Incontinence Associated Dermatitis (IAD) Defined
Incontinence-associated dermatitis (IAD) is a display of moisture-associated skin damage and is a common problem in patients with fecal or urinary incontinence. IAD, also known as Perineal Dermatitis, presents clinically as skin redness and irritation with or without blistering, skin erosion or loss of skin barrier function. Elderly patients, particularly those in long term care facilities, are at increased risk of developing IAD and it appears those with fecal incontinence are at a greater risk of developing IAD vs. those with urinary incontinence alone. NOTE: It is important to note that IAD and Pressure Sores (Bedsores) are not the same thing, are treated differently, and are not necessarily correlated. Please also see pressure relief air mattresses and wedges for additional help in warding off pressure sores.
Incontinence Associated Dermatitis (IAD) Origins
The origin of IAD is complex but often its presence can be attributed to a combination of factors: as the perineal skin is exposed to longer duration of contact with urine, feces, frequent cleansing, and increased friction from containment products, the integrity of the skin is compromised. Increased skin pH can cause it to become more alkaline and increase the risk of fungal and bacterial colonization, which in combination with weakened skin, can lead to IAD and further skin breakdown. Additional research on the causes of IAD can be found here
Eliminating IAD: Cleanse, Protect and Repair
Cleansers: The first line of defense is keeping the skin clear of harmful contaminants such as urine and feces. Start with a gentle, large wipe to remove these impurities. Next, a regular washing with specially prepared perineal cleansers will not only keep the diaper area clean, but can also be used on the whole body, with or without the need to rinse. Whether a patient is bedridden or not, this is an easy way to keep their skin free of acidic and bacterial matter so no breakdown occurs. Be careful to select a product which states "perineal or genital area" in the description when using a product for that very sensitive portion of the body. Moisture must be added to the skin in the process of skin cleansing and therefore a washing product that includes a moisturizing ingredient is essential. Soap and water are too harsh for continual cleansing of the perineal area!
Barrier Creams: When the skin has been thoroughly cleaned, a barrier cream or ointment should be applied to protect the skin between changes. These can soothe compromised skin as well as protect it from further irritation. Thicker than lotions, barrier creams form a defensive shield to block toxins and maintain skin integrity. We strongly advocate the use of barrier creams for overnight use in conjunction with super-absorbent incontinence briefs and or underwear.
Repair: Despite rigorous attempts to keep the skin clean and protected, occasional redness and rashes will occur. It is vital to repair these breakdowns as quickly as possible, before more discomfort and damage follow. These products will help heal dry, itchy, reddened or inflamed skin, and restore the skin pH of the perineal area.
The use of diapers and potential incontinence skin problems is not just limited to the elderly. Patients experiencing reduced mobility will require special attention paid to the cleaning and protecting of their skin as well. There are many products to help maintain skin integrity, cleanliness and good health. Let us help you find the ones for your specific needs.