What is Incontinence Associated Dermatitis?

What is Incontinence Associated Dermatitis?

Incontinence is characterized by the unintentional leaking of urine or stool. It’s usually caused by the weakening of the pelvic floor muscles or damage to the nerves that control impulses to release the bladder or bowels. One of the effects of incontinence if the skin is not properly cared for is dermatitis.

On top of finding the right incontinence products to help you manage leaks and stay fresh and dry all day, it's important to find skincare that cleanses, moisturizes, and protects your skin from urine exposure.

Dermatitis affects up to 27% of those who have incontinence, but there are ways to protect against it. This article explains incontinence-associated dermatitis and how you can prevent it.


Incontinence Associated Dermatitis

Dermatitis is any skin damage caused by moisture. There are different kinds of dermatitis, and each is characterized by what causes it. For instance, intertriginous dermatitis is skin irritation or inflammation caused by overexposure to sweat on the skin.

Incontinence-associated dermatitis is a skin condition that often accompanies urinary or fecal incontinence if proper skin care and hygiene measures aren’t taken. The condition involves inflammation and rash or breakage of the skin in the perineal area. If this dermatitis progresses enough, it can cause erosion of the skin.

The perineum is a diamond-shaped area from the front of the genitals, wrapping around the anus. It protects the pelvic floor muscles and plays an important role in bowel movements, urinating, intercourse, and childbirth. This form of dermatitis can also spread to the buttocks, labia, groin, upper thighs, and even stomach.


Here is a quick breakdown of how urine or stool results in dermatitis:

  • Urine or stool exposure causes the skin to be disrupted which can lead to maceration. Irritation begins in the skin leading to inflammation and the skin is at a higher risk of injury.
  • Moisture from the urine or stool is absorbed by the corneocytes (skin cells) which results in overhydration and pH changes.

The body’s skin barrier is an important aspect of why dermatitis occurs and how skin care can protect it.


Moisture Barrier

An important function of our skin is acting as a moisture barrier to protect our bodies from external stimuli and keep the internal environment in perfect homeostasis. This barrier specifically protects from toxins and irritating materials that we come in contact with, and two of these irritating materials are stool and urine.


The moisture barrier consists of a few parts:

Keratinocytes are a type of epithelial skin cell. An estimated 95% of our skin is made of these cells. Their main function is to protect our immunity by keeping our internal contents inside and the external environment outside. They’re so effective due to a protein known as keratin, which strengthens the skin, hair, and nails.

Fats are also an important part of our skin’s moisture barrier! Fats in the dermis and epidermis act as a border that prevents water and other foreign bodies from entering through our skin.

Sometimes, our moisture barrier can be thrown off due to external factors, health, and even age. This could increase your susceptibility to contracting dermatitis if you live with UI or fecal incontinence. 


Symptoms of Incontinence Associated Dermatitis

Below are some of the most common symptoms of incontinence-associated dermatitis and how to recognize them.

  • Inflammation or swelling around the perineum
  • Redness and visible changes in skin texture and color
  • Itching
  • Burning
  • Pain to the touch or tenderness
  • Heat and firmness of skin around the perineum
  • Lesions and wounds due to skin breakage or rash

If you do experience any of these symptoms or notice discomfort or pain around the perineum, see your doctor right away. While there are ways to treat and prevent dermatitis, it’s important to make sure there is no infection.


Causes of Incontinence Associated Dermatitis

While all forms of moisture-related dermatitis are caused by overexposure of the skin to some form of moisture such as sweat or urine, this form is specifically associated with urinary and fecal incontinence, but there may be other factors at play too.


Here are some factors that cause incontinence-associated dermatitis. 

  • Prolonged exposure to urine or stool
  • Using a rough washcloth that breaks the skin and makes it more susceptible to damage
  • Inadequate cleaning of the perineum after leaking
  • Changes in the skin’s pH
  • Ammonia made by urinary or fecal incontinence
  • Erosion of the skin due to keratinocytes being destroyed by bacteria
  • Overhydrating the skin or overexposure to moisture
  • Friction by incontinence underwear that’s too big, or clothing that chafes the skin
  • Cleaning the skin too often or with a non-gentle cleanser

Treating and Preventing Incontinence Associated Dermatitis

Dermatitis caused by incontinence can quickly become a serious issue and cause discomfort, pain, and even lead to wounds in the perineum. For this reason, it’s important to know how to treat it and prevent it in the future! Luckily, there are lots of easy treatments for incontinence-associated dermatitis. Below are some of the best ways to treat it.


