Human - Incontinence-Associated Dermatitis...What Next?

Incontinence-Associated Dermatitis...What Next?

by Linda Verde 

It’s sore! It itches! And, unless you are a contortionist, you can’t see what is causing the pain. A mirror might help, but it’s still awkward to see your bottom. Incontinence-associated dermatitis (IAD) seems like heaping insult onto injury when it comes to your dignity. Treating and preventing IAD, then, is a noble cause.

What is Incontinence-associated-dermatitis?

Incontinence-associated-dermatitis is skin damaged from exposure to urine or feces. It has many names: Irritant dermatitis, perineal dermatitis, perineal rash, diaper or nappy rash or dermatitis, moisture ulcers or moisture lesions.  Inconsistencies in describing the extent and degree of the condition, make it difficult to get an accurate understanding of its prevalence; even so, McNichol and colleagues believe IAD is under-reported. Still, they looked at studies of a variety of ages and settings and found it ranged from 7% to 35% in infants and the elderly and in acute care up to 50% of patients with diarrhea.

 Symptoms of IAD

  • Redness – light pink to dark red depending on skin tone
  • Patches or large area of inflammation
  • Warm and firm skin lesions
  • Pain or tenderness
  • Burning
  • Itching

How do you know if you have IAD?

Besides its many names, IAD is sometimes misdiagnosed as pressure ulcers because they often occur together. However, IAD works from the outside (skin side) in. The skin is damaged from the resulting wetness of urine or feces, or both. As the skin’s surface pH changes skin breaks down more easily. Such damage also predisposes skin to pressure ulcers. The constant stress exerted from remaining in the same position for long periods of time is one of the major causes of pressure sores. Pressure sores, though, work from inside out. The stress and slight sideways movement of bones constantly presses against tissue causes swelling that starts at the bone and expands out to the skin surface.

When there is skin weakened from urine or feces, the skin is more likely to breakdown.  Silver states that untreated, IAD can lead to secondary skin infections such as a yeast infection (Candida albicans) or a bacterial infection (caused by the skin bacteria Staphylococcus). These complications decrease your quality of life and increase health care system costs.  

What's the best way to treat IAD? 

  • Protect skin from further exposure to irritants
  • Establish a healing environment
  • Eliminate any skin infection*

Foam cleansers or wipes with emollients, clean and moisturize the area without causing excess wetness. In care facilities these products decrease staff time needed for perineal skin care. Gray suggests a daily cleansing regimens along with cleaning after each incontinence episode.

 Key Prevention Recommendations: A C T for IAD

  • Assess
  • Cleanse skin, correct cause, contain incontinence
  • Treat vulnerable skin and avoid traumatic skin injury

 Correcting incontinence is the best insurance against skin damage. Excess moisture from urine and feces breaks down the skin’s natural moisture barrier, and enzymes in feces accelerate the deterioration. Keeping clean and dry is key. Newer absorbent pad technology is designed to keep wetness away from the skin.


If IAD isn't able to be corrected, managing incontinence with a urine catheter or an indwelling fecal drainage system temporarily gives your skin a chance to heal. These are not long-term solutions. Gray also cautions against routinely using topical antimicrobial or steroid-based products. 

 So, take up the noble cause. Address incontinence-associated-dermatitis to reclaim dignity, independence, participation in activities, and even to get a good night’s sleep. You deserve it!

 *Taken from Gray, Beeckman et al., 2012

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