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Skin care and incontinence

Incontinence - skin care; Incontinence - pressure sore; Incontinence - pressure ulcer; Incontinence - bed sore

A person with incontinence is not able to prevent urine and stool from leaking. This can lead to skin problems near the buttocks, hips, genitals, and between the pelvis and rectum (perineum).

Information

People who have problems controlling their urine or bowels (called incontinence) are at risk for skin problems. The skin areas most affected are near the buttocks, hips, genitals, and between the pelvis and rectum (perineum).

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

Bedsores (pressure sores) may also develop if a person:

  • Has not been eating well (is malnourished)
  • Received radiation therapy to the area
  • Spends most or all of the day in a wheelchair, regular chair, or bed without changing position

TAKING CARE OF THE SKIN

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

  • Cleaning and drying the area right away after urinating or having a bowel movement.
  • Cleaning the skin with mild, dilute soap and water then rinsing well and gently patting dry.

Use soap-free skin cleansers that do not cause dryness or irritation. Follow the product's instructions. Some products do not require rinsing.

Moisturizing creams can help keep the skin moist. Avoid products that contain alcohol, which may irritate the skin. If you are receiving radiation therapy, ask your health care provider if it is OK 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, create a clear, protective film over the skin. Your provider can recommend barrier creams to help protect the skin.

Even if these products are used, the skin must still be cleaned each time after passing urine or stool. Reapply the cream or ointment after cleaning and drying the skin.

Incontinence can cause a yeast infection on the skin. This is an itchy, red, pimple-like rash. The skin may feel raw. Products are available to treat a yeast infection:

  • If the skin is moist most of the time, use a powder with antifungal medicine, such as nystatin or miconazole. Do not use baby powder.
  • A moisture barrier or skin sealant may be applied over the powder.
  • If severe skin irritation develops, contact your provider.
  • If bacterial infection occurs, antibiotics applied to the skin or taken by mouth may help.

The National Association for Continence (NAFC) has helpful information at www.nafc.org.

IF YOU ARE BEDRIDDEN OR USING A WHEELCHAIR

Check your skin for pressure sores every day. Look for reddened areas that do not turn white when pressed. Also look for blisters, sores, or open ulcers. Tell your provider if there is any foul-smelling drainage.

A healthy, well-balanced diet that contains enough calories and protein helps keep you and your skin healthy.

For people who must stay in bed:

  • Change your position often, at least every 2 hours
  • Change sheets and clothing right away after they are soiled
  • Use items that can help reduce pressure, such as pillows or foam padding

For people in a wheelchair:

  • Make sure your chair fits properly
  • Shift your weight every 15 to 20 minutes
  • Use items that can help reduce pressure, such as pillows or foam padding

Smoking affects healing of the skin, so stopping smoking is important.

Open References

References

Bliss DZ, Mathiason MA, Gurvich O, et al. Incidence and predictors of incontinence associated skin damage in nursing home residents with new onset incontinence. J Wound Ostomy Continence Nurs. 2017;44(2):165-171. PMID: 28267124 pubmed.ncbi.nlm.nih.gov/28267124/.

Boyko TV, Longaker MT, Yang GP. Review of the current management of pressure ulcers. Advances in Wound Care (New Rochelle). 2018;7(2):57-67. PMID: 29392094 pubmed.ncbi.nlm.nih.gov/29392094/.

Harper A, Wilkinson I, Preston Jo. Geriatric medicine, frailty and multimorbidity. In: Feather A, Randall D, Waterhouse M, eds. Kumar and Clark's Clinical Medicine. 10th ed. Philadelphia, PA: Elsevier; 2021:chap 15.

James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Dermatoses resulting from physical factors. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 3.

Khansa I, Janis JE. Pressure sores. In: Song DH, Hong JP, eds. Plastic Surgery: Volume 4: Lower Extremity, Trunk, and Burns. 5th ed. Philadelphia, PA: Elsevier; 2024:chap 16.

