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    skin issues and the toilet seat

    Hoping to find some tricks/ideas to keep your skin safe on the toilet when you need a lot of cushion for comfort/pain.

    Has anyone tried the ROHO toilet seat cushion on top of a square shaped elevated toilet seat? Does that work, or is it an unstable mess? Or has anyone had a custom ROHO made for an elevated square toilet seat (or shower chair)?

    My Dad has used the Activaid elevated toilet seat (order #101) over a regular toilet for years. He likes the height, the stability and the thick cushions you could get for it. He has a lot of chronic butt pain and needs the thick seat. For the past couple years, he specifically has used the Comfortuff 3” cushion on this elevated toilet seat frame. It is a large square cushion with a circular hole and front access.

    Unfortunately, he started developing a shear/pressure sore from the Comfortuff cushion earlier this year. It is in a kind of odd place... the top of the left thigh, just at the start of the butt cheek, close to the midline/scrotum area. It never got very serious and looked a bit like road rash. He leans towards that side during clean up, so the left side gets extra pressure.

    So we got one of the ROHO cushions designed for a square commode chair, and put that on top of the Activaid elevated toilet seat. My Dad really liked it, found it very comfortable, and it is easier for him to get on/off the toilet with the extra height.

    But then he started getting a new pressure injury right next to the old one! It turns out the ROHO commode cushion has a large square hole in the middle, but his elevated toilet seat has a smaller traditional circular hole. So his cheeks were easing into the large square hole of the ROHO and then rubbing a little on the Comfortuff cushion below.

    Anyone else using an elevated square toilet seat like my Dad, or a shower chair with a square seat, and using a ROHO on top of it? How did you make it work?

    I just ordered one of the traditional ROHOs for a typical toilet seat, but I anticipate problems with that since it will be smaller than the elevated toilet seat and may be difficult to attach. Custom is the next step, but my Dad is already annoyed that he is wasting his $ on all these cushions he can't use...

    Any ideas?

    Tx

    #2
    I use a Roho on top of a padded bath bench.

    Comment


    • hlh
      hlh commented
      Editing a comment
      Which ROHO? Over what kind of bath bench? Does the bath bench have a cut out?

    #3
    Damn.... I've been moved to supplies and equipment.

    Comment


      #4
      I think part of his problem is that he needs to scoot forward on the cushion for cleaning from behind. When he scoots forward, he is no longer sitting uniformly on the cushion and this may put too much pressure on his front upper legs on the cushion, causing it to collapse more? And he often spends 30-60min on the toilet. lots of the time is in this forward position.

      Does anyone do this, or have problems with sores/irritation in this area? Junction of upper rear thigh/butt cheek, close to top of scrotum.

      Comment


        #5
        I am a long time ROHO fan/user. I was disappointed with the ROHO bath, shower commode cushion. I tried using it on an ActveAid shower commode chair but could never get it to stay on straight. I tried to affix it on in various ways but never had any success. One of the problems may be the extra height it adds and I was doing a pivot transfer to the shower commode chair ( as opposed to say Hoyer lift).

        Below is a link to the cushion I used. I do see some reviews where people are satisfied and use different methods t get it to stay in one position.
        https://www.allegromedical.com/cushi...cB#SEATCMD89LP

        Edited to add, on the Allegro reviews one person gives a long review on how he got the roho to work. One thing he points out that resonates with me is getting the right size. He cautions about getting a size too large and the cells splaying out. I often felt my cushion was too big and what I have as a t2 buddha gut is made up for with a skin and bones butt... just a thought.
        Last edited by ChesBay; 2 Sep 2020, 5:39 PM. Reason: additional content

        Comment


          #6
          The sliding can cause shear and friction also.
          CWO
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

          Comment


            #7
            ChesBay - Thank you so much for this useful information.

            The cushion you linked to is exactly the one my Dad is using now on top of his square Activaid elevated toilet/commode/shower seat (the #101 static chair - not a rolling one). Which Activaid did you use? One you could roll into a roll in shower? One with a cushion with a circular hole and anterior cut out?).

            So did you have to give up on the ROHO right away, or did you use it for a period of time? What did you replace it with?

