Managing Incontinence-Associated Dermatitis with Topical Skin Care Products
Many suffer from incontinence in silence because of its perceived embarrassing nature, when in fact millions of Americans deal with some form of incontinence on a regular basis. Incontinence rears its head in the form of involuntary or accidental loss of urine from the bladder, or motion, feces or wind from the bowel varying in severity.
Patients suffering from urinary or bowel incontinence most commonly experience incontinence-associated dermatitis (IAD) that occurs when the skin comes into contact with urine and/or fecal matter.1 IAD is an inflammatory condition that presents with redness, swelling, excoriation and pain and may be complicated by fungal infections.2 For incontinence patients, the inflammation is usually confined to the skin areas that come into contact with urine and/or feces and can include the perianal and gluteal cleft, the buttocks, upper thighs, external genitalia and suprapubic areas.3 IAD is different from similar pressure injuries in that it is "top down" damage where superficial skin damage occurs initially and can progress to deeper tissue damage.4
Types of Incontinence
Loss of bladder control ranges in severity from occasionally leaking urine when you cough or sneeze, to having an urge to urinate so sudden and strong you don’t get to a toilet in time. Urinary incontinence occurs as you age, but doctors insist that it does not have to be an inevitable part of getting older. While not always preventable, some of the risk factors for developing urinary incontinence are reversible or within our control. Risk factors include:
-Other diseases such as diabetes
A symptom of an underlying medical condition, urinary incontinence occurs when there is a physical problem or change in your body including pregnancy, childbirth, changes with age, menopause, a hysterectomy, an enlarged prostate, prostate cancer, obstruction, or neurological disorders.
Urinary incontinence affects more than one-third of women aged 70 years and older and is often associated with functionality impairments, including reduced mobility. Women with limited or impaired mobility may take longer to reach the toilet, increasing the risk of leakage with a stronger urge to urinate.
The prevalence of urinary incontinence in men of all ages is certainly lower than that for women. Large studies have indicated that there is a 3% to 11% overall prevalence rate of incontinence in the male population. Of those males diagnosed with incontinence, urge incontinence is the prominent type reported in 40% to 80% of patients. Incontinence in men increases with age and appears to rise more steadily than it does in women. However, the estimates for severe incontinence in men in their 70s and 80s is still only about half of that in women.5
Those who suffer from bowel incontinence are not alone. Nearly 18 million adults in the U.S. have bowel incontinence, making them unable to control their bowel movements resulting in the leakage of solid or liquid stool. Risk factors for developing fecal incontinence include:
-Gender – females who have given birth or take menopausal or hormone replacement therapy
Common causes of bowel incontinence include diarrhea, constipation, muscle damage or weakness, nerve damage, little to no physical activity, childbirth, hemorrhoids, medical conditions, or certain medications. Like urinary incontinence, bowel incontinence comes in different forms and severity levels including urge, flatus (wind), passive, anal and rectal, and overflow.
Incontinence-Associated Dermatitis (IAD)
Symptoms of IAD can be very burdensome and sometimes painful to patients, including:
-Redness, ranging from light pink to dark red, depending on skin tone
-Patches of inflammation or a large, continuous area of inflammation
-Warm and firm skin
-Pain or tenderness
Preventing and Treating IAD:
Effectively treating IAD in incontinence patients is a specific process referred to as “routine pericare” – or skin care in the genital area. 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 surfactants that lift stool and urine from the skin. Clean the skin routinely and at the time of soiling. Use warm (not hot) water, and avoid excess force and friction to avoid further skin damage. Gentle cleansers that protect the lipid profile of the skin yet cleanse contaminants away easily should be chosen.
-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 in the stratum corneum.
-To protect the skin, apply a moisture-barrier cream or spray if the patent has significant urinary or fecal incontinence (or both). The protectant should be one that does not disintegrate easily in the presence of stool and urine and provides a barrier to moisture and caustic agents. If the skin is compromised, then choosing a barrier that can stick to moist skin is imperative. The barrier may be zinc-based, petrolatum-based, dimethicone-based, an acrylic polymer, or another type.
Scapa Healthcare has extensive experience and knowledge in the formulation development and manufacturing of custom topical wound care solutions and consumer skin care products including skin moisturizers and barrier creams. Our seasoned R&D team applies cutting-edge formulation capabilities and, when appropriate, green chemistry on a product-by-product basis to ensure high-effectiveness, quality and above, all safety. Learn more about our capabilities and expertise with topical skin care solutions.
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3. Borchert K, Bliss DZ, Savik K, Radosevich DM. The incontinence-associated dermatitis and its severity instrument: development and validation. J Wound Ostomy Continence Nurs. 2010;37(5):527-35. [Context Link]
4. Brown D. Perineal dermatitis risk factors: clinical validation of a conceptual framework. Ostomy Wound Manage. 1994;41(10):46-8, 50, 2-3. [Context Link]
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