How to prevent incontinence-related skin irrritation and IAD

People who experience incontinence are easily susceptible to intimate skin irritation and rashes. If the person you care for is elderly or has mobility issues, their skin will likely be more fragile, putting them at higher risk of infection.

Good continence care and intimate skincare is important, because exposure to urine and faeces increase the chances of experiencing skin issues such as incontinence associated dermatitis (IAD).

Caring for your loved one’s skin should form an important part of caregiving duties. Having healthy skin is crucial for quality of life and is also helpful prevent problems such as IAD. Intimate skin cleansing and treatment needs to be done in the right way with the right product to maintain skin health.

If the person you care for has incontinence problems, they are at risk of developing IAD. Anyone with incontinence can experience IAD, although is most common in people with fragile or vulnerable skin such as the elderly, those using medication or those with conditions that affect skin.

IAD, sometimes known as perineal dermatitis, is a form of skin inflammation and moisture-associated skin damage that comes from exposure to urine and faeces. When the skin´s protective barrier is damaged by incontinence, it causes an inflammation of the skin called IAD, leading to symptoms such as irritation, redness, inflammation, burning, itching and soreness.

Some factors that can increase the risk of IAD:

• Using non-breathable bed protection unnecessarily
• Aggressive cleansing of the skin
• Poor personal hygiene
• Cleaning with water and soap (disturbs skin’s natural pH)
• Exposure to liquid faecal leakages (especially diarrhoea)
• Using the wrong incontinence products
• Poor genital skin cleansing
• Not changing incontinence products on time
• Not toileting when needed

As a caregiver, you should do all that you can to prevent your loved one from developing IAD. Having IAD is not only uncomfortable and distressing, it also increases the risk of developing other skin infections. Good continence care is essential to keeping intimate skin healthy. The following tips around toileting are aimed at reducing the skin’s exposure to moisture and feces.

• Keep to a regular toileting routine and always help your loved one get to the toilet when they need to go.
• After helping your loved one go to the toilet, ensure they are properly clean and dry.
• If the person you care for has an accident, ensure prompt cleaning and changing of incontinence products.
• Do not use abrasive washcloths to clean intimate skin - be as gentle as possible
• Use the right absorbency incontinence products for their needs.
• After helping them change their incontinence product, ensure the skin is clean and dry, and apply a thin layer of skin barrier cream like TENA ProSkin Barrier Cream.

Bedsores, also known as pressure injuries, are different from IAD. Whereas IAD develops where the skin is exposed to faeces and urine, bedsores happen because of prolonged pressure on the skin. They can happen to anyone, but usually affect people confined to a bed or chair.

Symptoms of bedsores include unusual changes to skin colour and texture, tenderness and swelling in the affected area. Bedsores can appear anywhere on the body, especially where the skin is close to the bone. Like all skin issues, bedsores can be very painful and uncomfortable. Bedsores are divided into 4 stages, from least to most severe.

If you notice changes to your loved one’s skin, contact their GP to find out the best way to help treat them.

When caring for someone who has limited mobility, it is important to keep their skin healthy. There are plenty of ways to prevent bedsores:

• If your loved one is confined to a bed, chair or wheelchair, try to reposition them frequently to alleviate pressure on the skin.
• If they can move on their own without support, keep reminding them to adjust position.
• Provide soft padding in wheelchairs or a special mattress designed to prevent bedsores.
• Check their skin daily for early signs of bedsores or bruising.
• Encourage a healthy, balanced diet that contains enough protein, vitamins and minerals to keep skin healthy (good nutrition is also vital for skin healing).
• Provide good continence management: follow a regular changing routine and clean your loved one after every time they soil their incontinence product. To find out more about choosing the right incontinence product for the person you care for, check out our guide to changing an incontinence products.

If the person you’re caring for is recovering from illness or surgery at home, or you're caring for someone confined to bed or a wheelchair, it’s worth asking your GP for an assessment of their risk of developing bedsores.

If your loved one develops bedsores, contact their GP to find out about treatment options. Left untreated, the skin can break open and the area can become infected. Bedsores vary in severity, and some can become very deep, even extending into the muscle or bone. Once a bedsore develops, it can be very slow to heal. Don’t try to treat them yourself at home – get advice from a medical professional as soon as possible.

1. TENA global research on attitudes and awareness to family caregiving in the general population. July 2022 Poland, Canada, France, UK, USA. Each country Interviewed over 1,000 men and women (18+).