Incontinence Management in Long-Term Care: Choosing the Right Underpad

July 28, 2026

Incontinence Management in Long-Term Care: Choosing the Righ

Incontinence Management in Long-Term Care: Choosing the Right Underpad

Incontinence affects the majority of long-term care (LTC) residents in Canada. According to the Canadian Institute for Health Information (CIHI), over 70% of LTC residents require some form of incontinence care. For procurement managers and clinical directors, selecting the right underpad is not merely a supply chain decision — it is a clinical care decision that directly impacts resident skin health, dignity, and quality of life.

The Role of Underpads in Comprehensive Incontinence Management

Underpads serve as the second line of defence in incontinence management, working in tandem with incontinence briefs or adult diapers. While the primary absorbent product (brief or pad) captures and contains the initial void, underpads provide an additional barrier that protects the bed or chair from leakage. For residents who are immobile or who experience heavy incontinence episodes, this two-layer approach is essential for maintaining skin integrity and preventing pressure injuries.

A well-designed incontinence management program addresses four key objectives:

Skin protection — Keeping moisture away from skin to prevent incontinence-associated dermatitis (IAD) and pressure injuries
Odour control — Minimizing odour through absorbent technology and timely changing protocols
Dignity and comfort — Using products that are discreet, comfortable, and easy for staff to change
Cost efficiency — Balancing product performance with budget constraints

Disposable underpads with superabsorbent polymer (SAP) technology address all four objectives by locking fluid into a gel matrix, keeping the resident's skin dry even under sustained pressure from body weight.

Key Factors When Choosing Underpads for LTC

Size and Coverage
The 60x90cm (approximately 24x36 inches) format is the standard for LTC beds in Canada. This size provides adequate coverage for standard hospital beds without excessive overhang. For bariatric residents or larger bed frames, 90x180cm may be more appropriate. Ensure that the underpad covers the area from the resident's mid-back to mid-thigh when properly positioned — this is the zone most at risk for incontinence-related soiling.

Absorbency Capacity
Not all underpads are created equal. Basic underpads may absorb 300–500 mL of fluid, while SAP-enhanced underpads can absorb 800–1,200 mL or more. For overnight care (8–12 hours without changing), choose underpads with a minimum absorbency capacity of 800 mL. For daytime use with scheduled toileting and changing, 500 mL may be sufficient.

Rewet Performance
Rewet refers to the amount of fluid that returns to the surface under pressure. This is critical for immobile residents who cannot shift their weight. SAP-enhanced disposable absorbent pads typically achieve rewet values of less than 1 gram under standard test conditions (ASTM D5726), compared to 5–10 grams for basic fluff-pulp-only pads.

Skin pH Management
Urine and feces create an alkaline environment that damages skin barrier function. Some advanced underpads incorporate pH-modifying technologies that help maintain a skin-friendly acidic pH (4.5–5.5) within the pad, reducing the risk of IAD. When evaluating products, ask suppliers about pH management features.

Incontinence Management in Long-Term Care: Choosing the Righ

Clinical recommended Practices for Underpad Use

Recent Canadian evidence-based guidelines for incontinence management recommend:

Check and change schedules: Establish individualized toileting and pad-changing schedules. The goal is to change underpads before they reach saturation — not after leakage occurs.
Perineal care at each change: Each underpad change is an opportunity for cleansing, moisturizing, and skin assessment. SAP-enhanced pads support this by keeping the resident drier between changes, making perineal care less distressing for both resident and caregiver.
Use with pressure injury prevention protocols: Residents with incontinence have 3–5 times higher risk of developing pressure injuries. SAP underpads keep moisture away from skin, which is a critical component of pressure injury prevention in accordance with the NPUAP/EPUAP guidelines adopted by Canadian LTC.
Document product use and outcomes: Track pad consumption, skin integrity scores, and incontinence episodes monthly. This data helps procurement teams validate product performance and adjust specifications as needed.

Product Selection by Care Level

Heavy/Total Incontinence (overnight, immobile residents): Choose 60x90cm with SAP, minimum 800 mL capacity, low rewet. These residents need maximum protection and skin dryness. The CliniEco urology care kit with heavy-absorbency underpads is designed specifically for this population.

Moderate Incontinence (ambulatory, daytime): Choose 60x90cm standard absorbency or 45x60cm if smaller coverage is acceptable. These residents may be using toileting assistance programs and need less intensive protection.

Occasional Incontinence (continent with rare accidents): Choose lightweight underpads or reusable bed pads as appropriate. The focus is on protection during therapy sessions, meals, or other activities where timely toileting may not be possible.

Evaluating New Products: A Practical Protocol

Before committing to a large-volume contract, run a structured product trial:

Select 10–15 residents representing different incontinence care levels.
Use the trial product for 14 days with standardized documentation.
Track: pad consumption per resident per day, skin integrity scores (using the IADIT or similar tool), staff satisfaction (ease of use, changing time), and any leakage incidents.
Compare against your current product using the same metrics.
Make a data-driven decision based on actual facility-level outcomes.

Conclusion

The right underpad is a cornerstone of effective incontinence management in Canadian LTC homes. By matching product specifications to resident care needs — prioritizing SAP-enhanced 60x90cm options for heavy-care residents — facilities can improve skin health outcomes, reduce staff workload, and optimize their procurement budget. For facilities looking to streamline their supply chain, consolidating underpad orders with other facility essentials such as nitrile exam gloves can further reduce administrative costs and simplify inventory management.