How to Care for Elderly with Urinary and Fecal Incontinence? Prevention of Incontinence-Associated Dermatitis and Choosing the Right Diaper

Common types of incontinence in the elderly include urge, stress, overflow, and functional incontinence. Severe constipation can also cause overflow fecal incontinence. Hospital health education recommends following the three principles of cleanliness, ventilation, and isolation to prevent incontinence-associated dermatitis, and choosing appropriate diapers based on the elderly's mobility. The official Long-Term Care 2.0 payment list currently does not include diapers or underpads.

Understanding Urinary and Fecal Incontinence in the Elderly: Common Types and Causes

According to hospital and Ministry of Health and Welfare health education information, common types and causes of incontinence in the elderly are as follows:

Urinary incontinence refers to involuntary leakage of urine that cannot be controlled by consciousness and causes life distress; the most common type in the elderly is 'urge incontinence'—leaking urine before reaching the toilet when feeling the urge
Other common types include stress incontinence (leaking urine during exertion, coughing, or laughing), overflow incontinence (bladder overdistension exceeding urethral resistance), mixed incontinence, and functional incontinence due to non-urinary factors such as urinary tract infection, delirium, medications, depression, constipation, and prolonged bed rest
Fecal incontinence in the elderly is often associated with severe constipation: stool leaks around a fecal impaction, causing 'overflow fecal incontinence,' and treatment should focus on the underlying constipation (dietary adjustments, moderate activity) rather than solely addressing the incontinence itself
The prevalence of urinary incontinence is not low: among women aged 40 and above, nearly 20% have experienced inability to control urination in the past year, but most endure it, with only about 17.7% seeking medical help. In fact, most cases can be improved through evaluation and treatment

Incontinence-Associated Dermatitis (Diaper Rash): Causes and Three Principles of Skin Care

Nursing health education from Taichung Veterans General Hospital explains as follows:

Urine and feces are alkaline; prolonged skin contact with urine or feces disrupts the skin's natural weak acidic protective layer, causing redness and breakdown, commonly known as 'diaper rash' (incontinence-associated dermatitis)
Risk factors include aging skin, prolonged incontinence, moist and hot environment, limited mobility, impaired sensation, and friction from diaper or underpad materials
Care follows three principles: cleanliness (change promptly after urination, gently wipe with mild products instead of scrubbing), ventilation (check skin and diaper condition every 2 hours, avoid using hair dryers or electric heaters to dry the skin), and isolation (use barrier creams or ointments to protect the skin)
Cleansing products should be mild, free of alcohol, fragrances, and alkaline ingredients, ideally pH 5.5 no-rinse cleansers, to avoid further damaging the skin's natural acidic protective layer

How to Choose Diapers/Underpads: Select the Right Type Based on the Elderly's Mobility

Selection principles from the Geriatric Health Knowledge Network of National Taipei University of Nursing and Health Sciences:

For elderly who can still walk independently, pull-up (rehabilitation) pants are suitable for easy self-donning and doffing; pay attention to breathability, quick absorption, and capacity
For bedridden elderly, tape-type diapers are suitable; besides breathability and absorption, 'low rewet' is especially important—products with low rewet reduce the risk of moisture reabsorption and skin irritation, helping prevent incontinence-associated dermatitis
Proper fit is crucial: too loose can cause leakage, too tight may cause friction or affect blood circulation; choose based on the elderly's actual waist circumference and mobility
The selection principle is to comprehensively consider absorbency, breathability, and fit, rather than just price

Does Long-Term Care 2.0 Subsidize Diapers or Underpads? The Truth About Assistive Device Coverage

Verification of official announcements from the Ministry of Health and Welfare is as follows:

Upon checking the 'Long-Term Care Payment Standards/E-code Assistive Device Services' list announced by the Ministry of Health and Welfare's Long-Term Care Service Hotline (1966), as well as the complete official payment standards document (full-text search for keywords such as 'diaper,' 'adult diaper,' 'underpad,' 'incontinence'), none include incontinence consumables such as diapers or underpads
The assistive device subsidy scope mainly covers items such as wheelchairs, walkers, electric scooters, transfer aids, care beds, air mattresses, and stair climbers; not all long-term care needs are subsidized
Although the 'Assistive Device Resource Portal' of the Ministry of Health and Welfare's Social and Family Affairs Administration lists adult diaper product information for public inquiry and comparison, the page itself states that the website is 'not a basis for subsidies or qualification certification' and cannot be used as a basis for applying for subsidies
To confirm if there are other channels (such as disability assistive device expense subsidies) that can cover incontinence consumables, it is recommended to directly call the 1966 Long-Term Care Service Hotline or consult the local care management center, based on the latest on-site announcements, to avoid misinformation about subsidy amounts circulating publicly

