How to Change an Adult Diaper in Bed

Before you start: principles

• Dignity first. Close the door and curtains, cover the person with a sheet or towel, expose only what is necessary, and speak respectfully. See dignity in intimate care: words, privacy and consent.
• Explain every step before and during, even if the person has dementia or seems unresponsive. Use their preferred name and simple words.
• Let them help as much as they can, such as holding the bed rail or bending a knee.
• Work calmly and without disgust, since people notice your face and tone.
• Hygiene: wash hands, use disposable gloves, and change gloves if they become heavily soiled. See infection control for home caregivers.
• Look after your back: raise the bed to hip height if it adjusts, lower the side rail on your side only while you are at the bed, keep your feet apart and your back straight, and bend at the knees. Never leave a person unattended on a high bed with rails down.

Supplies to have ready

Gather everything within reach before you start:

• A clean brief of the right size, with the tabs ready; see how to measure for adult diapers and pull-ups.
• Disposable gloves and a small bag for rubbish.
• Wipes that are alcohol-free and fragrance-free, or warm water in a bowl with a soft cloth and a clean towel; see wipes and perineal hygiene done gently.
• A disposable or washable underpad under the person; see underpads: disposable and washable options.
• Barrier cream, if advised by the nurse; see barrier creams and skin care under pads.
• A clean sheet, spare nightwear and a towel.
• A sealable bag or a bin with a lid for used products.
• A pillow or wedge to support the position; see positioning a bedridden parent.
• Good light.

Step by step: the roll technique

1. Wash hands, put on gloves, and prepare the bed. Raise the bed to a comfortable height, lock the wheels or brakes, and lower the head of the bed to flat, or as flat as the person's condition allows, unless the doctor has advised otherwise. Place a clean underpad nearby.

2. Tell the person what you are about to do, and position them on their back with their knees bent, if they can manage.

3. Open the used diaper. Undo the tabs on both sides, folding them back so they do not stick to the skin. Lower the front panel down between the legs, letting it rest.

4. Clean the front. Using wipes or warm water and a soft cloth, clean from front to back. For women, wipe from the pubic area towards the anus, with a fresh wipe each time, never back to front; for men, clean the penis and scrotum, including skin folds, then towards the back, and gently retract the foreskin if present and replace it afterwards, if the person is uncircumcised. Use gentle patting, not rubbing. See wipes and perineal hygiene done gently.

5. Roll the person to one side. Ask them to turn towards you, or gently roll them away from you, holding their shoulder and hip, bending the top knee. Ask them to hold the bed rail if possible. Ensure they cannot fall. If they are heavy or cannot help, have a second person, or use a sliding sheet.

6. Clean the back. With the person on their side, remove stool and wipe the back and buttocks from front to back, with fresh wipes until clean. Dry thoroughly by patting with a towel. Look at the skin of the buttocks, base of the spine, hips and thighs for redness, blisters or sores; see preventing bedsores at home.

7. Remove the soiled diaper. Fold the used diaper inwards with the soiled side in, tuck the front half under, and place the rolled edge under the person's back. Roll it into a bundle and either remove it now or leave it tucked while you place the clean one.

8. Put on the clean brief. - Fold the clean brief lengthwise and place the back panel flat against the person's back, centred, with the top edge at the level of the waist, so the back covers the lower spine. - Tuck the rest of the clean brief under the buttocks and bundle the soiled one behind, as in making a bed.

9. Roll the person back onto the clean brief, towards you, to lie on their back; carefully remove the soiled diaper and the bundled clean parts, pulling the clean one flat. Place the soiled diaper in a bag or bin at once.

10. Fasten the clean brief. - Bring the front panel up between the legs and centre it over the abdomen. - Fasten the lower tabs first, angled slightly upward, then the upper tabs angled downward, so that the waist is snug but allows two fingers. - Pull out the leg gathers so that they sit on the outside and form a seal. - Smooth wrinkles.

11. Apply barrier cream to clean, dry skin before the new product, in a thin layer, if the nurse has advised; see barrier creams and skin care under pads. Do not apply thick layers or powders.

12. Tidy the bed. Check the underpad, and replace it if damp. Straighten and smooth the sheet to remove wrinkles, which cause pressure sores. Reposition the person comfortably, with pillows. See turning a bedridden patient.

13. Dispose and clean up. Seal and bin the used products; see disposal, laundry and odour control. Remove gloves and wash hands. Clean the equipment, and open a window to freshen the room.

14. Thank and reassure the person, ask if they are comfortable and cover them. Note the time, skin condition and anything unusual in a care diary; see care diary and handover notes.

Working alone and with a helper

• Alone, you can do the technique by rolling the person to each side once. Practise to be fast but gentle. Use the bed rail on the far side to prevent falls.
• With two people, one rolls and supports while the other cleans and places. This is kinder for heavy or painful patients.
• Use slide sheets or a draw sheet to reduce friction and avoid dragging the skin. Never pull a person by the arms.
• For people with hip fractures, spinal problems, recent surgery, severe pain or contractures, follow the surgeon's or physiotherapist's instructions on how to turn; keep the hips and spine aligned; do not twist. Ask for demonstration.

Skin and checks at each change

• Look at the skin of the groin, buttocks, hips, tailbone, heels and thighs. Redness that does not fade when pressed, blisters, open areas, dark or purple patches, and pain are warning signs. See pressure ulcers: stages, wound care and prevention and incontinence-associated skin damage: prevention and care.
• Check for fungal rash: bright red patches with small satellite spots, especially in skin folds. Tell the doctor.
• Change promptly after stool and when wet, and at regular intervals.
• Keep the skin dry, especially in humid weather, and between folds.
• Avoid hot water, which damages sensitive skin; see hot water and scald safety for older skin.
• Notice urine colour and smell, and how much, since changes can signal infection or dehydration; see urinary tract infections in older adults: atypical signs.
• Notice stool changes: diarrhoea, black or bloody stool, or hard small pellets; see bowel incontinence and constipation in later life.

Special situations

• Heavy soiling: use extra wipes, wet cloths and plenty of patience; consider two people.
• Restless or resistive person (dementia): explain simply, distract with music or conversation, work at their best time of day, and do not force. See incontinence and dementia: routines and reassurance and bathing a parent who resists.
• Catheter in place: take care not to pull the tube, keep the bag below the bladder level and follow the nurse's advice; see catheter care basics for families.
• Pain on moving: pre-medicate only as the doctor advises, move slowly, and support limbs.
• Hot weather: change more often, use breathable products, and keep the skin dry; see summer heat and bedridden care.
• Oxygen in use: keep tubing from tangling, and follow fire safety rules.
• Night changes: use low lighting, a warm touch and minimal disruption; see managing incontinence at night.

Common mistakes

• Wiping from back to front.
• Rubbing hard instead of patting.
• Leaving a damp or soiled diaper "to save time".
• Wrong size or twisted placement, causing leaks; see how to measure for adult diapers and pull-ups.
• Wrinkled sheets, causing pressure marks.
• Using plastic sheets directly under skin.
• Applying thick creams or powder.
• Dragging the person across the sheet.

When to ask a professional

Ask a nurse to demonstrate the technique, check skin, advise on products and positioning, and teach safe lifting. Ask a physiotherapist about turning with a hip or spinal problem. Call the doctor for broken or red skin that does not fade, blisters, sores, a spreading rash, foul-smelling urine, blood in urine or stool, or new diarrhoea. Seek urgent help for fever with confusion, no urine passed for many hours, severe pain or swelling, or a wound that is deep, black or oozing. Call 112 for emergencies.