Maintaining skin for those who deal with fecal or urinary incontinence is vital. The skin is our first line of defense against infection and is the largest organ in the body. Preventing skin breakdown should be a high priority. Stool and urine are caustic to the skin. If left on the skin too long, the skin will become red, irritated, inflamed, and develop breaks in the skin. This is painful and can lead to infection.
Moisture-associated skin damage (MASD) is prevalent in those with incontinence. MASD is defined as inflammation and erosion of the skin caused by prolonged exposure to moisture. The moisture can originate from urine, stool, sweat, mucous, or drainage from wounds.
Incontinence-associated dermatitis (IAD) is an irritant dermatitis from long-term exposure to urine or stool. In women, IAD can affect the labial folds, vulva and perineum, and the anus. In men, it affects the scrotum to the anus. If not addressed, it can spread to the groin, buttocks, gluteal folds, and down the thighs. Ammonia from urine and enzymes from stool causes inflammation of the skin, maceration, and eventually skin breakdown. The skin is more vulnerable to friction and damage from pathogens or microorganisms during this state. Other factors that worsen skin damage include:
The skin that is affected by prolonged exposure to moisture will start with redness and maceration. Maceration is when the skin turns soft, white, and deteriorates. The skin starts to peel away. Unlike sunburn, where the skin is dry, skin with maceration is moist. If not treated or the skin remains exposed to urine or stool, the skin becomes painful with partial-thickness erosions of the skin. Once this occurs, the skin begins to secrete serous fluid and the skin appears weepy. Again, left untreated, pressure, shear, and friction cause increase stress on the area, worsening skin breakdown. Once the skin is in this state of injury, rubbing of diapers, linens and washing can cause further injury and pain.
IAD can lead to infection and bacterial growth. Bacteria love warm, moist environments and can double in number very quickly. As the body’s first line of defense breaks down, bacteria can enter the body via the breaks in the skin. The ammonia in urine feeds bacteria, acting as nutrition for microorganisms. This increases the reproduction of bacterial organisms' growth. Those with fecal incontinence are at greater risk of infection due to the bacterial load found in the stool.
Fungal infections are very common in those with incontinence. Fungal organisms thrive in warm, moist environments as well. A fungal rash is very red, causing itching and burning. An antifungal topical is typically recommended for treatment. This requires a prescription.
Prevention and avoiding skin breakdown are optimal. Anyone with incontinence should take special care to keep skin clean and intact. To maintain the integrity of the skin, manage odor and keep the patient comfortable, here are a few tips:
The best prevention against skin damage due to moisture from incontinence is keeping the skin clean and dry. Keeping up with personal hygiene is important in managing incontinence. Care during the day is easier managed but nighttime care takes more thought and steps for management. Using heavy-duty absorptive products overnight can leave skin exposed to urine or stool for longer periods of time so be sure to use the barrier creams or ointments before bedtime. If skin irritation does not improve, see your doctor as you may need to be evaluated for an infection that requires a prescription for treatment.
Author Profile: Christine Kijek, Registered Colorectal Nurse
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