Key Points for Home Care of Catheters/Urinary Sheaths and When to Seek Medical Attention

Home care points from nursing health education at Taichung Veterans General Hospital:

For those with indwelling catheters, the urine bag should be kept below the bladder and not touch the ground; empty when urine reaches 1/2 to 2/3 full; avoid twisting, pulling, or pressure on the catheter; silicone catheters are generally replaced monthly or earlier as needed
For men using external urinary sheaths, care focuses on maintaining cleanliness to prevent urine from directly irritating the skin and causing inflammation; the sheath should be secured with moderate tightness (too tight may cause skin ulceration or swelling); replace when urine reaches about 60% full
Symptoms such as fever, chills, lower back or lower abdominal pain, cloudy urine, hematuria, or a sudden decrease in urine output in those using a catheter should prompt immediate medical attention, as they may indicate a urinary tract infection
Even painless hematuria should not be ignored: among elderly with recurrent hematuria, about 10-20% are associated with urinary system tumors, and further evaluation is recommended rather than self-observation

FAQ

What are the common types of urinary incontinence in the elderly?

Common types include urge incontinence (leaking urine before reaching the toilet, the most common cause in the elderly), stress incontinence (leaking urine when coughing, laughing, or exerting), overflow incontinence (bladder overdistension exceeding urethral resistance), mixed incontinence, and functional incontinence due to non-urinary factors such as urinary tract infection, delirium, medications, depression, constipation, and prolonged bed rest. (Sources: National Taiwan University Hospital, Ministry of Health and Welfare Xinying Hospital)

Is fecal incontinence in the elderly always due to bowel degeneration?

Not necessarily. Nursing health education from Taichung Veterans General Hospital indicates that severe constipation can cause 'overflow fecal incontinence'—where stool leaks around a fecal impaction. In such cases, treatment should focus on the underlying constipation (e.g., dietary adjustments, moderate activity) rather than solely addressing the incontinence itself.

How to prevent diaper rash (incontinence-associated dermatitis)?

Nursing health education from Taichung Veterans General Hospital recommends following the three principles of 'cleanliness, ventilation, and isolation': change promptly after urination, gently wipe with mild products instead of scrubbing, check skin and diaper condition every 2 hours, choose highly absorbent products, and use barrier creams or ointments to protect the skin. Avoid using hair dryers or electric heaters to dry the skin.

What key points should be considered when choosing diapers for the elderly?

According to the Geriatric Health Knowledge Network of National Taipei University of Nursing and Health Sciences, choose the type based on the elderly's mobility: those who can still walk are suitable for pull-up (rehabilitation) pants, focusing on breathability, quick absorption, and capacity; bedridden individuals are suitable for tape-type diapers, where besides breathability and absorption, 'low rewet' is especially important to reduce moisture reabsorption and skin irritation. Size should be snug; too loose can cause leakage.

Does Long-Term Care 2.0 subsidize diapers or underpads?

Upon checking the 'Long-Term Care Payment Standards/E-code Assistive Device Services' list announced by the Ministry of Health and Welfare's Long-Term Care Service Hotline 1966, as well as the complete official payment standards document, neither includes incontinence consumables such as diapers or underpads. The subsidy scope mainly covers assistive devices like wheelchairs, walkers, electric scooters, transfer aids, care beds, and air mattresses. To confirm if there are other subsidy channels, it is recommended to directly call the 1966 Long-Term Care Service Hotline for the latest regulations, avoiding misinformation about subsidy amounts circulating publicly.

What symptoms in the elderly require immediate medical attention?

Health education materials from Taichung Veterans General Hospital and the Ministry of Health and Welfare Xinying Hospital indicate that symptoms such as fever, chills, lower back or lower abdominal pain, cloudy urine, hematuria, or a sudden decrease in urine output in those using a catheter should prompt immediate medical attention. Even painless hematuria should be evaluated, as recurrent hematuria is associated with urinary system tumors in about 10-20% of cases.

Updated: 2026-07-17 · This page is a neutral compilation of information for reference only, not medical, legal, tax, or admission advice. For actual regulations and services, please refer to official announcements from competent authorities and the institutions themselves.