Introduction

Urinary incontinence is a relatively common condition marked by loss of control of the bladder. In severe cases, it can have a detrimental impact on the quality of life of patients with this condition. Because of the sensitive and embarrassing nature of the topic, urinary incontinence tends to be underreported.¹ There are multiple risk factors for urinary incontinence, including²:

• Sex: Women are more likely to develop stress incontinence as a result of normal female anatomy, pregnancy, childbirth, and menopause. Men with problems related to their prostate gland can have a higher risk of developing incontinence as well.
• Age: With age, the muscles in the bladder and urethra can decline, increasing the risk of incontinence.
• Obesity: As compared with women who have a normal body mass index, those who are overweight have an approximately one-third increase in urinary incontinence. The risk is doubled for obese women.³
• Disease: Diabetes, as well as some neurological diseases, may increase the risk of incontinence.
• Family history: Those with a family history of urinary incontinence have a higher risk of developing the condition.
• Smoking: Tobacco use can increase the risk of incontinence.

Similar to urinary incontinence, fecal incontinence is underreported. It is also closely associated with age and sex. Although it occurs in approximately 8% of all adults, this figure jumps to 15% for those older than 70 years. Vaginal childbirth is also a primary risk factor for fecal incontinence. For men, those who have had previous anal surgery are at an increased risk for the condition. All patients with Crohn’s disease are at a higher risk for developing fecal incontinence.⁴

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Incontinence and Skin Health

Urinary and fecal incontinence can have a detrimental impact on skin health. Incontinence-associated dermatitis (IAD) is one type of moisture-associated skin damage (MASD). Prolonged exposure to urine or stool can cause inflammation or erosion of the epidermis or stratum corneum skin. Depending on the care setting, the prevalence of IAD can range from 5.2% to 46%.5 Residents in long-term care settings are at greater risk of IAD because they tend to be of advanced age and have incontinence.⁶ Increased age is another risk factor for IAD because the skin’s ability to act as a moisture barrier degrades over time. Mobility and diminished sensory perception can also contribute to the overall risk of developing IAD.⁶Incontinence-Associated Dermatitis Versus Pressure Injury IAD and pressure injuries share many risk factors, such as reduced mobility, incontinence, additional linen layers, longer inpatient treatment durations, and increased Braden Scale for Predicting Pressure Sore Risk© scores. Distinguishing IAD from superficial pressure injuries can be clinically challenging.⁶ Both IAD and pressure injuries are susceptible to infection. IAD is characterized by erythema and edema of the surface of the skin, sometimes accompanied by serous exudate, erosion, or secondary cutaneous infection.⁵

Managing Incontinence

Managing and treating incontinence and associated IAD can be challenging, particularly for certain patient populations, such as those with Alzheimer’s disease. Management strategies for incontinence reduce the skin’s exposure to urine and stool and thereby decrease the risk of skin damage. Strategies can include⁷:

• Timed voiding schedules: Toileting schedules can help you to control your bladder. When you urinate on a schedule, you can slowly begin to extend the time between bathroom trips. Timed voiding can make it easier to control incontinence.
• Absorbent briefs: Severe cases of incontinence can require the use of absorbent briefs or adult diapers.
• Lifestyle changes: Losing weight, quitting smoking, and reducing alcohol and caffeine consumption can all help reduce the effects of incontinence.
• Pelvic muscle exercises: Kegel exercises can increase the strength of the muscles that are required to stop the stream of urine.
• Barrier creams: Barrier creams can protect the skin from exposure to urine and stool and prevent IAD.

Conclusion

Incontinence can have an extremely negative impact on the lives of patients. In addition to embarrassment and challenges with managing the condition, incontinence can cause painful damage to the skin. Managing incontinence is crucial to enhancing the quality of life of these patients and reducing the risk of associated skin problems such as IAD, pressure injuries, and infection.

References

1. Pedersen LS, Lose G, Hoybye MT, et al. Prevalence of urinary incontinence among women and analysis of potential risk factors in Germany and Denmark. Acta Obstet Gynecol Scand. 2017;96(8):939-948.
2. Mayo Clinic. Urinary incontinence. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/sym…. Accessed April 1, 2021.
3. Lamerton TJ, Torquati L, Brown WJ. Overweight and obesity as major, modifiable risk factors for urinary incontinence in young to mid-aged women: a systematic review and meta-analysis. Obes Rev. 2018;19(12):1735-1745.
4. Vollebregt PF, Visscher AP, van Bodegraven AA, Flet-Bersma RJF. Validation of risk factors for fecal incontinence in patients with Crohn’s disease. In Visscher AP, ed. Fecal Incontinence: Risk Factors, Impact on Quality of Life and Future Treatment Strategies. Erbe: Vrije Universiteit.
5. Gray M, Guiliano KK. Incontinence-associated dermatitis characteristics and relationship to pressure injury: a multisite epidemiological analysis. J Wound Ostomy Continence Nurs. 2018;45(1):63-67.
6. Kayser SA, Phipps L, VanGilder CA, Lachenbruch C. Examining prevalence and risk factors of incontinence-associated dermatitis using the international pressure ulcer prevalence study. J Wound Ostomy Continence Nurs. 2019;46(4):285-290.
7. National Institute on Aging. Urinary incontinence in older adults. https://www.nia.nih.gov/health/urinary-incontinence-older-adults. Accessed April 1, 2021.