People who suffer from incontinence are at risk of skin damage. Skin areas most affected are near the buttocks, hips, genitals, and between the pelvis and rectum (perineum). Excess moisture in these areas causes skin problems such as redness, peeling, irritation, and yeast infections. The most common condition related to incontinence and skin care is moisture-associated skin damage (MASD).
MASD is the general term for inflammation or skin erosion caused by prolonged exposure to a source of moisture such as urine, stool, sweat, wound drainage, saliva, or mucus. When the skin is exposed to excessive amounts of moisture, it will soften, swell, and become wrinkled, making it more susceptible to damage. This can also be worsened by drying soaps and detergents, occlusive dressings, or containment devices.
Incontinence-associated dermatitis (IAD) is predominantly a chemical irritation resulting from urine or stool coming in contact with the skin. Ammonia from urine and enzymes from stool can disrupt the acid mantle of the skin and eventually cause the skin to break down.
Exposure to urine and feces is one of the most common causes of skin breakdown and makes the skin more susceptible to breakdown and infection.
Taking Care of the Skin
Using pads and other absorbent products may worsen the situation. Although they may keep bedding and clothing cleaner, these products allow urine or stool to be in constant contact with the skin. It is recommended to utilize underpads, which absorb urine and trap it away from the skin. Special care must be taken to keep the skin clean and dry.
The three essentials of IAD prevention are to cleanse, moisturize, and protect.
• Cleanse the skin with a mild soap that’s balanced to skin pH and contains gentle surfactants that lift stool and urine from the skin. Clean the skin routinely and at the time of soiling. Use warm water, and avoid excess force and friction to avoid further skin damage.
• Moisturize the skin daily and as needed. Moisturizers may be applied alone or incorporated into a cleanser. Typically, they contain an emollient such as lanolin to replace lost lipids or silicones to provide a thin breathable barrier for the skin, as well as additional moisturization.
• Protect the skin by applying a moisture-barrier cream or spray if the patient has significant urinary or fecal incontinence (or both). The barrier may be zinc-based, petrolatum-based, dimethicone-based, an acrylic polymer, or another type.
In order to maintain skin integrity, control odor and provide comfort, a three-step approach to incontinence care is recommended:
1. Cleanse the perineal area by using gentle, but effective, cleansers to maintain skin integrity, control odor, and provide comfort and improved self-esteem. Appropriate cleansers for perineal skin care are non-irritating and non-drying and contain special ingredients to help gently remove dried fecal matter with minimal scrubbing.
2. Condition and Protect perineal skin from continued exposure to moisture, irritating fluids, friction, dryness, and bacteria with barrier ointments and creams, and barrier sprays. Barrier ointments, creams and sprays are specifically designed to form a protective coating on the skin that minimizes skin contact with urine, feces and perspiration.
3. Keep the Skin Dry by using products that have a soft top sheet next to the skin and an absorbent core which quickly wicks the moisture away and traps it.
Maintaining healthy skin in the face of incontinence is an important aspect to preventing further discomfort, and promoting a healthier, happier life. By taking the proper precautions and treating the conditions assertively, patients and healthcare providers can manage the many skin care side effects associated with incontinence.