  • Urinary incontinence

    Animation

    •  

    Urinary incontinence - Animation

    When you enter a store or restaurant, are you often looking to find the establishments bathroom? If you're having trouble holding in your urine, or if you often leak urine, you probably have what's called urinary incontinence. Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow more and more urine. You should feel the first urge to urinate when there is about 200 mL, just under 1 cup of urine stored in your bladder. A healthy nervous system will respond to this stretching sensation by letting you know that you have to urinate. But, at the same time, the bladder should keep filling. But the system doesn't work correctly in people with urinary incontinence. Some people with urinary incontinence leak urine during activities like coughing, sneezing, laughing, or exercise. This is called stress incontinence. When you have a sudden, strong need to urinate, but can't make it to the bathroom before you do urinate, it's called urge incontinence. Other people have what's called overflow incontinence, when the bladder cannot empty and they dribble. Urinary incontinence can have many causes, and it's most common in older adults. Women are more likely than men to have it. For some people the bladder muscle is overactive. For others, the muscles holding the urine in are weak. And for others, the problem is sensing when the bladder is full. They might have brain or nerve problems, dementia or other health problems that make it hard to feel and respond to the urge to urinate, or problems with the urinary system itself. To treat urinary incontinence, your doctor can help you form a treatment plan. Most likely, exercises to strengthen the muscles of your pelvic floor will be part of that plan. Bladder training exercises can also be effective. And depending on the cause of incontinence, oral medications, or topical estrogen may be helpful. If you have overflow incontinence and cannot empty your bladder completely, you may need to use a catheter. Your doctor can recommend the best catheter for you. For urine leaks, you might wear absorbent pads or undergarments. Whatever else you try, lifestyle changes may help. Aim for an ideal weight. Losing excess weight and increasing exercise both often improve incontinence, especially in women. Also, some specific beverages and foods might increase leaking in some people. For instance, you might try eliminating alcohol, caffeine, carbonated beverages, even decaf coffee. Drink plenty of water, but do NOT drink anything 2 to 4 hours before going to bed. Be sure to empty your bladder before going to bed to help prevent urine leakage at night. Throughout the day, urinate at set times, even if you do not feel the urge. Schedule yourself every 3 to 4 hours. Urinary incontinence is very common, but many people never talk to their doctor about it. Don't let that be you. See your doctor and bring it up at your next doctor's visit.

  • Areas where bedsores occur

    Areas where bedsores occur - illustration

    Bedsores, also known as pressure sores or decubitis ulcers, are a breakdown and ulceration of tissue due to a combination of the weight of the body on the surface of the skin and the friction of a resistant surface such as a bed. Areas where bony prominences are less padded by muscle and fat, such as the hip bones, tailbone and heels of the feet, are most susceptible to bedsores. Non-mobile patients are vulnerable to the formation pressure sores when left lying for long periods of time in the same prone position.

    Areas where bedsores occur

    illustration

  • Urinary incontinence

    Animation

    •  

    Urinary incontinence - Animation

    When you enter a store or restaurant, are you often looking to find the establishments bathroom? If you're having trouble holding in your urine, or if you often leak urine, you probably have what's called urinary incontinence. Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow more and more urine. You should feel the first urge to urinate when there is about 200 mL, just under 1 cup of urine stored in your bladder. A healthy nervous system will respond to this stretching sensation by letting you know that you have to urinate. But, at the same time, the bladder should keep filling. But the system doesn't work correctly in people with urinary incontinence. Some people with urinary incontinence leak urine during activities like coughing, sneezing, laughing, or exercise. This is called stress incontinence. When you have a sudden, strong need to urinate, but can't make it to the bathroom before you do urinate, it's called urge incontinence. Other people have what's called overflow incontinence, when the bladder cannot empty and they dribble. Urinary incontinence can have many causes, and it's most common in older adults. Women are more likely than men to have it. For some people the bladder muscle is overactive. For others, the muscles holding the urine in are weak. And for others, the problem is sensing when the bladder is full. They might have brain or nerve problems, dementia or other health problems that make it hard to feel and respond to the urge to urinate, or problems with the urinary system itself. To treat urinary incontinence, your doctor can help you form a treatment plan. Most likely, exercises to strengthen the muscles of your pelvic floor will be part of that plan. Bladder training exercises can also be effective. And depending on the cause of incontinence, oral medications, or topical estrogen may be helpful. If you have overflow incontinence and cannot empty your bladder completely, you may need to use a catheter. Your doctor can recommend the best catheter for you. For urine leaks, you might wear absorbent pads or undergarments. Whatever else you try, lifestyle changes may help. Aim for an ideal weight. Losing excess weight and increasing exercise both often improve incontinence, especially in women. Also, some specific beverages and foods might increase leaking in some people. For instance, you might try eliminating alcohol, caffeine, carbonated beverages, even decaf coffee. Drink plenty of water, but do NOT drink anything 2 to 4 hours before going to bed. Be sure to empty your bladder before going to bed to help prevent urine leakage at night. Throughout the day, urinate at set times, even if you do not feel the urge. Schedule yourself every 3 to 4 hours. Urinary incontinence is very common, but many people never talk to their doctor about it. Don't let that be you. See your doctor and bring it up at your next doctor's visit.

  • Areas where bedsores occur

    Areas where bedsores occur - illustration

    Bedsores, also known as pressure sores or decubitis ulcers, are a breakdown and ulceration of tissue due to a combination of the weight of the body on the surface of the skin and the friction of a resistant surface such as a bed. Areas where bony prominences are less padded by muscle and fat, such as the hip bones, tailbone and heels of the feet, are most susceptible to bedsores. Non-mobile patients are vulnerable to the formation pressure sores when left lying for long periods of time in the same prone position.

    Areas where bedsores occur

    illustration

A Closer Look

 

Talking to your MD

 

Self Care

 
 

Review Date: 2/15/2024

Reviewed By: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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