The bidet may be a fixture in bathrooms the world over, but it has never really caught on in the United States. Instead of washing with water after relieving ourselves, we’d rather deforest millions of acres to produce toilet paper. We think bidets are too European, maybe. Or we suspect that they have something to do with s-e-x.
A recent e-mail from a reader wondering whether bidets make good sense for older people caught my attention, though – primarily because it came from Dr. Mary Tinetti, chief of geriatrics at Yale Medical School. By chance, she’d heard from several colleagues and family members who were praising bidets as a safer and more effective way for the elderly to clean themselves.
“It made me think, ‘Why isn’t this more broadly recognized?’ ” she told me in an interview. “It’s a theoretical benefit.”
Definitions first: She was talking about a bidet toilet, rather than the traditional free-standing bidet. Those take up considerable room in a bathroom, and older users could have trouble positioning themselves thereupon. A bidet toilet has a wand under the seat that moves into position and sprays warmed water over the perineal area; some also come equipped with warm-air dryers. More practically, for those not interested in major plumbing investments, bidet seats can be installed atop existing toilets.
Sales are rising, said Jeff Mayerl, a project manager at Kohler, the largest United States manufacturer of bidets, and the aging population is one reason. Kohler’s bidet seats are pricey: one model tops $1,000, and the other (with a remote!) is close to $2,000, plus installation. But they’re often sold at a discount. Online, I found other brands of bidet seats at a dizzying array of prices, from under $60 to nearly $900.
Why bother? Dr. Tinetti and a colleague, Dr. Manisha Juthani-Mehta, an infectious-disease specialist at Yale, think bidets might solve a couple of problems for older users.
“As people get older and frailer, it’s harder for them to do good personal hygiene, particularly if they have arthritis,” Dr. Tinetti said. “They can’t maneuver around” to wipe or wash themselves effectively. In their attempts, they can even fall from the toilet.
Bathrooms are dangerous places for people with poor mobility and balance — there are all those hard, wet surfaces. If older adults can take fewer showers and baths, using the bidet to wash their lower bodies and a washcloth and soap for their upper bodies, they might reduce the risk of falling, Dr. Tinetti said.
Moreover, in theory, the use of bidets could prevent urinary tract infections, said Dr. Juthani-Mehta. That’s no small thing, particularly for women. Hormonal changes after menopause, plus difficulties with keeping clean (compounded by incontinence), allow bacteria to colonize the vagina and then enter the urethra. Urinary infections are commonplace in nursing homes and a prime reason that older adults get sent to hospitals.
Another problem is that a high proportion of older people typically have bacteria colonizing their urine but suffer no problems or symptoms; it’s normal for them. The medical recommendation for years has been not to treat this condition, called asymptomatic bacteriuria, but doctors routinely ignore those guidelines and prescribe antibiotics anyway.
“Bad things can happen from a course of antibiotics,” said Dr. Juthani-Mehta. They include interactions with other drugs, the emergence of resistant strains of bacteria and vulnerability to the vicious Clostridium difficile bacterium.
Can a bidet prevent all that? Nobody knows, which is why Dr. Tinetti and Dr. Juthani-Mehta kept saying “theoretically.” Maybe Kohler and Yale should join forces on a pilot project.
For now, it’s just an interesting idea. If you or your parent is an experienced bidet user, please weigh in with a comment and enlighten the rest of us.
Among the satisfied customers are Dr. Juthani-Mehta’s parents. Her 71-year-old father is a geriatrician; her grandmother shares the household. They remodeled their bathroom recently and, interested in keeping the house liveable for as long as possible, installed a top-of-the-line Kohler Numi. It includes a hilarious number of features: motion-activated lid, heated seat that raises and lowers, warmed air at the feet, ambient lighting, music via built-in speakers. It also looks as if it could fly to Cincinnati.
“They love this thing,” Dr. Juthani-Mehta said.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”