Impact of Incontinence on Skin

Skin is a very important organ of the body, apart from being the largest. And it requires good caring and nurturing. A small cut or rash does hurt, doesn’t it? So, we really need to keep our skin in good condition and this is particularly applicable to those who have very fragile skin or who are constantly exposed to moisture which can have a debilitating effect on the skin. Elderly people have to be extra careful because as we grow older, the skin becomes thinner and less elastic. Hence, it is more exposed to skin damage and can easily be injured.

Skin Breakdown due to Incontinence

Incontinence is one of those conditions whose long-term sufferers are most likely to encounter skin problems. Continuous exposure to urine and feces is one of the most common causes of skin breakdown. The chemical present in these waste products has an effect on the skin making it fragile and causing it to break and injure easily. Feces, in particular, can break down the skin because residual enzymes and bacteria are present in them. Fecal bacteria may pierce the skin escalating the risk of secondary infection.

Incontinence and Skin Integrity

Skin care for incontinent patients becomes exceptionally crucial, particularly in the region around the buttocks, hips, genitals and the area between the pelvis and rectum.

Pressure Sores

Because of excess moisture in these areas, there is a likelihood of redness, peeling, irritation and yeast infections the result of which are bed sores or pressure sores. It is advisable to seek immediate medical attention on first spotting redness or sores on the skin because pressure ulcers can lead to serious infection or tissue death if not attended to urgently. And in such a case, they can take some months to heal completely causing a lot of discomfort and pain. Bed sores may also develop in malnourished people, those who are immobile and confined to the bed or chair all day long and also in those who have had radiation therapy in that region. And people with dry skin have to be extra cautious because dry skin is almost a breeding ground for germs.

Urine Skin Burns

Urine is alkaline in nature and its pH ranges from 4.5 to 8.0. This alkaline characteristic is damaging to the skin especially if urine is in contact with the body for a long period of time. In such a case, the skin becomes more prone to friction and erosion because the urine changes the normal skin flora and increases the permeability of the stratum corneum.

When urine comes in contact with the hydrolipid film, which is the skin’s protective layer, the risk of bacterial infection increases because the skin becomes more porous to germs and is easily injured by even slight friction or shearing. Exposure to ammonia in urine leads to the growth of bacterial colonization on the skin apart from burning and irritation. Urine skin burn can be painful and troublesome to get rid of.

Risk for Impaired Skin Integrity

Impaired skin integrity related to incontinence can be the result of following conditions:

• Incontinence can cause IAD, or incontinence associated dermatitis, which is also known as perineal dermatitis and diaper rash. IAD does not necessarily affect only the aged but can have an impact all age groups – from babies to old people.
• If exposed to urine or feces for prolonged periods of time, the skin can become macerated or moisture-laden thus making it very fragile. Slight friction or pressure can result in skin shear. Even gentle rubbing by bed linens, diapers or cloth can cause the skin to break up.
• With longer exposure, the skin also comes into contact with bacteria present in these waste products. This can lead to the growth of bacterial infection.
• And moist and damp skin can also allow a fungal infection to develop with symptoms like fiery red skin, itching, and burning.

Incontinence Skin Care Best Practices

Special perineal skin care for the incontinent patients is essential because they are required to wear diapers at all times. Their skin needs to be kept clean and dry all the time.

• Change absorbent products, like diapers and briefs, as soon as they are soiled.
• Soon after a urine or bowel movement, the area should be washed with mild soap and water and then rinsed and dried thoroughly. Instead of soap, a no-rinse perineal wash may also be used which is gentle on the skin.
• Clean gently and thoroughly.
• Gently rub moisturizing cream on the area.
• You can also use a skin barrier cream for incontinence available in the market which are helpful for they form a protective barrier on the skin. Try out Coloplast Baza Clear Moisture Barrier Ointment.
• Give the patient a bath regularly so as to maintain a general personal hygiene.
• Ensure that the client drinks lots of water and eats a well-balanced diet containing calories and protein to stay healthy and maintain skin integrity.

Incontinence Skin Care Protocol

Check the skin daily for redness, rash or skin breakdown from urine. If redness is present, press it to see if it turns white. If it does not, then consult a doctor immediately. Warning signs include skin that is pink, bright red, burned, irritated, or chafed.

If the incontinent patient is bed-ridden

• Ensure that the patient changes positions as frequently as every two hours so as to not be lying down in one spot for too long. Turning regularly helps prevent incontinence sores or pressure ulcers.
• Make them lie down on mattresses that are designed to reduce pressure. Use pressure-relieving equipment with advice from the nurse in charge. A softer surface spreads weight over a larger skin area and lessens pressure under the bones. An egg-crate pad, like BioClinic eggcrate bed pads, can help cushion the bed comfortably.
• Use wrinkle-free mattresses because wrinkles may cause friction.
• Change sheets and clothing as soon as they are soiled. Do not delay.

If the incontinent patient is confined to wheelchair

• Make the patient change positions every 15-20 minutes.
• Provide support with specially designed pillows and padding. You can try out the BioClinic eggcrate wheelchair cushion.
• Use wrinkle-free cushions and padding because wrinkles may cause friction.
• Make sure that the chair being used fits properly and the user is not uncomfortable with it.
• Change sheets and clothing as soon as they are soiled. Do not delay.

Some Dos and Don’ts

• Do not apply powder because it traps moisture in skin folds.
• Do not use scented products to cleanse the skin in order to maintain skin integrity.
• Avoid vigorous rubbing of the skin to avoid friction. Pat, it dries gently.
• Do not allow an incontinence product to be worn even after it is soiled.
• Select moisturizing creams for skin breakdown and barrier creams for pressure ulcers that do not have alcohol in them because alcohol can cause irritation.

 

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