People who are incontinent with urine, faeces, or both often suffer from skin irritations — the most common of which is incontinence-associated dermatitis (IAD).
In this guide, we explain the causes and potential complications of incontinence-associated dermatitis, as well as how to alleviate the symptoms of IAD.
What is incontinence-associated dermatitis?
IAD is a form of irritant contact dermatitis. It is also classified as a type of moisture-associated skin damage (MASD) that occurs when the skin is exposed to urinary, faecal, or dual urinary and faecal incontinence. Those more commonly affected by incontinence, such as the elderly, are most likely to experience IAD.
Incontinence-associated dermatitis presents in affected patients as redness and swelling of the genital and anal skin. In some more advanced cases, IAD can also lead to skin erosions and blisters.
Genital and anal skin affected by IAD often has a wet, macerated appearance during acute periods while patients in the chronic phase experience severe dryness and peeling skin. IAD may also spread to the skin and skin folds of areas not directly in contact with urine and faeces, such as the legs and hips, although these areas are usually less severely affected.
IAD can affect anyone with incontinence. Prevalence rates can vary but an extensive analysis of over 5,300 people found that 45.7% of patients with incontinence had incontinence-associated dermatitis.
What causes IAD?
Incontinence-associated dermatitis occurs as the result of damage to the protective barrier created by the skin.
In many cases, IAD occurs when the bacteria and ammonia created by urinary and faecal incontinence increase the skin’s pH level. This bacteria also breaks down the protein in keratin-producing skin cells, making skin more permeable and unable to function well as a natural barrier. In turn, this increases the risk of infection and irritation.
People with faecal or dual incontinence tend to experience more severe incontinence-associated dermatitis. This is because faeces irritate the skin much more than urine. Friction from clothing, bed linen, and absorbent pads can also cause more discomfort and worsen symptoms.
The possible complications of IAD
IAD can lead to secondary skin infections. These include candidiasis, an infection caused by the fungus Candida albicans, and staph infections caused by Staphylococcus bacteria.
People who develop IAD are also more likely to develop pressure injuries such as bedsores and pressure ulcers, especially if they have limited mobility and are unable to switch positions.
Another possible complication of IAD is medical adhesive-related skin injury (MARSI), where the adhesives from absorbent pads and other medical-related items can stick to the skin and cause further injury.
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