Purpose: To explore how people in rural Bangladesh with paraplegia accessed water and sanitation in their home environment. Method: Based on a qualitative design, semi-structured interviews were used to gather direct experiences. Six people with complete paraplegia were recruited and their interview data were subject to thematic analysis. Findings: There were different ways of accessing water and sanitation. Experience varied depending on accessibility within the home environment, design of assistive devices, and individual skills. The dynamics between these factors determined how much time and energy were required. Easier access was associated with higher life satisfaction and a sense of occupational balance. Barriers to access have serious implications for health and wellbeing, but independence can be achieved through environmental adaptation or modification, appropriate design of assistive devices and development of individual skills. Conclusions: Community-based rehabilitation and other campaigns could use these findings to advocate for improved access to water and sanitation for people with paraplegia. At an individual level, occupational therapists can address barriers to access, by enabling people to gain skills, and adapt their environment and routines. Combining individual and community approaches could have many benefits for occupational balance, health and well-being.