Continence-Related Sensitive Skin: Understanding and Managing Incontinence-Associated Dermatitis
Learn how to protect and care for skin affected by incontinence. Practical guidance on preventing IAD, barrier creams, and skincare routines.
What is Incontinence-Associated Dermatitis?
Incontinence-associated dermatitis (IAD) is skin damage caused by prolonged or repeated exposure to urine, faeces, or both. If you use continence pads or have any form of urinary incontinence, you’re at risk of developing this condition. The skin in the perineal area, inner thighs, buttocks, and lower abdomen becomes irritated, red, and sometimes breaks down entirely.
IAD isn’t just uncomfortable—it’s surprisingly common. Studies suggest that between 25% and 50% of people using continence products experience some degree of skin damage 1. In care home settings, rates can be even higher. Yet many people suffer in silence, assuming sore skin is just an inevitable consequence of bladder problems. It isn’t.
The condition goes by several names in medical literature: perineal dermatitis, moisture-associated skin damage (MASD), and sometimes “nappy rash” when people are being less clinical about it. Whatever you call it, the mechanism is the same: moisture and irritants from bodily waste break down the skin’s natural protective barrier.
How IAD Develops
Your skin has a remarkable ability to protect itself, but it wasn’t designed to withstand constant moisture. The outermost layer, the stratum corneum, acts as a barrier against irritants and infection. When skin stays wet for extended periods, this barrier softens and becomes permeable—a process called maceration.
Urine isn’t sterile once it leaves the bladder. Bacteria on the skin convert urea in urine into ammonia, which raises the skin’s pH. Healthy skin sits at around pH 5.5 (slightly acidic), but exposure to urine can push this toward alkaline levels. An alkaline environment damages the acid mantle, activates faecal enzymes, and makes skin more vulnerable to friction and bacterial infection 2.
Faeces presents an even greater challenge. Digestive enzymes, particularly lipases and proteases, actively break down skin cells. Combined with the bacteria present in stool, faecal incontinence causes more severe and rapid skin damage than urinary incontinence alone. People with double incontinence (both urinary and faecal) face the highest risk.
Add friction from incontinence pads rubbing against compromised skin, and you have a recipe for breakdown. This is why IAD often appears in skin folds and areas where products sit against the body most closely.
Recognising the Signs
IAD typically develops gradually, though it can appear within hours in some situations. Early recognition gives you the best chance of preventing progression to more serious skin breakdown.
Early stage signs:
- Redness that doesn’t fade when pressed (unlike temporary flushing)
- Skin feels warm to the touch
- Mild burning or stinging sensation
- Skin looks shiny or “wet” even when recently dried
Progressive damage:
- Defined areas of inflammation, often matching pad boundaries
- Blistering or peeling
- Erosions (shallow breaks in the skin surface)
- Oozing or weeping areas
- Pain during cleaning or pad changes
Severe IAD:
- Open wounds
- Secondary fungal infection (often presenting as satellite lesions—small red spots around the main affected area)
- Bacterial infection (increased pain, pus, spreading redness, fever)
- Deep tissue damage
The pattern of IAD often gives clues about its cause. Urinary incontinence typically affects the groin, inner thighs, and lower buttocks symmetrically. Faecal incontinence causes damage centred on the perianal area. Mixed incontinence affects a wider region.
Prevention: The Foundation of Skin Health
Managing IAD successfully requires addressing the underlying cause where possible. If you have overactive bladder or stress urinary incontinence, effective treatment of your bladder condition reduces skin exposure to moisture. Even partial improvement in continence can make a substantial difference to skin health.
That said, complete continence isn’t always achievable, and many people need ongoing strategies to protect their skin.
Choose Appropriate Continence Products
The type and absorbency of continence products matters enormously. Products should match your level of incontinence—using pads with insufficient absorbency means skin stays wet longer, while overly bulky products can increase friction and heat.
Look for products with a “stay-dry” layer that wicks moisture away from the skin surface. Modern continence pads use superabsorbent polymers that lock fluid into gel form, keeping the skin-facing surface relatively dry. Change products promptly when saturated rather than waiting for scheduled times.
I should mention that no particular brand outperforms all others in research studies. What works best depends on your anatomy, the nature and volume of your incontinence, your activity level, and personal preference. Finding the right product often involves some trial and error.
Gentle Cleansing
Overly aggressive cleansing does more harm than good. Scrubbing damaged skin or using harsh soaps strips away what remains of the protective barrier and introduces friction damage.
The NHS recommends gentle cleansing with pH-balanced products specifically designed for incontinence care, or simply lukewarm water 3. Avoid standard soap, which tends to be alkaline and drying. If you use wipes, choose those formulated for sensitive skin without alcohol or fragrances.
Pat skin dry rather than rubbing. Allow the area to air-dry briefly before applying any products or fresh pads, as even a minute or two of air exposure helps restore the skin’s natural environment.
