We’ve partnered with MoliCare® to bring you this health guide to Incontinence-Associated Dermatitis (IAD). This condition is a skin irritation caused by urine and faeces coming into contact with the skin for a prolonged period of time. It can occur in people who experience incontinence, whether urinary or faecal. IAD is common and can be found in around 5.6% to 50% of people with incontinence if the condition is not managed appropriately and using the right products.
Causes of Incontinence-Associated Dermatitis
Incontinence-associated dermatitis can be caused by a mixture of chemical and physical skin irritation. Contact with urine and faeces can affect and increase skin pH, which weakens the skin barrier and heightens the risk of infections. Friction contributes to physical irritation, further weakening the skin's defences. Using MoliCare® skin barrier cream and incontinence pads which neutralise and quickly absorb urine can lessen these effects and help keep the skin clean and healthy.
What are the Symptoms of Incontinence-Associated Dermatitis
In IAD, also known as ‘adult nappy rash’ can include noticeable signs such as redness and swelling on genital and anal skin's curved parts, sometimes leading to blisters (bullae) and erosions. Depending on positioning, the rash's distribution can be symmetrical or asymmetrical.
During the acute phase, surrounding skin might appear wet and softened, while in the chronic phase, it could display dryness and peeling. Dermatitis might extend to skin folds or even areas not in direct contact with urine and faeces, although these regions typically experience milder effects.
What Could Happen Due to IAD
IAD can lead to notable irritation and discomfort, affecting both the person experiencing it and those providing care.
Skin infections, often caused by Candida albicans and Staphylococcus aureus, become more likely. In some cases, incontinence-associated dermatitis can even result in pressure ulcers of varying depths.
The severity of IAD depends on factors like the overall health of the skin, health and nutrition, and exposure to allergens. People with incontinence are more prone to more severe IAD, as they have more frequent exposure to urine and faeces.
How To Get Diagnosed for IAD
Diagnosing IAD involves a few steps:
- Visual Examination: Your GP can examine the affected skin. They'll look for redness, inflammation, and any other visible signs of irritation
- Medical History: The doctor might ask about your symptoms, how long they've been present, and your history of incontinence.
- Skin pH Test: In some cases, a pH test might be performed on the affected area. Increased pH levels can indicate the presence of IAD.
- Exclusion of Other Conditions: Sometimes, similar skin conditions might need to be ruled out. This could involve tests or assessments to differentiate between different skin issues.
- Microbial Testing: If there's suspicion of infection, swabs might be taken from the affected area for laboratory testing to identify any present microorganisms.
How To Treat Incontinence Associated Dermatitis
Prevention is the best course of treatment for IAD by following a good skin cleansing and care routine, using appropriate skin cleansers, using barrier creams and choosing an absorbent product such as MoliCare® which actively neutralises pH. Other treatments could include:
- Maintaining regular toileting routines.
- Using the right absorbent incontinence pants or pads for the level of incontinence and change when needed.
- Intermittent or indwelling urinary catheters.
- Systems like rectal catheters or anal bags for faecal management.
To treat IAD:
- Safeguard skin from further urine and faeces exposure.
- Create a healing environment.
- Address any accompanying infections.
For confirmed bacterial and fungal infections, antibiotics and antifungal agents are recommended.
What to Expect from IAD
Managing IAD can be challenging and tends to reappear. Effective skin care and addressing incontinence care, along with related infections or pressure sores, can lead to the clearance of the dermatitis or a reduction in its intensity.
Risk Factors and Preventative Measures
Risk Factors
Certain factors increase the likelihood of developing IAD:
- Immobility or limited movement.
- Being bedridden or using a wheelchair.
- Impaired cognitive ability that prevents recognising or communicating discomfort.
- Specific medical conditions that cause urinary or faecal incontinence, such as neurological disorders.
Preventive Measures
Preventing IAD involves a multi-faceted approach:
- Choosing fast-absorbing incontinence products which neutralise pH like MoliCare®.
- Keeping the skin clean and dry.
- Using pH-balanced skin cleansers.
- Applying a water-in-oil-in-water barrier cream.
- Ensuring timely changes of incontinence products to prevent prolonged exposure.
Choosing Incontinence Products:
Selecting the right absorbent products is crucial:
- Choose a product which provides the appropriate level of absorbency for your type of incontinence. If you’re saturating the pad or pants every 2 hours, try a higher absorbency.
- Choose a product which minimises moisture exposure, such as fast absorbing, 3-layer absorbent core, skin pH balanced products.
- Ensure a proper fit to prevent leaks and friction. You can order a free sample of MoliCare® products to find out what is right for you at the following link: Order MoliCare Sample.
Promoting Skin Healing
For those who already have IAD, create an environment conducive to healing by:
- Keeping the skin clean and dry to prevent infection.
- Use prescribed creams to support healing.
- Address any secondary infections promptly with prescribed antibiotics or antifungal medications.
Sources
Cleveland Clinic (n.d.) Candida Albicans. [online] Available at: https://my.clevelandclinic.org/health/diseases/22961-candida-albicans [accessed 17/08/23]
Taylor, T.A., Unakal, C.G., (2022) Staphylococcus aureus Infection. [online]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441868/ [accessed 17/08/23]
