Underpads: Disposable and Washable Options

What underpads are for

• Protecting the mattress, which is expensive, hard to dry and quickly becomes smelly and mouldy in humid weather.
• Containing leaks that escape a brief or pull-up, especially at night or when the product is full.
• Making changes easier, since a pad can be replaced without changing the whole bed, and used with a roll or slide technique.
• Protecting chairs, wheelchairs and car seats.
• Absorbing moisture during dressing, bed baths and wound care.
• Providing a clean surface for personal care, as in how to change an adult diaper in bed.

Underpads are a backup, not the main protection. If your parent leaks regularly, use an absorbent product on the body and add the pad beneath; see pull-ups or briefs: choosing the right product.

Disposable underpads

What they are. Rectangular pads with a soft top layer, an absorbent core and a waterproof, often plastic, backing. They come in different sizes and absorbencies, and some have adhesive strips to hold them in place.

Advantages - Convenient: no laundry, quick to change. - Hygienic for heavy soiling, infection, diarrhoea or when laundry is limited. - Light and easy to store. - Useful for travel, hospital visits and short-term care. - Many are very absorbent, locking liquid away.

Disadvantages - Recurring cost, which adds up for daily use. - Waste to dispose of; see disposal, laundry and odour control. - Plastic backing can feel hot, noisy and sticky, and trap heat and moisture, particularly in hot weather. - Some can slip, bunch or tear. - Variable quality; thin cheap pads may leak.

Choosing - Size: common sizes cover the mid-bed area, from about 60 by 60 cm to 60 by 90 cm or larger. A bigger pad covers more, helpful for restless sleepers and heavy leakage. - Absorbency: light, medium or heavy; match to the leakage. Check the pack's rating. - Backing: breathable backings reduce heat. - Top sheet softness, for sensitive skin. - Non-slip or adhesive strip to keep it in place. - Quality and authenticity: buy from a reliable source; see spotting fake or poor-quality care products.

Washable (reusable) underpads

What they are. Fabric pads with layers: a soft top, an absorbent middle (often cotton, bamboo, microfibre or similar) and a waterproof backing, designed to be machine-washed and reused. Some have tuck-in wings to hold them in place. See washable underpads: washing, drying and lifespan.

Advantages - Lower cost over time for daily use. - Less waste, and a softer, quieter feel. - Many are more breathable and kinder to sensitive skin. - Often larger and more durable. - Useful for chairs and wheelchairs.

Disadvantages - Need regular washing and drying, which is hard in the monsoon or with limited laundry, space or machines. - Initial cost is higher. - Heavy soiling needs pre-rinsing and careful handling; see disposal, laundry and odour control. - Absorbency drops over time and with misuse. - Heavy when wet, which makes changing harder. - Slower to dry, so you need several.

Choosing - Absorbency and layers: check the stated absorbency and the weight of the core. - Waterproof backing quality: soft, quiet and truly waterproof, not just water-resistant. - Size: large enough for the whole bed area where leakage occurs, with wings that tuck. - Fabric: soft, non-irritating; avoid rough or synthetic tops for fragile skin. - Washing instructions, temperature limits and durability. - Number needed: at least three or four per bed so that one is in use, one in the wash, and spares.

Which to choose: a quick guide

• Occasional or light leakage, short-term illness, travel, outings: disposable.
• Heavy leakage, diarrhoea, infection or when laundry is hard: disposable.
• Long-term daily use, with reliable laundry and sun drying: washable, often as the main bed pad.
• Hot climate and sensitive skin: a breathable washable pad, with a high-quality waterproof mattress cover below; see mattress protectors for incontinence.
• Combination: many families use washable pads in daily routine and keep disposable ones for travel, infections or emergencies.
• Chairs and wheelchairs: small washable seat pads, or disposable pads taped or placed, while taking care for pressure; see pressure care in a wheelchair.

How to place and use

1. Place the pad flat and smooth under the hips and thighs, centred where leaks occur. The top (absorbent) side faces up, the plastic or waterproof side faces down. Check the pack: some have the label or blue side up. 2. Keep it wrinkle-free and tucked in firmly so that it does not bunch. Wrinkles can cause pressure sores; see preventing bedsores at home. 3. Use one pad at a time under the person. Stacking many pads makes the bed uneven and hot. For heavy leakage, use a more absorbent pad, not several. 4. Under the pad, use a mattress protector. Pads can shift, and a protector is the second line of defence. 5. Do not place plastic or rubber sheets directly under the skin; they trap moisture and heat. If a plastic sheet is used, cover it with a cotton sheet and a pad. 6. Combine with an absorbent product on the body. 7. Change promptly when wet or soiled, and at least with each care round. Do not leave a person lying on a damp pad, which damages skin; see incontinence-associated skin damage: prevention and care. 8. Change the pad along with the brief using a roll technique; see how to change an adult diaper in bed. 9. Check the skin for redness or marks from creases or edges. 10. Dispose or launder properly.

Pressure and skin safety

• Pads add a layer between the body and the support surface. On pressure-relieving or air mattresses, thick or non-breathable pads can reduce their effect; ask the nurse which type suits. See air mattress for pressure sores and choosing an anti-bedsore mattress.
• Avoid plastic-backed pads on air mattresses unless the maker allows.
• Keep the skin clean, dry and creased-free.
• Watch for heat and sweat, especially in summer; see summer heat and bedridden care.
• Use breathable linen, such as cotton; see bed linen for sensitive older skin.
• Do not use pads to avoid turning; a bedridden person still needs repositioning; see turning a bedridden patient.

Cost thinking

Costs vary widely. Compare the cost per use: a disposable pad costs per day, and a washable one costs per wash. Include water, detergent, electricity and effort. In many cases, washable pads save money after a few weeks of daily use, but only if they can be dried reliably. Count how many pads you use per day, check for quality and buy a small trial pack before bulk. See an incontinence products budget: what a month costs.

Common mistakes

• Using one thin pad for heavy leakage, and then wondering why the bed is wet.
• Wrinkled or bunched pads.
• Placing the waterproof side up.
• Leaving wet pads on for hours.
• Stacking several pads.
• Using pads instead of a proper brief.
• Washing at too high a temperature or using fabric softener, which reduces absorbency in washable pads.
• Not having enough pads, so that damp ones are reused.
• Flushing disposable pads or putting them loose in the bin.

Hygiene and infection control

Wear gloves when changing, wash hands after, and keep clean pads away from soiled items. For people with infections or diarrhoea, use disposable pads and follow infection control advice; see infection control for home caregivers.

When to ask a professional

Ask a nurse or continence adviser which type and size suit your parent's mattress, skin and leakage. Ask for advice if there is redness, sores, blisters or a rash, or if leaks persist despite protection; see incontinence in older adults: causes and types. Seek urgent help for fever with confusion, blood in urine, no urine for many hours, spreading skin damage or a deep wound; call 112 for emergencies.