). The arms are very narrow and hard but it has a few levels of easy seat height adjustment and a small amount of arm height adjustment – this was about the middle setting. The toilet pan is fixed flush with the wall and the chair goes over it well.  It fits well in-between the wall grab rail and can still be used with the commode pan and slide rack it came with. It feels robust and managed the journey pushing it from the carpark to our room. Doubles up as a luggage cart (but slightly unsteady over some bumpy ground). I didn’t use it over the toilet this time as the height of the pan was a little high for transferring but I did use it for showering. It’s not light, so you would need the wheely bag (or a case) to transport it in if you can’t take it pre-assembled. We fit it behind me in our sit in the front wheelchair accessible car without a problem.

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