Commode Chairs: Bedside Toileting With Dignity

What a commode chair is

A commode chair looks like a chair with a hole in the seat. Under the hole is a removable pot or bucket, usually plastic, with a lid. Most have a padded or moulded seat with a lift-up lid, a backrest and arms. A user sits as on a toilet, passes urine or stool into the pot and then wipes and stands. A carer removes, empties and cleans the pot afterwards.

A commode is not the same as a toilet frame, which is a frame placed over a toilet; see the toilet frame guide. It is also not a urinal or a bed pan, which are used lying or sitting in bed; see the urinal guide and the bed pan guide. Commodes can also be used over a toilet, as a raised seat with arms, when the pot is removed.

Who benefits

Consider a commode for a parent who:

• cannot walk to the toilet quickly or safely, such as after a hip fracture or surgery;
• has urgency or frequency of urination, particularly at night;
• tires easily, is breathless or dizzy on standing;
• has Parkinson's disease, stroke weakness or poor balance;
• lives in a home where the toilet is on another floor or far from the bedroom;
• has dementia and gets lost or confused on the way to the toilet;
• is recovering and has temporary limits, such as post-operative restrictions.

A commode is not a long-term solution for everyone. It may reduce the walking that keeps a person mobile, and it can feel like a loss of independence. Your parent's physiotherapist can say whether to use it only at night, or for a short period.

Types of commode chair

Fixed-frame commode. A basic, rigid chair with a seat, back and arms. Sturdy and cheaper, but does not fold, so it needs permanent space.

Folding commode. The frame folds flat for storage or travel. Handy in small rooms and for families who keep it only for use at night. Check that the folding mechanism locks firmly.

Drop-arm commode. One or both arms swing down, so a person can slide across from a bed or wheelchair, or a carer can approach from the side. Useful for those who transfer sideways.

Height-adjustable commode. Legs adjust so the seat matches your parent's height, or so the commode can be used as a raised toilet seat over a toilet.

Wheeled commode (shower commode). A chair on four castors, with brakes, that can be pushed over a toilet or into a shower. It is for people who need help to move and need a combined toilet and shower chair; read shower seat, bath bench or commode. Check that all brakes lock, since a rolling commode is dangerous when moving.

Commode with padded seat and backrest. For people who spend longer sitting, or who are thin and need comfort. Check the cushions are easy to wipe.

Heavy-duty commode. A wider and stronger model for larger bodies. Many standard commodes carry about 100 to 136 kg, and heavy-duty ones more.

Disguised commode. Some look like a wooden chair or a stool, with the bucket hidden. They fit a living room or bedroom better but may be less supportive.

What to check when buying

1. Weight limit. Choose a commode rated above your parent's weight, with margin. 2. Seat height. The seat should be at a height where your parent's feet are flat and knees at about a right angle. Typical heights range from 45 to 55 cm with the pot in place. 3. Seat width and shape. Wide enough for comfort, with a firm rim and a well-shaped opening. A small opening is a hygiene problem. 4. Arms. Check that they are the right height to push on, firmly fixed and comfortable to grip. 5. Stability. Rock it from side to side. It should not tilt when a person sits down quickly. 6. Feet. Rubber ferrules that grip the floor; check them for wear. 7. Pot or bucket. It should slide in and out easily, have a handle and lid, and be large enough for night-time use. Some have splash guards. 8. Lid. A heavy lid that slams is a danger to fingers. A lid that lowers gently or stays up is better. 9. Material. Powder-coated steel is sturdy but can rust where scratched, aluminium resists rust and is lighter, and plastic is easy to clean. In humid cities, rust resistance matters. 10. Wipe-clean surfaces. No fabric parts that soak up urine. 11. Space. Check the floor area it needs, including room for a carer and a walker.

Placing the commode

Near the bed. For night use, place it beside the bed on the side your parent gets out of, at a short distance so they can reach it with one or two steps. Do not put it where a person must pass across the bed end. Fix the lighting, using a motion-sensor night light. See bedroom setup for night safety.

On a firm, level floor, not on a carpet or a rug that might slip. Check it does not slide on polished marble; add rubber feet or a non-slip base if needed.

Brakes on (if wheeled) every time.

Privacy. Use a screen, curtain or a folding partition so that the person feels private, and a cover over the commode that looks like a chair cover. In a joint family home, agree where it can go and how people will leave the room. See setting up a care room in a joint family home.

Keep it within reach of a call button or a bell, so a person who cannot stand can ask for help.

Using it in an Indian home

Some Indian-specific questions:

• Squat toilets. If the only toilet is a floor pan, a commode with the bucket removed may be placed over the pan as a raised seat with arms, if the legs sit securely on both sides. Check the stability, as the legs may land on a sloped or wet floor. See adapting an Indian bathroom for knees and hips.
• Water for cleaning. Many people prefer to wash with water rather than paper. Place a jug or a bidet spray within reach, and a towel for drying. Use a waterproof pad beneath the commode if water may spill.
• Disposal. The pot is emptied into the toilet and washed. Never empty it into a drain that is not connected to the sewer. See disposal, laundry and odour control.
• Hot and humid conditions. Odour builds quickly. Keep a lid on, empty promptly and ventilate. Hot weather makes sitting on plastic uncomfortable and sweaty, so use a thin washable seat cover.
• Cultural and religious comfort. Some families have concerns about using a toilet inside a bedroom. Discuss placement, a separate room or a screen, and the use of a commode only at night.

Getting on and off safely

1. Check the commode is stable, with brakes on if wheeled. 2. Stand at the commode, turn and back up until the legs touch the seat. 3. Reach for the arms with both hands and lower slowly. 4. Clothing. Slacks or a lungi that open easily are best. Elastic waists help. Undo clothing before sitting, or stand just before sitting. A carer can help if needed. 5. Wipe or wash, then stand up with a pause and a steady hold on the arms. 6. Wait before walking, especially at night, to let any dizziness pass.

For a person who cannot stand, a carer may need to use a transfer belt or a sliding board. See how to lift and transfer safely to protect your own back.

Dignity and routine

Be matter-of-fact. Never make a parent feel they are a burden. Offer privacy by leaving the room if they can sit alone, but stay close enough to hear a call. Keep a regular toileting schedule, for example after meals and before bed, which can reduce accidents; see bladder training and timed toileting. And keep the commode clean and fresh so it does not become a source of shame. The guide on commode chair hygiene covers cleaning in detail, and bedside commode and urinal routines help plan a routine.

When to ask a professional

An occupational therapist or physiotherapist can assess how your parent moves and which commode suits them. They can also teach safe transfers. A nurse can advise on skin care, bowel routine and infection control. Tell a doctor if your parent has a sudden change in urination or bowel habits, pain on passing urine, blood in the stool or urine, repeated falls on the way to the toilet or new confusion.