Protecting skin from the effects of incontinence is crucial to avoid discomfort and prevent severe complications, writes Dr Harikrishna K. Ragavan Nair
SKIN, the largest organ of the human body fulfils a variety of vital functions but it does not always get the attention it deserves.
With a total area of approximately 1.86 square metres (20 square feet) consisting of three interconnected layers — epidermis, dermis and subcutaneous —our skin has many functions, among them, acting as a protective barrier between the body and the external environment.
Therefore, any damage to the skin can compromise this barrier and lead to a range of effects, including discomfort, increased risk of infection and in some severe cases, skin breakdown.
The occurrence of skin breakdown is fairly common and may lead to a wide range of potentially serious and debilitating complications.
Among the most challenging and concerning causes of skin breakdown is incontinence. Prevention of skin breakdown in these situations requires excellent management of the predisposing cause and protection for vulnerable skin. Ideally skin protectants need to be effective, easy and comfortable to apply, long lasting and most importantly, cost effective.
INCONTINENCE AND IMPLICATIONS
Incontinence is a medical condition and a set of diseases that defines any accidental or involuntary loss of urine from the bladder (urinary incontinence) or faeces from the bowel (faecal incontinence).
According to the Global Forum on Incontinence, this condition affects between 4 to 8 per cent of the population or the lives of almost 400 million people worldwide.
Despite the high prevalence and the social and economic implications of the condition, incontinence is still not a priority on the health and social policy and stakeholder agenda worldwide.
Inadequate or poor management of incontinence can eventually result in a loss of patient dignity, prolonged hospital stays as well as increased patient care costs.
INCONTINENCE AND SKIN
Faecal and urinary incontinence leaves the ageing population at risk for impaired skin integrity. Prolonged exposure to urine and faeces is one of the most common causes of skin breakdown and it makes the skin more susceptible to injuries.
Incontinence-Associated Dermatitis (IAD) is a common condition related to incontinence. Also widely known as perineal dermatitis or diaper rash, this medical condition affects all age groups from infancy to old age.
IAD is predominantly a chemical irritation resulting from faeces or urine coming into contact with the skin.
Enzymes from faeces and ammonia from urine can disrupt the acid mantel of the skin and eventually cause the skin to break down.
The affected area will have erythema (reddening of the skin), as well as maceration. The area may also progress to having painful, partial-thickness erosions with weepy serous exudate.
If left untreated, pressure and friction may increase stress on the affected area, leading to skin breakdown. IAD is not necessarily limited to the perineal area and can extend up onto the lower back or down onto the inner thighs, depending on the areas exposed to urine and stool.
PROTECTING THE SKIN
While urinary incontinence may lead to IAD, it is much more common in individuals with faecal incontinence or mixed urinary and faecal incontinence. Therefore, maintaining skin integrity is crucial.
For patients whose skin is regularly exposed to irritant bodily fluids such as urine or faeces, protection layer is required and a product that acts as a protective layer is highly recommended.
The writer is head of Wound Care Unit, Kuala Lumpur Hospital.
Barrier cream
THE 3M Cavilon Durable Barrier Cream is specially formulated to create a barrier to protect the skin from bodily fluids such as urine and faeces while also moisturising the affected parts. It helps form a thin yet durable barrier on the skin, which is vital in preventing skin breakdown.
By preventing over-hydration of the skin’s outer layer (epidermis), the cream also lowers the risk of further skin damage due to incontinence, such as sores, erythema, inflammation, erosion and maceration. Being a highly concentrated cream, it provides long-lasting protection from bodily fluids for up to three to four washes without the need for frequent reapplication.
The cream, clinically proven to reduce IAD, can also be used in conjunction with moisture-retentive adhesive dressings that promote healing, such as transparent film and hydrocolloids.