Protective Underwear

One of the most popular ways to treat and prevent this kind of dermatitis is to use protective underwear. While there can still sometimes be a damaging stigma around incontinence underwear, they are important for preventing serious skin conditions and for ensuring incontinence-associated dermatitis doesn’t get worse.

If you have urinary incontinence and tend to void lots of urine at a time, a maximum bladder control underwear holds up to four cups of liquid at a time. Use these in place of regular underwear to absorb leaks. If you already have incontinence-associated dermatitis or are susceptible to it, be sure to change your underwear as soon as you can after a leak.

If you tend to have smaller leaks of urine or stool, consider using a pad or booster. These can be added protection on top of incontinence underwear or regular underwear. By having absorbent underwear, urine and stool can be absorbed better and protect your skin. It is still important to change underwear if you leak urine or stool to protect your skin and prevent dermatitis or worsening of the condition.


Proper Skincare

Proper skin care techniques for incontinence are essential to treating and preventing dermatitis. Because of the skin’s moisture barrier, it’s vital to protect the skin with moisture, proper cleansing, and protectants from urine and stool.

Having a cleanser is essential to maintaining good hygiene, but many rely on soap and water or harsh cleansers to stay clean. Studies have shown that cleansers are more effective than soap and water, but, it’s important to steer clear of harsh cleansers that dry your skin and further irritate dermatitis. Our Aloe moisturizer flushable wipes are great for gentle cleaning, and they’re also pH balanced for your protection! You can also consider a no-rinse cleanser for on-the-go.

Besides maintaining proper hygiene and keeping the perineal area clean, it’s also important to keep it moisturized and to soothe broken or irritated skin! This is also important as it helps the skin heal! Try a protective skin cream to heal and moisturize irritated skin.  Infused with Vitamin E and zinc, this serves to repair and protect skin from chafing, irritation, itching, burning, and sore spots. It also acts as an extra moisture barrier and seals out wetness to keep skin dry and healthy


Treatments for Incontinence

One way to avoid incontinence-associated dermatitis is to target the issue at the source. There are many ways to help reduce incontinence and increase bladder and bowel control. Some treatments such as a urinary catheter or a rectal catheter can help manage and prevent leaks. There are also surgeries, medications, and physical therapy that can help reduce incontinence.

Sometimes surgeries and medical procedures aren’t always ideal, but there are other ways to target and reduce incontinence. For instance, avoid foods that irritate the bladder such as spicy foods, citrus foods, dairy, and gluten. You can also avoid caffeine, sugar, and strong foods like vinegar or heavy spices.

Pelvic floor exercises are another great way to treat incontinence and regain control of the bladder and bowel muscles! Explore our resources on how you can do pelvic floor exercises to help control incontinence, without even leaving your own home!


Summary

Incontinence-associated dermatitis can develop into a serious condition if proper measures aren’t taken. It can not only result in discomfort and pain but can lead to infections and even open wounds if the skin is left unattended or overexposed to urine. For this reason, it’s important to take care of the skin around the perineum. By moisturizing, protecting the skin, cleaning it, and protecting it with underwear or absorbent pads you can reduce dermatitis and promote skin health.

If you live with urinary or fecal incontinence and experience any of the signs or symptoms associated with dermatitis, talk to your doctor right away. They can help you make sure there’s no infection or underlying health condition causing dermatitis and talk to you about what treatment options may be right for you.

 

Sources:

Incontinence Associated Dermatitis | Aging Lifecare Journal

Treating Incontinence Associated Dermatitis | Nursing Times

Incontinence Associated Dermatitis Risk Factors | Nursing Times

Structure & Function of Keratin Proteins | NCBI

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