Those with incontinence, whether urinary or faecal, may be familiar with Incontinence Associated Dermatitis (IAD), also known as perineal dermatitis. 

 

IAD is a skin condition that is caused by exposure to bacteria in urine and/or stool. It primarily affects the skin around the genitals, perianal area and abdomen - essentially the areas where urine and stool may sit when wearing incontinence products such as pull-up pants, pads and slips. 

 

If you’re wondering what you can do to prevent the condition, don’t worry, we’re here to help. These are our incontinence associated dermatitis prevention and management tips.

What does IAD look like?

Knowing what IAD can look like is part of helping to prevent it!

 

If you experience incontinence, these are the symptoms to look out for that could indicate you have IAD:

 

• Redness - this can range from light pink up to dark red depending on your skin tone

• Inflammation to small or large patches of skin

• Pain or tenderness

• Lesions

• Burning

• Itching

• Warm, firm skin

The combination and severity of these symptoms can differ from person to person.

 

What causes IAD and how common is it?

We’ve briefly touched on the overall cause of incontinence associated dermatitis at the start of this article, but let’s dive a little deeper.

 

As mentioned, IAD is directly related to incontinence. If someone is experiencing any similar symptoms to IAD around the genital, thigh and abdomen area they should speak to their GP for a diagnosis.

 

When the skin is exposed to urine or faeces, its epidermis (the outermost layer of skin that protects the body) becomes compromised, as the bacteria and moisture from bodily fluids start to penetrate it and erode it. 

 

The change in the skin’s pH level from coming into contact with urine and faeces can also cause IAD. The skin surface is acidic, with a pH level between 4 and 6, which helps prevent bacteria growth and protect the skin [1][2]. When the skin is exposed to urine and/or faeces, an enzyme called urease (a pathogenic bacteria that has a toxic effect on skin cells) converts into ammonia [3]. Ammonia then causes the skin’s pH level to elevate, which results in impaired protection and skin barrier function.

 

However, it’s not only urine and faeces coming into contact with the skin that can cause IAD. In fact, inefficiently or overly cleaning and maintaining the genital and perineal area can also cause IAD.

 

This includes:

• Over-hydrating the skin with cream

• Using soap and water to frequently clean the affected area

• Friction caused by absorbent pads or other materials such as underwear

 

IAD is most commonly experienced by people with incontinence that are largely sedentary, injured, elderly and/or in critical care. 

 

For example, statistics show that IAD incidence occurs in 29-36% of critical care patients, 7% in long-term acute care residences, and 3-4% of nursing home residents [4]. 

 

Other analysis of data on IAD shows that the highest rates are seen in acute geriatric care facilities [5]. One study in an intensive care unit (ICU) found that 36% of patients developed IAD within an average of four days [6].

 

Incontinence associated dermatitis prevention

By managing your incontinence, you’ll then be a step ahead in preventing IAD.

So, some of the ways that you can manage your incontinence that promotes skin health include:

• Wear absorbent incontinence pads with the right absorbency levels for your needs. Our range of incontinence pads, pull-ups and slips are dermatologically tested and have high levels of absorbency to help protect against discomfort and skin irritation.
• Know how to apply incontinence pads and pull-ups. Ensuring you have the right fit and are wearing your products correctly can help with absorbency and comfort.
• It’s important to change incontinence pads and/or pull-ups as soon as they’re wet to avoid urine and/or faeces keeping in contact with the skin. Pads should also be changed at least four to six times a day as a general rule of thumb.
• Wash your genital, anal, thigh and abdomen areas with a mild, pH balanced cleanser and warm water. If using a cloth, ensure it is a gentle fabric.
• Use wipes, like our Cleansing Wet Wipes, for clean-ups between changes or when you’re out on the go.
• Use a barrier cream to create physical space between your skin and urine/faeces and helps deter irritation. Opt for one that contains zinc oxide and is also fragrance and paraben-free. Apply to clean, dry skin and be sure to use sparingly, as too thick of a layer can interfere with the absorbency of your incontinence products.
• As soon as you notice any changes to your skin, see your doctor to avoid it getting worse.

 

It’s important to note that even when following these hygiene protocols, there is still a possibility you could experience IAD.

 

Incontinence associated dermatitis treatment

If you do develop IAD, don’t worry it can be treated. Just be sure to get it looked at by your doctor as soon as possible to avoid it worsening. 

 

Once diagnosed by your health professional, treatments can look quite similar to the prevention methods mentioned earlier and will work to repair the skin over time. Essentially, the main aim is to eliminate prolonged moisture on the skin.  

 

First and foremost is to ensure your incontinence products are being changed as soon as they’re wet with urine or soiled with faeces.  

 

Properly cleaning the skin is another crucial element of IAD treatment. As mentioned, using a gentle material washcloth and a pH-balanced, moisturising cleanser is paramount. Remember, the skin’s natural pH falls between 4 and 6 so finding a cleanser that falls in this range is ideal as many out there have pH levels of up to 9. Using a moisturiser cream or cleanser can help repair the skin barrier, reduces transepidermal water vapour loss (water that passively evaporates through the skin) and restores the lipid barrier which protects against microorganism invasion of the skin [9].  

 

Using a barrier cream as a barrier to reduce contact between your IAD and urine/faeces will also help. It means there is less friction between your skin and incontinence products too which can assist in reducing skin irritation. In a trial using a washcloth containing a barrier product (along with standardised incontinence care protocol), only 8% of incontinent patients developed IAD compared to 27% of patients who only used perineal skin care with water and pH-neutral soap [9]. 

 

Again, just ensure you’re not over-applying creams as they can affect skin breathability but also the efficacy of your incontinence products as mentioned above.

 

Incontinence associated dermatitis vs pressure injury

Pressure injuries, also known as bed sores or pressure ulcers, occur when there is a breakdown of skin quality due to pressure on the body caused by contact with another external surface i.e. a bed, or clothes [7].

 

Essentially, if you are laying or sitting down in the same position for a period of time, pressure is being applied to different parts of your body, which can cause a pressure injury if it’s not relieved.

 

People who develop IAD are more likely to suffer from pressure injury - this is most commonly experienced by older adults or people who have a medical condition that limit their mobility and ability to switch positions. 

 

According to Queensland Health, pressure injuries can appear as minor as redness of the skin, but harbour more damage under the skin’s surface. Pressure injuries can escalate quickly and cause significant pain, infection and, in some extreme cases, lead to death. Some research states that individuals with pressure injuries have a 4.5 times greater risk of death than persons with the same risk factors but without pressure injuries [8].

 

So while this is a separate condition from IAD, it’s important to understand that someone with IAD is at risk of developing pressure injury if they are mostly sedentary. Always speak to your health professional if you have any concerns or symptoms.

 

We hope that you have found these incontinence associated dermatitis prevention and treatment tips helpful. For any assistance when it comes to choosing the incontinence products that are right for you or someone you care for, don’t hesitate to get in touch with us.