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Skin care and incontinence

Definition

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

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

Bedsores (pressure sores) may also develop on people who:

• Have not been eating well (are malnourished)
• Have received radiation therapy to the area
• Spend most or all of the day in a wheelchair, regular chair, or bed

TAKING CARE OF YOUR SKIN

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

After urinating or having a bowel movement, clean and dry the area right away.

Clean the skin with mild, dilute soap and water. Rinse well, and gently pat dry.

Look for skin cleansers that do not cause dryness or irritation. These products include foams, non-aerosol sprays, and wet wipes (individual disposable towelettes). Be sure to follow the product's instructions. Some of the products do not rquire rinsing. Be aware that some people may have allergies to the fragrances used in these cleansers.

You may use moisturizing creams to keep the skin moist. Avoid products that have alcohol in them, because this may irritate the skin. If you are receiving radiation therapy, ask your health care provider if it is okay 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) can create a clear, protective film over the skin. A doctor or nurse can recommend barrier creams to help protect the skin.

Even if you use these products, you must still clean the skin after each episode of incontinence. Reapply the cream or ointment after cleaning and drying the skin.

People who often have incontinence problems may develop a yeast infection on the skin. An itchy, red, pimple-like rash appears. The skin may feel raw.

There are several products (both over-the-counter and prescription) that can be used to treat the yeast infection. If the skin is moist most of the time, you may use a powder with antifungal medication (such as nystatin powder). A moisture barrier or skin sealant may be applied over the powder. If severe skin irritation develops, see your health care provider.

The National Association For Continence (NAFC) publishes a resource guide of continence products and services, which includes a listing of the manufacturers and distributors of specific products. To get a copy of this resource guide, call 1-800-BLADDER or go to the website www.nafc.org.

IF YOU ARE BEDRIDDEN OR USING A WHEELCHAIR

You or your caregiver should check the skin for pressure sores every day. Look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters.

Eat healthy, well-balanced meals that contain enough calories and protein to keep you healthy.

People who must stay in bed should:

• Change positions often, at least every 2 hours
• Have clean sheets and clothing
• Use items that can help reduce pressure (pillows, sheepskin, foam padding)

People who use a wheelchair should:

• Make sure the chair fits properly
• Shift their weight every 15 - 20 minutes
• Use items that can help reduce pressure (pillows, sheepskin, foam padding)

References

Nviriesy P. Vulvovaginal candidiasis and bacterial vaginosis. Infect Dis Clin North Am. 2008;22:637-652.

Buestein D, Javaheri A. Pressure ulcers: prevention, evaluation, and management. Am Fam Physician. 2008;78:1186-1194.