Skin Care and Incontinence Management

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.

Your NDIS Planning for Continence Management

You do not require a Continence Assessment if you are happy with your current products and management. If your goals have changed to your continence management this should be included in your plan and is best done in consultation with a Continence Specialist.

You need to specifically mention continence in your planning meeting or it will not be included.

Ask your NDIS planner or Local Area Co-ordinator to allow for a continence assessment and/or follow up review (approximately 4 hours therapy per annum) to be approved for you in your NDIS plan under the category Individual Assessment Therapy and /or Training (includes assistive technology)15_048_0128_1_3.

Continence aids and products you require will need to be included in your NDIS plan under Core Support: Consumables. The NDIS principles of ‘Reasonable and Necessary’ applies when it comes to a delegate approving prescription items.

Your NDIS plan is focused around you achieving your goals. You will need to express how your incontinence affects your goals as this is what the funding is related to. For example; if your goal is to return to employment, what continence requirements do you require to meet this goal?

A Continence Related Assistive Technology Assessment will document requirements in line with achieving your goals when conducted by an experienced Continence Specialist.

Finally, talk about incontinence at your planning meeting, if it is not part of your NDIS plan goal, it is not part of your plan.

What is a bladder diary, and should I keep one?

Everyone who experiences incontinence should try keeping a bladder or bowel diary for at least a couple of days. What you see may surprise you, or, at the very least, provide a roadmap of your concerns that you can share with your health practitioner.
A bladder diary is a great tool for those looking to treat their incontinence, and should be used as the first step in understanding your specific condition. A bladder diary will track the number of times you have gone to the toilet in a day, if you’ve had any leakage (and the amount), and also tracks your food and drink consumption. By recording all of this over a series of days (at least 2-3 but up to a week or two can be really helpful), you may be able to see trends over time. For instance, perhaps you always experience leakage at a certain time of day, or after you’ve had a certain food or drink. This tracking can help you adjust your routine (or your diet) to avoid leaking. This tool can be extremely helpful to your clinician, as it gives him/her a better picture of your situation and may help advise better treatment options that will work for you.