People who experience urinary and/or fecal (bowel) incontinence are at great risk for skin breakdown, ulceration, and infection. Additionally, certain people are even more susceptible to skin breakdown, including those who have received radiation therapy to the perineum or who are confined to a wheelchair or bed.
Use of diapers and other containment devices may prevent the bedding and clothing from getting soiled, however they tend to keep the urine or stool in constant contact with the skin. Within a short period of time, the skin can become damaged. Special care must be taken to prevent skin breakdown by keeping the skin clean and dry.
The skin and perineal area should be promptly cleansed after each incontinence occurrence. Cleanse the skin with a mild soap and water, rinse thoroughly, and gently pat dry. Frequent cleansing of the skin may cause drying and irritation. Moisturizing creams may be applied to keep the skin moist, however, avoid products that contain alcohol since this may further irritate the skin. If you are receiving radiation therapy to the skin or perineal area, consult with your radiation oncologist prior to using any creams and lotions.
Several skin cleansers are available that are specifically designed to cleanse and deodorize the skin without causing excessive dryness or irritation. These products include foams, non-aerosol sprays, and wet wipes (individual disposable towelettes). Follow the manufacturer’s instructions on use of these products, since some of these products do not require rinsing. Be aware that some people may have allergies to the fragrances that are used in these products.
If there is constant exposure to urine or stool, you should consider using a skin sealant or moisture barrier to protect the skin. There are several creams or ointments that contain lanolin or petrolatum which forms a protective barrier to the urine or stool. Other skin care products (often in the form of a spray or a towelette) actually create a transparent film over the skin, thus protecting the skin from the caustic effects of urine on the raw skin.
Use of these products does not replace the need to cleanse the skin after each incontinence occurrence. You must re-apply the cream or ointment after thoroughly cleansing and drying the skin.
People who are frequently incontinent are at high risk for developing a yeast infection (Candida albicans) on the skin. The rash appears as an area of red pimple-like lesions with satellite lesions. The skin may itch and 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 constantly moist, a medicated antifungal powder (such as Mycostatin powder) may be used. A moisture barrier or skin sealant may be applied over the powder. An antifungal cream is also available for use in people who have a yeast infection on dry, cracked skin. If severe skin irritation develops, see your health care provider.
Several different skin care products are commercially available. An urology nurse or enterostomal therapy nurse can provide you with a list of incontinence care products.
Also, 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 obtain this resource guide call 1-800-BLADDER or go to the website http://www.nafc.org.
by Martin A. Harms, M.D.
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.