Barrier Products: Your Skin’s Shield
This is where prevention becomes active rather than passive. Barrier products create a protective layer between skin and irritants, much like a raincoat for your perineum. They fall into several categories:
Petrolatum-based products (petroleum jelly) provide excellent moisture protection and have been used for decades. They’re inexpensive and widely available. The downside is that thick layers can reduce the absorbency of some continence products and be messy to apply.
Zinc oxide creams offer barrier protection plus some healing properties. Many nappy rash creams fall into this category. They’re effective but again can be thick and difficult to spread.
Silicone-based barrier films represent newer technology. They form a breathable, long-lasting barrier that doesn’t interfere with pad absorbency. Some can be applied as sprays or wipes, making application easier for people with limited mobility. These products often need reapplication only once or twice daily rather than after every pad change.
Acrylate-based barrier films work similarly to silicone products and include several clinical-grade options used in hospitals. They create a transparent protective layer that allows clinicians to monitor skin condition while still providing protection.
Which type works best for you depends on your skin condition, the nature of your incontinence, and practical factors like how often you can apply products. Someone with mild urinary incontinence might manage well with petroleum jelly applied after morning and evening cleansing. Someone with frequent faecal incontinence may need a longer-lasting barrier film.
Moisture Management Beyond Products
Environmental factors matter too. Breathable clothing and loose-fitting trousers reduce heat and moisture accumulation. Cotton underwear allows better airflow than synthetic fabrics. Sitting for extended periods without position changes increases pressure and moisture buildup—regular repositioning helps.
If you’re managing incontinence at night, waterproof mattress protectors are essential for your mattress but shouldn’t be placed directly against skin. Use appropriate continence products as the interface between your body and any waterproof surfaces.
Treating Established IAD
Once IAD has developed, the goals shift to healing damaged skin while preventing further deterioration. The principles remain the same—reduce moisture exposure, protect from irritants, treat any infection—but intensity increases.
Mild to moderate IAD often responds well to consistent application of the prevention measures described above. Ensure thorough but gentle cleansing, apply barrier products regularly, and consider more frequent pad changes temporarily.
When to involve a healthcare professional:
- Skin breakdown with open areas
- Signs of infection (increasing pain, pus, spreading redness, fever)
- IAD that doesn’t improve despite consistent prevention measures
- Uncertainty about whether you’re dealing with IAD or another condition
Healthcare professionals can prescribe stronger barrier products, antifungal treatments if yeast infection is present, topical antibiotics for bacterial infection, or low-potency topical steroids for severe inflammation. They can also assess whether underlying continence issues can be better managed.
I’ve seen people struggle for months with skin problems before mentioning it to a doctor, often because they’re embarrassed or assume nothing can be done. Clinicians who work with continence issues see IAD regularly—it won’t surprise or shock them, and they have effective treatments available.
The Difference Between IAD and Pressure Ulcers
IAD and pressure ulcers (bedsores) can look similar and may even occur together, but they develop through different mechanisms and require different management. Distinguishing between them matters because the treatment priorities differ.
IAD results from moisture and chemical irritation. It affects superficial skin layers, follows the distribution of moisture exposure, and often has irregular, diffuse edges. The skin damage typically starts at the surface and doesn’t extend deeply into tissue.
Pressure ulcers result from sustained pressure cutting off blood supply to tissue. They form over bony prominences (sacrum, heels, hips), have more defined edges, and damage extends from deep tissue outward. A classic pressure ulcer begins as deep tissue injury before the surface skin shows obvious damage.
A person with incontinence who also has limited mobility can develop both conditions simultaneously. The presence of moisture from incontinence actually increases pressure ulcer risk by making skin more fragile and increasing friction. Managing both requires addressing moisture exposure and pressure redistribution.
Psychological Impact
Something often overlooked in clinical discussions of IAD: it’s distressing. Dealing with sore, painful skin in intimate areas affects dignity and self-image. The discomfort can make people reluctant to leave home, avoid physical intimacy, or feel dependent on others for care they’d prefer to manage privately.
If skin problems are affecting your quality of life or mental wellbeing, that’s worth mentioning to your healthcare provider. Support is available, and effectively managing both your bladder condition and your skin can restore considerable independence and comfort.
Key Points to Remember
Incontinence-associated dermatitis is common but not inevitable. With appropriate continence product selection, gentle skincare routines, and consistent use of barrier products, most skin damage can be prevented or minimised.
If you’re already experiencing sore or broken skin, healing is possible with attention to the basics: keeping skin clean and dry, protecting it from irritants, and seeking professional help when home measures aren’t enough.
Your bladder condition may be ongoing, but skin problems don’t have to be a permanent feature of living with incontinence. The effort invested in good skin care pays off in comfort and quality of life.
For more information on managing specific types of incontinence, see our guides to stress incontinence, urge incontinence, overactive bladder, and mixed incontinence.
References
Medical Disclaimer: The information provided is for educational purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional before making any changes to your diet, supplement regimen, or treatment plan.