FOCUS ON INCONTINENCE-RELATED SKIN DAMAGE
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SKIN CARE TODAY
2015,Vol 1, No 1
23
A
lthough bladder and bowel
problems are considered to
occur predominantly in the
older person, they can occur in all
age groups. It is possible that the
individual’s problem may be a result
of a progressive disease or illness
affecting more than one system
within the body. Consequently, it is
vital that healthcare professionals
undertake a thorough assessment of
the person, including their medical
and surgical history. Should they
have a specific continence issue
they will benefit from assessment
from a continence specialist. This
has been widely recognised by the
National Institute for Health and
Care Excellence (NICE; 2007, 2010,
2012, 2013, 2014) as being not only
in the best interests of the individual,
but also a measure that will ensure
that the appropriate, cost-effective
interventions are made.
Avoiding the deleterious effects of
incontinence-related skin damage
Pauline Beldon, retired tissue viability nurse
IN BRIEF
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POPULATION AFFECTED
BY INCONTINENCE
It is estimated that approximately six
million adults in the UK struggle to
control their bladder function (Irwin
et al, 2005), suffering with stress,
dribbling incontinence or even voiding
large amounts of urine. Prevalence is
estimated to be 15% in healthy older
adults and 65% of old frail adults
(Landi et al, 2003). However, it is likely
that this is an underestimation since
many adults may prefer to manage
their continence problems privately,
INCONTINENCE-ASSOCIATED DERMATITIS (IAD)
Incontinence-associated dermatitis (IAD) is common among
patients who are incontinent of faecal and/or urinary incontinence
(Beeckman et al, 2011). If urine is allowed to overhydrate the skin, the
moisture increases the skin’s:
i
Vulnerability to friction and shear
i
Permeability
i
Microbial load.
The predominant cause of IAD is that of the deleterious effect of
moisture, whether from urine or loose stool. Excessive moisture over-
hydrates the skin, causing it to become oedematous. As a result, the skin
becomes increasingly fragile and vulnerable to breakdown. Once small
tears appear in the skin, bacteria from either urine or faeces have the
potential to cause infection, leading to further inflammation.
rather than seek help. Buckley et
al (2007) concluded that men were
more likely to report a bladder-only
problem, while women were more