            My Dad has been using it for a couple of months, and while it initially seemed to help, now it seems to be making his sore worse. I do think it is the shear/friction (thanks nurse!) when he bottoms out. The sore is not at a traditional location of a pressure sore at all.

            Thank you for adding the additional info from the later link. I need to get some hair spray! Fortunately the cushion has worked out stability wise for my Dad, but I would like the base rubber to adhere better to the Activaid below it.

            I agree that the size of the cushion (and the butt!) is a big issue. The ROHO commode cushion square hole is just too big, and my Dad's skin sinks into the hole and then rubs on the Activaid cushion below. This does not happen when he sits squarely on the chair/hole. But when he wants to clean, and he scoots forward (ouch! scoot! probably causing sheer but he tries to lift and sit), then his weight is not evenly distributed on the fingers (he's not sitting on the back of the ROHO), and he probably collapses them more and falls into the ROHO hole and rubs on the Activaid below. When he sits more on the anterior part of the chair to reach around the back with his right hand for clean up, he also leans toward the left (the side of his sore) so he bottoms out more there. Hence, the sore location.

            I tried tying down some of the ROHO fingers near the sore area, thinking the sore was getting worse because of the pressure from the fingers. But that didn't work well.... he bottomed out a little more and rubbed on the area with the tied down/taped down fingers.

            Sorry for the long post. I'm hoping you or someone understands the situation and has some more advice. I wonder with other paras "clean up" like my Dad and develop sores in a similar places from pressure/rubbing. Or if there is a way to trouble shoot.

            Right now he is trying to sit in a way to float the sore area over nothing while on the toilet. Hard to do. We just got the ROHO toilet seat cushion (the round shaped one, in two pieces), and I will try that one soon. But that one looks too small. I wish we had someone who could help us design a custom ROHO... not sure of the best strategy.
            Last edited by hlh; 6 Sep 2020, 1:50 PM.

            Comment


              #8
              ive had the same issue for 3 years i just keep an eye on ot i cant really figure out whats causing it
              to alcohol the cause of-and solution to-all of lifes problems [homer simpson]

              Comment


                #9
                Originally posted by wheelin 48 View Post
                ive had the same issue for 3 years i just keep an eye on ot i cant really figure out whats causing it

                Sorry to hear that. Has it broken through the skin yet? What toilet cushion do you use? Do you put anything on your skin?

                I failed to mention a couple things that my Dad has been trying to protect the skin/sore. When it first started it seemed that a simple barrier cream or one of those Cavilon ?wipes that leave behind a protective layer to prevent breakdown/moisture helped. But a lot has changed since then.

                But since starting with the ROHO, the rubbery ROHO surface sticks to my Dad's skin. So we put down a thin piece of an old cotton T-shirt to cover the critical areas on the ROHO so his sore can't stick to the ROHO. We tried buying a custom ROHO cover for the ROHO, but it is poorly designed and literally has a large seam exactly where my Dad's sore could rub.

                A visiting RN who knows little about pressure sores suggested covering the area with a large traditional dressing, but my Dad's SCI physiatrist who is more knowledgeable said not to use one of those big bulky sticky dressings, which might create more problems. The affected area is where there is are lot of loose skin/folds/near scrotum so a large sticky dressing would create a lot of problems. So the only thing we do is put Silvadene and a moisturizing barrier cream (Proshield Plus) over the sore and a non-stick Tefla on top just before he sits on the toilet to protect it slightly. Then we take it off when he gets off the toilet. It is impossible to keep the sore covered with creams etc... because his underwear just rubs them off. So we reapply often. He is staying off his butt a lot, but the area is actually not a high pressure area when sitting. It is kind of hidden up in the folds.

                Comment


                  #10
                  Originally posted by hlh View Post
                  ChesBay - Thank you so much for this useful information.

                  The cushion you linked to is exactly the one my Dad is using now on top of his square Activaid elevated toilet/commode/shower seat (the #101 static chair - not a rolling one). Which Activaid did you use? One you could roll into a roll in shower? One with a cushion with a circular hole and anterior cut out?).

                  So did you have to give up on the ROHO right away, or did you use it for a period of time? What did you replace it with?

