Caring for Intimate Skin: Incontinence-Associated Dermatitis in Women

When you’re living with incontinence, you may experience incontinence-associated dermatitis at some stage during your journey. We’re here to help you understand the condition, what causes it, and what you can do to care for your intimate skin to prevent IAD and keep your skin healthy.

Let’s start at the beginning. Incontinence-associated dermatitis (IAD) is a painful skin condition that occurs when your perineal area (the buttocks, genitals and inner thighs), comes in regular contact with urine or stool for too long.^1,2

This skin irritation isn’t caused directly by incontinence, but it is a contributing factor.

Both fecal and urinary incontinence are common in women.^1,3,4 And childbirth also increases the risk of both types of incontinence in women, and with it, IAD.^1,3,4

It’s easy to confuse IAD with other skin problems. For example, it might look like pressure sores or itch like allergic contact dermatitis, but IAD has its own signs and patterns that make it unique.

Incontinence could lead to IAD in three ways:

Moisture overload

While keeping your skin moisturized is important, too much moisture from urine or over-washing weakens the skin barrier.⁵ This puts your skin at greater risk for irritation, infection, and breakdown.⁵

Alkaline environment

Frequent contact with urine or stool changes your skin’s pH from acidic to alkaline.¹ This shift increases the activity of enzymes on the skin.1 As these enzymes are more common in older adults, and they cause skin damage.¹

Friction

Friction from pads or skin-to-skin contact makes an already damp skin vulnerable to breakdown.⁵

Hormonal changes during menopause affect the pelvic floor, increasing the risk of urinary incontinence.⁶

There are several types of urinary incontinence, including:⁷

• Stress incontinence: Leaks from coughing or laughing.
• Urge incontinence: Sudden, intense need to pee.
• Overflow incontinence: Leaks when the bladder doesn’t fully empty.

While urinary and fecal incontinence don’t cause IAD in women directly, when combined with certain situations, incontinence skin damage can occur.⁸ They include:

• Infrequent pad changes – Leaving pads on too long can increase the risk of irritation.⁹ Learn more about how often you should change your pad.
• Using harsh soaps or fragranced products: These can further irritate and damage your skin.⁴
• Poor mobility and cognitive issues: Dementia or stiffened joints could affect how well you take care of yourself, leading to skin issues.¹⁰

There are two types of IAD with varying symptoms.8 Mild IAD typically occur with redness and swelling, and when it becomes severe, it can cause blisters.⁸

Here are some other signs and symptoms of IAD you might notice:

• Redness¹
• Pain and tenderness¹
• Open sores¹¹
• Discomfort¹
• Swelling¹
• Burning, tingling, or itchy skin ¹

It’s important to note that IAD has different appearances across skin tones.² On lighter skin, irritation may look red.2 On darker skin tones, you might see dark patches or discoloration instead.² Also, in women with urinary incontinence, IAD affects the labia.3 For those with fecal incontinence, it affects the perineal area.³

Once you notice these signs, it's a good idea to see your doctor.

Certain factors make incontinence more likely, increasing your risk for IAD.¹

You may be more vulnerable to IAD if you:

• Are recovering from childbirth.¹²
• Are going through menopause.¹²
• Have a condition that affects your mobility or brain, like dementia.⁷
• Rely on caregivers for hygiene. ⁵

Caring for someone close? Here’s a guide to help your caregiver give you the best care: Hygiene guide for caregivers

Incontinence products use a technology that securely locks away urine at the core of the pad or liner, leaving the surface dry and fresh. In addition, if you have sensitive skin you might want to use gentler cleansing and care products to keep irritation to a minimum.

How to avoid skin irritation when the bladder is weakened:  

• Avoid harsh soaps. Instead, use a no-rinse product to gently clean, restore, and protect delicate skin. 
• Use barrier creams for IAD containing zinc oxide or petroleum jelly to keep your skin protected.
• Change your pads regularly to avoid further irritation.
• Use skin-friendly incontinence products for women made of breathable material to avoid getting a rash from wearing incontinence pads.
• Talk to your doctor. Bladder weakness can be treated, and your physician can give you practical advice or refer you to a specialist. 

If you're already dealing with IAD, these small changes can help ease discomfort:

• Cleanse gently, don't scrub or rub.
• Use pH-balanced cleansers made for sensitive skin.
• Cleanse and moisturize after each incontinence change.
• Choose breathable underwear like cotton.

It's a good idea to talk to your doctor if you notice your skin is getting worse, like:⁸

• Blisters
• Open sores
• Signs of infection like unpleasant smells, pus, or increase in size