Incontinence-Associated Dermatitis

WoundSource Practice Accelerator's picture

Vulnerable skin within the skin microclimate is caused by a multitude of factors that are often aggravated by one another. Urine and feces, for example, have a negative impact on the skin as a result of the microorganisms and enzymes they contain. These factors break down the skin barrier and cause inflammation through the release of cytokines that trigger an immune response leading to symptoms of dermatitis (i.e., moisture-associated skin damage [MASD]). Incontinence-associated dermatitis (IAD) is one type of MASD, and the external factors that contribute to IAD include microclimate (water, temperature, pH), mechanical forces (friction, pressure, shear), and biochemical factors (fungi, irritants, bacteria, enzymes).

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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.

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Absorbent briefs: Briefs used to absorb urine and stool and to help prevent moisture-associated skin damage in patients with incontinence issues. Briefs with high breathability and wicking help to maintain the skin microclimate.

Barrier products: Creams, sprays, wipes, or other products used to seal the skin and protect it from breakdown caused by moisture or incontinence.

Cyanoacrylates: A skin sealant that bonds to the skin surface and integrates with the epidermis. Cyanoacrylates are strong and resistant to washing off.

First Quality Products's picture

By: M. Sanantonio RN, C. Gunner RN, S. Trousaant LVN, M. Moore LVN

It is important for skilled nursing facilities to utilize quality incontinent products for their residents that are facing the daily challenges of both bladder and bowel incontinence. However, products alone do not make for a successful continence management program. It is imperative that the caregivers receive education in multiple areas that ultimately have an effect on the resident’s quality of life, quality outcomes and overall facility cost efficiencies. This study demonstrates the combination of quality incontinent products and education and its overall effectiveness in skilled nursing facilities.

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Margaret Heale's picture
Continence Assessment

By Margaret Heale, RN, MSc, CWOCN

Not very long ago, when working in an in-patient rehab center, I was shocked to discover patients calling the adult incontinence garments "hospital underwear." We were making good inroads into reducing the use of these products with the hope that if we used less it would be possible to acquire higher-quality products that would function optimally for patients who really needed them. It was of concern that some facilities had become diaper-free because many of our patients benefited from briefs, particularly as a "just in case security blanket" and we felt it was unrealistic for our patient population to be brief-free.

Ivy Razmus's picture
moisture-associated skin damage

Ivy Razmus, RN, PhD, CWOCN

Moisture-associated dermatitis has been described as "inflammation and erosion of the skin due to prolonged exposure to moisture and its contents which include urine, stool, perspiration, wound exudate, mucus, or saliva." Incontinence dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations. Indeed, diaper dermatitis has been used to describe an infant's skin breakdown related to moisture exposure.

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by the WoundSource Editors

Epidermis: the outer layer of the skin, which is the protective layer against the outside elements.

Epithelialization: the growth of the epidermis over a wound during the remodeling stage.

Granulation: condition occurring in a full-thickness wound where the growth of small vessels and connective tissue forms “scaffolding” as the wound rebuilds.

Janet Wolfson's picture
A Multidisciplinary Approach to Incontinence

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA

My current job as wound coordinator has pulled me into the world of incontinence and the many disciplines that care for people challenged by this disorder. I was previously acquainted with the therapy side as I worked with therapists certified in pelvic floor therapy. My work with venous edema acquainted me with medications that caused continence-challenged people to resort to absorbent adult briefs. As I work more closely with physicians, I am more familiar with medications to support weakened or sensitive pelvic muscles and nerves. On the nursing side, I have researched support surfaces, incontinence pads, and barrier creams. I see patients and occupational therapists working together to regain continence independence through problem-solving mobility issues.

Holly Hovan's picture
Geriatric Skin

by Holly M. Hovan, MSN, APRN, ACNS-BC, CWOCN-AP

With a growing population of Americans aged 65 or older, it is important to know what skin changes are normal and abnormal and what we can do in terms of treatment, education, and prevention of skin injuries.

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Obesity

By Sharon Baranoski, MSN, RN, CWCN, APN-CCNS, FAAN and Kimberly LeBlanc, PhD, RN, WOCC©, IIWCC

Editor's note:This blog post is part of the WoundSource Trending Topics series, bringing you insight into the latest clinical issues and advancement in wound management, with contributions by the WoundSource Editorial Advisory Board.