What is Incontinence Associated Dermatitis?

For those suffering from urinary incontinence, it’s important to understand that the condition doesn’t just affect your bladder movements. It can also lead to other conditions such as incontinence associated dermatitis (known as IAD). IAD is a physical reaction of your skin due toprolonged exposure from urine. While dealing with IAD on top of incontinence may seem like a real burden and added stress, it’s useful to understand that it can be treated.

We have spoken to Dr. John S. Young, Associate Professor in Urology, to help us not only recognise the physical symptoms of this common skin issue, but also provide us with helpful tips and solutions for those suffering from or caring for an individual with IAD. 

 

What causes incontinence associated dermatitis and how can you recognise it?

IAD is essentially skin damage, resulting from the prolonged exposure of the skin to urine. Dr. John specifically highlights that both the ammonia and bacteria in urine are what break down the outer layer of the skin and impair its own barrier function; ultimately causing inflammation and further skin breakdown. 
 
General skin inflammation is quite common and can be caused by a number of different factors such as sweat or by wearing itchy clothing – so how can you differentiate IAD from general skin inflammation and other skin conditions such as eczema or hives?
 
Dr. John specifies that “to the untrained eye, it may be difficult to distinguish IAD from pressure ulcers. For this reason and to ensure timely treatment, it’s strongly recommended to see your GP at the first sign of redness.”
 
However, Dr. John also pinpointed some of the main characteristics that can help you identify IAD: 
 
● Pain – along with burning, itching, tingling sensations
 
● Reddened skin, with or without skin loss. In many cases, the reddened skin will turn white when pressed with a fingertip, and then immediately turn red again when pressure is removed
 
● Dispersed inflammation with poorly defined and often blotchy edges 
 
● Inflammation, located in the following areas; perineum, labial folds (in women), groin (in men), buttocks, gluteal cleft, upper thighs, or lower abdomen

How can you treat incontinence associated dermatitis?

As with all skin conditions, it’s important to tackle the root of the problem as a way of controlling and minimising the response your skin has to it. In the case of IAD, it’s therefore essential that you reduce the amount of urine and time when it comes into contact with your skin. 
 
Dr. John recommends the following, to not only prevent IAD but also to help minimise the effect it has on your skin:
 
Limit your skin’s exposure to urine
 
“The most effective treatment of IAD is the management of the patient’s incontinence. Incontinence management products represent the simplest solution by containing the urine and keeping it away from the skin.”
 
Clean your skin after incontinence episodes
 
“It is still crucial however, even when using incontinence management products, that the skin is cleaned after every episode of incontinence. This will ensure that the skin’s barrier function is maintained, rather than being compromised by long-term exposure to urine.”
 
Do not use harsh chemical products on your skin
 
“Skin cleansers should not contain soap and, ideally, they should contain moisturisers. Skin protectants that form a barrier between skin and urine can also be highly effective. The most effective protectants are those which are easy to apply, transparent (allowing inspection of the skin by the patient or caregiver), and do not affect fluid uptake by absorbent incontinence products.”

What should you do if you care for someone with IAD?

When caring for someone with known IAD or incontinence in general, it’s important to be able to first recognise the symptoms of IAD (listed above). 
 
Dr. John advises carers to regularly inspect the area and consult a GP at the first signs of redness. It’s also advisable that as a carer, you are mindful of any changes in circumstances that will impact on the patient’s ability to manage their own incontinence and associated hygiene. These changes could be associated with mobility, diminished cognitive awareness, reduced personal hygiene or diminished overall health.
 
 
Now that you know a little bit more about IAD, hopefully you will be able to spot it yourself or in someone else! In general though, when dealing with incontinence associated dermatitis, being proactive about seeking help is the best approach to take. By doing this your GP will be able to suggest an effective remedy, which will allow you to quickly manage the effects IAD has on your skin.