IAD happens when skin is exposed to moisture, especially from urine and stool, for extended periods. This constant wetness, combined with friction from movement or clothing, damages the skin.
“I frequently see mild incontinence-related dermatitis in patients who are new to incontinence. Often, they just recently started wearing a pad or a disposable undergarment,” says Elizabeth Kiracofe, MD, a dermatologist at AIRIA Comprehensive Dermatology in Chicago.
Friction from adult diapers, clothing, or bed surfaces can increase the risk of IAD. So can bacteria that transform urine into ammonia, which can increase skin pH and irritation.
“Sometimes people with incontinence-associated dermatitis also have decreased sensation in the area, and so they’re not aware that they’re feeling wetness,” Dr. Kiracofe says.
Moderate to severe IAD is more likely in older adults who have limited mobility or live in long-term care facilities.
In this case, it’s not just prolonged exposure to urine, but also stool, which can cause the skin — particularly the epidermis, the skin’s outer layer — to be very vulnerable, says Murphree.
That’s because the same enzymes that digest food in the small intestine are still present in stool, though in a smaller amount, and those can break down skin tissue. “Stool, even solid stool, contains proteolytic enzymes that can ‘eat’ our skin,” Murphree says.
Other risk factors for IAD include:
- Older age or limited mobility
- Female sex
- Diabetes or dementia
- Overweight or obesity
- Smoking
- Adult diapers or pads worn for too long after they are soiled
- Inadequate or infrequent bathing
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