Bathroom Safety for Parkinson's Disease

How Parkinson's affects bathroom use

Every person is different, and symptoms change over time, but common problems include:

• Slowness of movement (bradykinesia), making dressing, undressing and washing take longer and feel exhausting.
• Stiffness and rigidity, especially in the trunk, which makes turning and getting up harder.
• Tremor, which affects holding a cup, a flannel or a razor, and fastening buttons.
• Shuffling and small steps, with a tendency to trip on thresholds and mats.
• Freezing of gait, where the feet suddenly stick to the floor, typically at doorways, in narrow spaces, when turning or when hurrying to the toilet. See Parkinson's freezing and falls.
• Postural instability, with poor balance responses, so a small stumble becomes a fall.
• Low blood pressure on standing (orthostatic hypotension), which can cause dizziness or fainting, especially after a warm shower or at night. See dizziness and low blood pressure when standing.
• "On" and "off" periods, related to medicine timing, when movement is good or poor.
• Urgency and frequency of urination, and constipation, which strain toileting.
• Soft voice, making it hard to call for help.
• Fatigue, low mood and anxiety, which affect motivation and safety.
• Thinking and memory changes in some people, particularly later.
• Reduced sense of smell and sweating changes, and in hot bathrooms overheating.

Plan the bathroom around a person's worst times, not their best, and review as the condition changes. Also see Parkinson's disease home care guide and caring for a parent with Parkinson's.

Timing: bathe when medicines work best

Many people with Parkinson's move best about an hour after a dose of levodopa, and worst when it is wearing off. Plan bathing in an "on" period, and avoid it before a dose is due, when stiff and slow. Do not change medicine times without the doctor's advice. Keep a diary of when your parent moves best, and share it with the neurologist or Parkinson's nurse. Avoid bathing right after a heavy protein meal if it affects medicine absorption, according to the doctor's advice.

The route and the doorway

Doorways are classic places for freezing.

• Widen or clear the route. Remove clutter, mats and furniture. A path at least 90 cm wide is helpful.
• Door width. Standard narrow Indian bathroom doors can trigger freezing. Widen if possible, or use a sliding door. See bathroom layout for wheelchair and walker users.
• Threshold. A raised sill is a trip hazard for shuffling feet. Lower it or add a gentle ramp; see portable ramps for thresholds.
• Floor cues. A coloured line or tape across the threshold, or a series of lines on the floor leading to the toilet, can act as a visual cue to step over. Many people with Parkinson's find that stepping over a line helps overcome freezing. A therapist can advise on placement. Keep patterns simple so they do not cause confusion.
• Auditory cues. A rhythmic beat or counting out loud "one, two, three" or a metronome app can help restart walking.
• Light. Good, even lighting and a night light reduce risk. Strong shadows or patterns on the floor can cause freezing, so choose plain floors.
• Open door and visible toilet. A clear view of the destination can help.

Toilet transfers

Standing up from a low toilet can be a struggle for stiff muscles.

• Raised seat. A raised toilet seat reduces the height to rise.
• Frame or bars. A toilet frame or wall bars on both sides give push-up support. See where to fit grab bars.
• Space. Leave room to turn before sitting. Do not place a toilet in a very tight corner if you can avoid it.
• Rock to stand. A therapist may teach a "rocking" technique: lean forward, count down, then push up.
• Slow turning. Teach a person to turn by stepping around in small steps rather than pivoting on one foot, which can trigger a fall.
• Clothing. Elastic waists, loose pyjama bottoms and Velcro make undressing quick when urgency strikes.
• Plan for urgency. A commode near the bed for night, a urinal for men and a short route to the toilet reduce rushing. See night-time toilet trips and falls.
• Constipation. Common in Parkinson's. A doctor can advise on fluids, fibre and medicines. See constipation in older adults.

Showering and bathing

• Sit to bathe. A shower chair with a backrest and arms is usually recommended, to avoid standing on a wet floor. Choose a model with a firm back, and set the height so that standing is easy.
• Grab bars. Vertical bars at the entrance and horizontal bars along the wall; see grab bar buying guide.
• Handheld shower. It lets a seated person wash without turning; see handheld shower guide. Controls should be easy to reach and use with a tremor, such as large levers.
• Non-slip floor. See non-slip bath mats and anti-slip tape and coatings. Avoid thick mats that catch shuffling feet.
• Wash aids. A soap-on-a-rope or a pump dispenser, a wash mitt with a loop, a long-handled sponge and a non-slip flannel make washing easier with tremor.
• Towels. A large, soft, towelling robe is easier than a towel to wrap; put it on while seated.
• Dry and dress seated. Dressing aids, such as a button hook or elastic laces, help; see dressing aid guide.
• Short and warm. Fatigue and dizziness are more likely in a long, hot shower. Keep the room well ventilated and the water warm, not hot; see hot water and scald safety.
• After the shower, sit for a few minutes before standing up, to avoid a blood pressure drop.

Shaving, grooming and tooth care

• Electric razor reduces cuts with tremor. Wet shaving with a safety razor may be risky.
• Electric toothbrush with a thick handle helps.
• A seat at the basin, so grooming is done sitting; see bathroom layout for wheelchair and walker users for basin heights.
• Mirror, with a light and a tilt, so a person can see without leaning.
• Weighted or thick-handled utensils. A therapist may suggest adaptations. See eating with tremor or weak grip.
• Soap and cleaning products within reach and not on the floor.

Managing low blood pressure and dizziness

Standing from a warm bath or after toileting can cause faintness. Practical steps:

• Sit for a minute before standing and stand slowly, pausing at the edge of the seat.
• Tighten calf muscles or flex the ankles before standing.
• Avoid very hot water, long baths and heavy meals before bathing.
• Drink fluids as your doctor suggests.
• Have a firm support to hold on standing.
• Report dizziness or fainting to the doctor, who may adjust medicines.

Night safety and help

• Light the path and keep the route clear. Many falls occur at night.
• Bedside commode or urinal for urgency.
• A bell, a baby monitor or a pendant within reach, though a soft voice may not be heard. A call button or alarm that does not need speech is better; see calling for help from the bathroom.
• Bed height and rails to ease getting up; see bed height and getting out of bed.
• Make sure someone can enter if the door is locked.

Staying active, and what a carer can do

Exercise helps maintain strength, flexibility and balance in Parkinson's, and reduces falls. See exercise for Parkinson's and walking aids for Parkinson's. A carer should allow time, avoid rushing and not take over tasks the person can do. Offer help when it is needed and wanted. Use cues, such as "big steps" and counting, which the physiotherapist may teach. Keep your own back safe; see how to lift and transfer safely.

When to ask a professional

People with Parkinson's benefit from a team. A Parkinson's nurse specialist or neurologist can review medicines, blood pressure and bladder symptoms. A physiotherapist can teach strategies for freezing, turning and getting up. An occupational therapist can assess the bathroom and recommend equipment. A speech and language therapist can help with a soft voice and swallowing. See the doctor promptly for repeated falls, sudden changes in movement, fainting, hallucinations or new confusion.