Many people who have incontinence will experience incontinence-associated dermatitis (IAD) at one point or another. This is especially common in older adults.
Incontinence refers to your body’s inability to control the release of urine or stool. IAD occurs when the protective barrier created by your skin is damaged.
Exposure to the bacteria in urine or stool can result in painful symptoms, such as burning and itching. The condition primarily affects the area around your genitals, thighs, and abdomen.
You should have your doctor review any area you suspect is affected by the condition. Your doctor will help you determine how to best manage and treat your incontinence and IAD. In most cases, IAD is temporary and will clear up with treatment.
IAD may also be referred to as perineal dermatitis, irritant dermatitis, moisture lesions, or even diaper rash, though these are all different conditions.
Keep reading to learn how to identify IAD, options for treatment, and more.
How to recognize IAD
Healthy skin works as a barrier between the environments outside and inside your body. IAD can erode this barrier, causing severe and uncomfortable symptoms.
Symptoms of IAD include:
- redness, ranging from light pink to dark red, depending on skin tone
- patches of inflammation or a large, continuous area of inflammation
- warm and firm skin
- pain or tenderness
IAD can affect skin on many parts of your body, including the:
- labial folds (in women)
- groin (in men)
- gluteal cleft
- upper thighs
- lower abdomen
The severity of your symptoms depends on several factors, including:
- the condition of your skin tissue
- overall health and nutrition
- allergen exposure
If you have a form of incontinence that makes you more prone to leakage or accidents, you may also experience more severe IAD. This is because your skin is more frequently exposed to urine and stool.
Pictures of IAD
Causes of IAD
This condition is directly related to incontinence. The skin, when exposed to urine or feces regularly, can become inflamed. The condition is worse for those with fecal incontinence, as stool can irritate the skin more than urine.
In many cases, IAD is caused by:
- an increase in the skin’s pH level
- the creation of ammonia by urinary and fecal incontinence
- skin erosion from bacteria breaking down protein in keratin-producing cells
Attempts to clean the area may result in IAD due to:
- overhydrating the skin
- friction caused by absorbent pads or other materials, including underwear and bed linens
- frequent cleaning of the affected area with soap and water
Ineffective or poor condition management can also lead to IAD. This includes:
- prolonged exposure to urine and feces
- inadequate cleaning of the exposed area
- the application of thick ointments
- the use of abrasive washcloths
Your individual symptoms can help your doctor determine the exact cause of your IAD.
How IAD is diagnosed
If you’re experiencing symptoms of IAD, consult your doctor. Often your doctor will be able to make a diagnosis after reviewing the affected areas and discussing your medical history.
Your doctor will ask you about your incontinence, as well as discuss other factors that may be contributing to your skin condition.
If your symptoms are unclear or if you have extenuating health factors, your doctor may wish to rule out certain look-a-like conditions.
Once your doctor makes a diagnosis, they will go over your treatment options. Depending on the cause of your IAD, they may make additional recommendations on how to effectively manage incontinence.
How to treat IAD
Historically, incontinence has been managed by cleaning affected areas with soap and water. Soap can dry and rub the skin, leading to inflammation. This can result in IAD and is no longer a standard practice of care.
Treating IAD is a multiple-step process, outlined here.
- Use gentle linens to clean the area.
- Wash the area with a cleanser that balances your skin’s pH level.
- Add moisture back into your skin with hydrogel or petroleum-based products.
- Protect the area with products containing zinc oxide.
- Wear absorbent or containment pads to help manage any urine leakage.
Your doctor may be able to recommend an all-in-one product that cleanses, moisturizes, and protects.
If you’ve developed any secondary infection, your doctor may prescribe a topical antifungal or oral antibiotic medication.
Complications of IAD
People who develop IAD are more likely to develop pressure ulcers, or bed sores. This is typically seen in older adults or people who have a medical condition that limits their ability to switch positions.
The symptoms for bed sores are usually the same as for IAD:
- broken skin
- pain or tenderness
If you think you’re developing bed sores, see your doctor. Mild bed sores can be successfully treated over time. Treatment for more severe bed sores focuses on symptom management.
IAD can also lead to other secondary skin infections. These are typically caused by Candida albicans, a fungus that comes from the gastrointestinal tract, or Staphylococcus, which is bacteria from the perineal skin.
If you develop a secondary infection, you may experience:
- pain during urination
- unusual discharge
These infections require different treatment from IAD and should be diagnosed by a doctor.
Managing IAD goes along with managing incontinence. You should see your doctor to discuss management plans for both conditions.
If you do have IAD, treating the condition is essential to controlling its severity. If left untreated, IAD can lead to additional complications. Using proper prevention techniques will lessen your chances of experiencing IAD flare-ups in the future.
How to prevent future episodes of IAD
The only way to reduce your risk for IAD is to be diligent in incontinence management. You should protect your skin, clean it with appropriate products, and change absorbent or containment pads regularly. However, even with proper care, it’s still possible to develop IAD.