                  My Dad has been using it for a couple of months, and while it initially seemed to help, now it seems to be making his sore worse. I do think it is the shear/friction (thanks nurse!) when he bottoms out. The sore is not at a traditional location of a pressure sore at all.

                  Thank you for adding the additional info from the later link. I need to get some hair spray! Fortunately the cushion has worked out stability wise for my Dad, but I would like the base rubber to adhere better to the Activaid below it .
                  My Activeaid is a shower commode chair that I propel with pneumatic tires hih. I was using the Roho for preventative reasons, so I didn’t have a sore I was trying to heal ,thankfully. Every once in a while I will try to get creative with keeping the Roho in place but for the most part just going without using it.

                  The reviewer on Allegro site had some pretty interesting DIY’s to get his cushion to stay, love the hairspray! Whatever it takes.

                  I am probably going to be in the market for anew shower chair and have been keeping an eye on some CC threads. I will be keeping padding in mind when I make a purchase.

                  Comment


                    #11
                    Appreciate your comments. Yes, you are lucky you don't have a sore now, and are smart to experiment. I just ordered some hairspray!

                    That Allegro site reviewer also mentioned briefly the problem my Dad has..... that the dimensions that are critical are not the overall dimensions of the cushion/seat, but the dimensions of the holes/cutouts when you stack two cushions/seats on top of each other.

                    "The pressure points you'll need to address are around that hole where your butt falls in."

                    The reviewer did well with his combo similar to yours - Activaid shower chair + ROHO commode cushion because they line up pretty well. But they are not perfect and the ROHO hole is too big.. Since the reviewer is 300 lbs, he probably has a bit more butt to keep him riding high. My Dad is over 6 foot, but is more than 100 lbs lighter, so he falls in the hole just a little and that's where his pressure points happen... rubbing on the Activaid cushion below.

                    We just got a regular ROHO toilet seat cushion in the mail, and my Dad will try it today. It doesn't fit well on the Activaid, so there is a large area not protected by fingers and that may rub other areas (probably his thighs). It is so small ...and the fingers that are adjacent to the hole are much shorter. So I worry the same problem will happen.... He will shear slip down into the hole during cleaning when he scoots forward on this low cushion. He'll try it today nonetheless. And I am starting to worry that even a custom ROHO will not work.

                    I'm worried that my Dad's current way of doing bowels may not be sustainable.... scooting forward on the cushion/chair, cleaning by reaching behind and leaning to the left for 30-60 minutes a day.

                    If anyone has any ideas/cushions/practical tips we would appreciate it.

                    Comment


                      #12
                      mine is a lil higher up but isnt opened luckily and ive been sitting more forward on showerchair
                      i just have a mariner shower chair not sure what caused my problem but my doc wasnt to concerned about it so i guess thats a good thing
                      to alcohol the cause of-and solution to-all of lifes problems [homer simpson]

                      Comment


                        #13
                        I have been using for 40 years, the E&J Folding Rehab Shower Commode has earned its reputation as the industry’s premier self-propelled personal hygiene-care wheelchair, and we are pleased to welcome it back to the Everest & Jennings product line.
                        But I am glad to see a resurgence of other options.
                        ActiveAid 1024 Rehab Shower / Commode Chair - Seat Slope Adjustable
                        GO-ANYWHERE COMMODE 'N SHOWER CHAIR - SELF-PROPEL (SP)

                        Comment


                          #14
                          Thanks for sharing what you guys do / use.

                          So my Dad tried the ROHO toilet cushion (rounded, 2 pieces) attached on top to his Activaid elevated toilet seat cushion. It didn't work well..... The fingers are too short and he sorta bottomed out and rubbed on the Activaid cushion below. His sore totally peeled and opened up.

                          So today, out of desperation, my Dad put the ROHO toilet cushion on top of the ROHO commode cushion. While it looked crazy and is not great for long term use, he was able to float his sore successfully over the hole and found it comfortable.

                          But I am looking into a provider to help us with a custom ROHO. You can apparently make them up to 4" height (fingers).

                          Comment


                            #15
                            Sounds like you have a plan -- for other situations, Action Products gel commode covers are worth a look.

                            Comment

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