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Skin care and incontinence

People who have problems controlling their urine or bowels (called incontinence) are at risk of skin problems around the buttocks, hips, genitals, and the area between the pelvis and rectum (perineum).

Excess moisture in these areas makes skin problems such as redness, peeling, irritation, and yeast infections likely.

Bedsores (pressure sores) may also develop if the person:

  • Has not been eating well (is malnourished)
  • Received radiation therapy to the area
  • Spends most or all of the day in a wheelchair, regular chair, or bed

TAKING CARE OF THE SKIN

Using diapers and other products can make skin problems worse. Although they may keep bedding and clothing cleaner, these products allow urine or stool to be in constant contact with the skin. Over time, the skin breaks down. Special care must be taken to keep the skin clean and dry. This can be done by:

  • Cleaning and drying the area right away after urinating or having a bowel movement.
  • Cleaning the skin with mild, dilute soap and water then rinsing well and gently patting dry.

Use soap-free skin cleansers that do not cause dryness or irritation. Follow the product's instructions. Some products do not require rinsing.

Moisturizing creams can help keep the skin moist. Avoid products that contain alcohol, which may irritate the skin. If you are receiving radiation therapy, ask your health care provider if it is OK to use any creams or lotions.

Consider using a skin sealant or moisture barrier. Creams or ointments that contain zinc oxide, lanolin, or petrolatum form a protective barrier on the skin. Some skin care products, often in the form of a spray or a towelette, create a clear, protective film over the skin. A doctor or nurse can recommend barrier creams to help protect the skin.

Even if these products are used, the skin must still be cleaned after each episode of incontinence. Reapply the cream or ointment after cleaning and drying the skin.

Incontinence problems can cause a yeast infection on the skin. This is an itchy, red, pimple-like rash. The skin may feel raw. Products are available to treat a yeast infection:

  • If the skin is moist most of the time, use a powder with antifungal medication, such as nystatin.
  • A moisture barrier or skin sealant may be applied over the powder.
  • If severe skin irritation develops, see the health care provider.

The National Association for Continence (NAFC) publishes many helpful patient resources at www.nafc.org.

IF THE PERSON IS BEDRIDDEN OR USING A WHEELCHAIR

Check the skin for pressure sores every day. Look for reddened areas that do not turn white when pressed. Also look for blisters, sores, or craters. Tell the doctor or nurse if there is any foul-smelling drainage.

A healthy, well-balanced diet that contains enough calories and protein helps keep the person healthy.

If the person must stay in bed:

  • Have him or her change positions often, at least every 2 hours
  • Change sheets and clothing right away after they are soiled
  • Use items that can help reduce pressure such as pillows or foam padding

If the person is in a wheelchair:

  • Make sure the chair fits properly
  • Have him or her shift their weight every 15 to 20 minutes
  • Use items that can help reduce pressure, such as pillows or foam padding

Alternative Names

Incontinence - skin care

References

Beeckman, D, Schoonhoven, L, Verhaeghe, S, et al. Prevention and treatment of incontinence-associated dermatitis: literature review. J Adv Nurs. 2009;65:1141-1154.

Nazarko, L. Skin care: Incontinence dermatitis. Nurs Residential Care. 2007;9:310-313.

Update Date: 3/18/2014

Updated by: Michael Langan, MD, Department of Geriatrics, Massachusetts General Hospital, Boston, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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