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Incontinence Advice

What You Need To Know About Incontinence Associated Dermatitis

For those who are either new or already knowledgeable about the skin, you may have come across the phrase ‘incontinence-associated dermatitis’ or IAD. But what exactly is this condition, and how can it affect incontinence as a whole? This article will answer these questions, so that you may gain a better understanding of the condition, so that you can prepare yourself on how this may affect incontinence, and how to manage the condition. 

elderly couple learning about incontinence associated dermatitis

Incontinence-Associated Dermatitis

Incontinence-associated dermatitis is a skin irritation caused by urine and faeces contacting the skin. It occurs in people who experience urinary or faecal incontinence, or both at the same time (dual or double incontinence).

Who can get Incontinence-Associated Dermatitis

Incontinence-associated dermatitis can occur in people who experience different types or levels of incontinence. IAD can be found in around 5.6% to 50% of cases, with occurrence rates ranging from 3.4% to 25% across different situations and groups. Around a third of people experiencing faecal incontinence commonly encounter incontinence-associated dermatitis.


Causes of Incontinence-Associated Dermatitis

Incontinence-associated dermatitis can be caused by the incorrect mixture of chemical and physical skin irritation. The contact of urine and faeces can affect and increase skin pH, which weakens the skin barrier and heightens infection risk. Friction contributes to physical irritation, further weakening the skin's defences. Using MoliCare® skin barrier cream can lessen these effects and aid in keeping the skin fresh. 


Clinical Features of Incontinence-Associated Dermatitis

In incontinence-associated dermatitis, noticeable signs include redness and swelling on genital and anal skin's curved parts, sometimes leading to blisters (bullae) and erosions. Depending on positioning, the rash's distribution can be symmetrical or asymmetrical.

During the acute phase, surrounding skin might appear wet and softened, while in the chronic phase, it could display dryness and peeling. Dermatitis might extend to skin folds or even areas not in direct contact with urine and faeces, although these regions typically experience milder effects.


What Could Happen Due To Incontinence-Associated Dermatitis

Incontinence-associated dermatitis can lead to notable irritation and discomfort, affecting both the person experiencing it and those providing care.

Skin infections, often caused by Candida albicans and Staphylococcus aureus, become more likely. In some cases, incontinence-associated dermatitis can even result in pressure ulcers of varying depths.

doctor assisting with incontinence associated dermatitis

Severity of Incontinence Associated Dermatitis

Symptom intensity depends on factors like the overall health of the skin, health and nutrition, and exposure to allergens. Those prone to leakage or accidents due to their specific incontinence condition might experience more severe IAD, as they have more frequent exposure to urine and faeces.

How To Get Diagnosed For Incontinence Associated Dermatitis

Diagnosing incontinence-associated dermatitis involves a few steps:


  • Visual Examination: Your GP can examine the affected skin. They'll look for redness, inflammation, and any other visible signs of irritation
  • Medical History: The doctor might ask about your symptoms, how long they've been present, and your history of incontinence.
  • Skin pH Test: In some cases, a pH test might be performed on the affected area. Increased pH levels can indicate the presence of incontinence-associated dermatitis.
  • Exclusion of Other Conditions: Sometimes, similar skin conditions might need to be ruled out. This could involve tests or assessments to differentiate between different skin issues.
  • Microbial Testing: If there's suspicion of infection, swabs might be taken from the affected area for laboratory testing to identify any present microorganisms.


How To Treat Incontinence Associated Dermatitis

You can help prevent and treat incontinence-associated dermatitis by following a good skin cleansing and care routine, using appropriate skin cleansers, and using barrier creams.

Manage incontinence by using appropriate methods. Consider:

  • Maintaining regular toileting routines.
  • Using appropriate absorbent pads or panties, changed when needed.
  • Intermittent or indwelling urinary catheters.
  • Systems like rectal catheters or anal bags for faecal management.

To treat incontinence-associated dermatitis:

  • Safeguard skin from further urine and faeces exposure.
  • Create a healing environment.
  • Address any accompanying infections.

For confirmed bacterial and fungal infections, antibiotics and antifungal agents are recommended.

doctor helping elderly indian lady with incontinence associated dermatitis

What to Expect from Incontinence Associated Dermatitis

Managing existing incontinence-associated dermatitis can be challenging and tends to reappear. Effective skin care and addressing incontinence, along with related infections or pressure sores, can lead to the clearance of the dermatitis or a reduction in its intensity.

Risk Factors and Preventative Measures

Risk Factors

Certain factors increase the likelihood of developing IAD:


  • Immobility or limited movement.
  • Being bedridden or using a wheelchair.
  • Impaired cognitive ability that prevents recognizing or communicating discomfort.
  • Specific medical conditions that cause urinary or faecal incontinence, such as neurological disorders.

Preventive Measures

Preventing IAD involves a multi-faceted approach:


  • Choosing fast-absorbing incontinence products.
  • Keeping the skin clean and dry.
  • Using pH-balanced skin cleansers.
  • Applying skin protectants or barrier creams.
  • Ensuring timely changes of incontinence products to prevent prolonged exposure.

Proper Skin Care

IAD's impact can be minimised with meticulous skin care practices such as the following:


  • Gently cleanse the affected area using mild, non-irritating cleansers.
  • Pat the skin dry instead of rubbing it.
  • Avoid products with alcohol, fragrance, or strong chemicals that can worsen irritation.
  • Use moisturisers to keep the skin hydrated and supple.
  • Utilise barrier creams to create a protective layer between the skin and urine/faeces.


Choosing Incontinence Products:

Selecting the right absorbent products is crucial:


  • Speak to a healthcare professional about the appropriate level of absorbency.
  • Choose products with features that minimise moisture exposure, such as fast absorbing, 3-layer absorbent core, skin pH balanced products. 
  • Ensure a proper fit to prevent leaks and friction.

Promoting Skin Healing

For established IAD cases, creating an environment conducive to healing is essential:


  • Keep the skin clean and dry to prevent infection.
  • Use prescribed creams to support healing.
  • Address any secondary infections promptly with prescribed antibiotics or antifungal medications.


Being Aware of IAD

Incontinence-associated dermatitis can pose different and unique challenges to anyone who comes across it and can affect comfort and well-being. Understanding its causes, symptoms, and management options in this article can aid in helping people deal with the condition. While treating established cases can be complex and recurring, diligent skin care, incontinence management, and infection control stand as crucial strategies. If conditions lessen or worsen, be sure to keep your GP informed throughout. For more information, our dedicated team at HARTMANN UK is always on hand to help too, and can recommend incontinence products that can aid your experiences with IAD.


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What causes incontinence-associated dermatitis?

IAD is primarily caused by the prolonged exposure of the skin to urine or faeces, which can lead to irritation, maceration (softening of the skin), and breakdown of the skin's natural protective barrier. Friction, pressure, and the presence of enzymes in urine and faeces further contribute to its development.

What are the symptoms of incontinence-associated dermatitis?

Common symptoms of IAD include redness, irritation, swelling, tenderness, and sometimes open sores or blisters on the affected skin. The skin may feel warm to the touch and may become painful if not managed promptly.

How is incontinence-associated dermatitis diagnosed?

Diagnosis is usually based on a visual examination of the affected area by a GP. In some cases, they may perform tests to rule out other possible skin conditions that may have similar symptoms.