Of all the surgeries I see as an OT, hip replacements are some of the most painful recoveries. It’s painful to get out of bed, walk, and it’s painful using the toilet.
Most toilets and bedside commodes are not built for people experiencing pain when sitting. Sitting too low can make getting up difficult and may cause dislocation to the surgical hip.
So what’s the best way to avoid pain and dislocation after a hip replacement?
When toileting after a hip replacement, it’s best to use a seat that is soft with a toilet that’s slightly elevated.
In this article, I’ll explain what kind of seat you will need and other modifications/accessories to make toileting easier.
The best bedside commode after a hip replacement
The image below is my pick and one of the most recommended bedside commodes you can buy.
How to make toileting less painful
Here are a few tips to make toileting less painful.
Use a bedside commode
While walking to the toilet is the best exercise, it’s not always possible. In the meantime, use a bedside commode.
Bedside commodes can sometimes be more beneficial than a regular toilet seat. They can be raised or lowered, they have handles, and they can be adjusted to make toileting easier.
Not all bedside commodes are equal. Most bedside commodes have a hard seat, are narrow, and don’t adjust. That’s why I would avoid a standard bedside commode after surgery.
The best bedside commodes have a padded seat and can be repositioned to make toilet hygiene easier. For example, if wiping from the back is too hard, you can reposition the seat to reach from the front or the side.
Watch this video on how to reposition your bedside commode to make toileting easier.
This custom seat can even provide less pressure to the surgical hip. After a bedside commode is no longer needed, it can be used on top of the toilet.
Using the bedside commode on top of the toilet will increase your toilet height, add rails, provide cushion, and provide the positioning that will make toileting easier.
Padded toilet seat
Instead of using a standard toilet seat, replace it with a soft seat. The extra padding won’t alleviate all the pain, but it will make toileting more tolerable.
Wider is sometimes better
After a hip replacement, there will be increased swelling at the surgical site. That’s why you may want to avoid buying a bedside commode that is too narrow.
Most bedside commodes have a small seat and can make wiping more challenging. This can be fixed with an adjustable seat or a wider commode.
How to transfer onto a toilet without pain
Getting on and off the toilet can be painful after a hip replacement and can also cause dislocation.
The solution? Don’t sit on a toilet that is too low.
Here are my top 3 suggestions to avoid pain or possible dislocation.
Correct positioning
It’s important to make sure you are seated with your feet on the floor with your knees bent slightly greater than 90 degrees.
Try to keep your feet on the floor, and if that’s not possible, elevate your legs with a stool. If your feet are not resting on a flat surface, you can pass out. The pressure on your legs when they are hanging off a chair can cause loss of circulation and cause a sudden drop in blood pressure. (Vasovagal)
Apply this method to other low seats in your home or car and try to avoid getting up from a low seated position until your hip is healed.
Consider a Sara STEDY
If transferring to a toilet is not safe or the patient is not able to walk or pivot, consider using a Sara Stedy. It can make all the differences for patients who need that extra assistance.
How long do you use a raised toilet seat after a hip replacement
A raised toilet seat should usually be used until the hip is healed or 6-8 weeks.
If it’s still too difficult to get up from a raised toilet seat, gradually lower the seat or work with an physical or Occupational therapist to improve your strength.
If your hip replacement is an anterior approach, you only need to use a raised toilet seat to reduce pain or until you feel safe transferring to a standard seat height.
Maintaining hip precautions
If you had a hip replacement your doctor or therapist will talk with you about hip precautions to avoid dislocation.
Recently hip precautions have undergone changes. To learn more, read my other article here.
Listed below are the two most common surgical approaches for a total hip replacement.
Posterior approach
- No bending more than 90 degrees
- No internally/externally rotating
- Avoid stepping back
- Do not cross your legs
Anterior approach
- avoid extreme positions (internal rotation)
If you had a posterior approach hip replacement, try to avoid bending and internally rotating your hip. This motion is how most people stand from a low seated position.
You might also avoid shaving your legs or crossing your legs to put socks or shoes on.
Instead use a reacher, sock aide, and long handled shoe horn.
Here are a few accessories to use to avoid hip pain and dislocation.
Conclusion
I hope these tips were helpful. Remember, it’s important to be out of bed as often as possible, but avoid those low seated positions.
Use adaptive equipment such as reachers and sock aides, until your hip is healed, and avoid hard surfaces.
If you’re not sure about your hip precautions or weight bearing restrictions, always check with your doctor first.
David is the lead editor of OT Focus. He has been practicing as an Occupational Therapist since 2013. He specializes in acute care, hand therapy, and ergonomics.
