Incontinence Associated Dermatitis is a worldwide health challenge for individuals with incontinence. In addition to causing pain and embarrassment, it is a well-recognised risk factor for pressure ulcer development.
The condition is commonly referred to as “perineal dermatitis” or “diaper rash”. Although Incontinence Associated Dermatitis is a life-altering condition encountered in all areas of nursing practice, gaps remain in our understanding of the contributing factors. As the condition can cause your quality of life to reduce rapidly, it is vital to understand the symptoms and how to prevent it.
What Causes Incontinence Associated Dermatitis?
When our skin is exposed to urine or faeces on a regular basis, it can become inflamed. Specialists agree that urinary incontinence on its own does not commonly lead to IAD, however urine combined with faeces significantly increases the risk. The main factors contributing to Incontinence Associated Dermatitis are the skin inflammation, overhydration of the epidermis and an increase in the skin PH. When urine and stool mix, bacteria in stool converts urea in the urine to ammonia. This mix of ammonia and stool can cause a dramatic shift in the PH of the skin and the stool into the alkaline range. This means the skin’s protective mantle is stripped away, reducing its ability to act as a barrier against the proliferation of microorganisms. When your skin is prolonged to exposure to a constantly moist environment, this makes the skin more vulnerable to the harmful effect of pressure.
What are the Symptoms of Incontinence Associated Dermatitis?
Exposure to bacteria in urine or stool can result in painful symptoms, including burning and itching. Moisture lesions are caused when the skin is exposed to excessive moisture for a long period of time. In those with lighter skin, IAD appears initially as erythema which ranges from pink to red shades. In patients with darker skin tones, the skin may become paler, darker, purple, dark red or yellow. The affected area often has poorly defined edges and you should look out for patches over large areas. Incontinence Associated Dermatitis typically effects the labia in women and the scrotum in men, as well as the inner thigh and buttocks in both sexes. When Incontinence Associated Dermatitis is ignored, it can lead to excoriation and skin breakdown, which can quickly become infected. Moisture lesions on the skin can vary in size, colour and shape. Due to the underlying inflammation, areas of IAD on the skin may feel slightly warmer and firmer than the rest of your skin.
Managing and Preventing Incontinence Associated Dermatitis
Bacteria thrive in a warm and moist environment, so it is important to ensure the skin is clean and dry. The longer the skin is exposed to moisture, the more damaging it will be. You should, therefore, let your nurse or carer know if you need assistance with personal care. Good hygiene care and continence management are fundamental duties in preventing the development of Incontinence Associated Dermatitis.
It is important to be diligent in incontinence management. You should ensure you protect your skin, clean it with appropriate products and change protective products frequently. It is vital to see your doctor to discuss management plans for both conditions. A major function of healthy skin is the maintenance of a physical barrier against the environment. This barrier prevents the entry of harmful substances and pathogens, and provides a well-developed immunological defence mechanism. This is achieved by the epidermis, the uppermost layer of the skin. Cleansing the skin of the perineal region should involve a product whose PH allows the maintenance of an acid environment, value between 5.4 and 5.9. Cleansing products specially designed for incontinence skin care are recommended over soap and water methods. Foams and milks can provide an effective alternative to traditional methods. The removal of washbowls and replacement with a pre-packaged solution has been shown to demonstrate a significant reduction in urinary tract infections. Incontinence cleansing moist wipes feature a moisturising composition that deodorises skin and fights bacteria. Bed bath wipes also offer a method for cleansing all parts of the body for individuals with delicate or sensitive skin. Alternatively, dry wipes that have not been pre-moistened provide effective cleaning by wetting with warm water. You can also use dry wipes alongside your choice of cleansing foam. Most skin cleansers in the market are designed to match the PH of the skin, thus not stripping it of sebum. Skin subject to constant humidity requires other care, which consists of applying a moisturizer and a barrier cream. In the presence of faecal matter, it is advisable to wash the region with warm water and dry the skin well before application of a washing product.
Additional Tips on Preventing Incontinence Associated Dermatitis:
- Ensure you cleanse skin immediately after evacuating/urinating
- Mitigate friction damage from towels through taking care to towel dry gently or dry through evaporation
- Avoid excessive irritation of the skin
- Maintaining a healthy weight and good fluid intake helps to maintain good skin integrity. Ensure you have a balanced diet and drink at least 6-8 glasses of water a day.
iD Care is one of the many brands that offer a range of products suitable for cleansing the skin of an incontinent individual. Here are some of the products you can purchase to ensure your skin maintains healthy:
The No Rinse Body Cleansing Foam cleanses the whole body without the need for rinsing with water The product also leaves a pleasant fragrance on the skin.
iD Care Zinc Oxide Ointment Glycerin Oil calms skin irritations caused by incontinence associated dermatitis.
The product effectively protects the skin, forming a physical barrier between the skin and possible contaminants.
This cleansing gel is delicately fragranced and gently cleanses the skin and hair.
The emollient qualities in the product effectively soothe and moisturise the skin, leaving your skin feeling soft and pampered.
You can visit the full iD Skincare and Protection range here.