Effects of Faecal Incontinence on Skin

IntegrityK Lenne USL Medical 2012

Maintenance of healthy, intact perineal skin constant challenge when caring for incontinent people

Urinary and faecal incontinence can have devastating effect on the skin of an individual regardless of age

In severe cases skin is so badly damaged that a moisture lesion or pressure ulcer can develop

42% incontinence sufferers skin conditions (IAD) Long term use pads frequently results in IAD in

otherwise healthy skin 7% 65 yrs+ affected FI Long term elderly care 66% FI 1 in 4 in residential care Ageing population FI increase Major implications for patients

+ health system

Prevalence

Complex cascade events involving attack of skin by physical, chemical, enzymatic and microbial factors.

Moisture, physical irritants, chemical irritants, faecal enzymes, ph and microbes all play a roll in the downward cycle of events.

Aetiology Incontinence Dermatitis

Moisture Excessive moisture from urine, sweat + frequent washing increases friction - rubbing against pads Skin overhydrated + stratum corneum swells - more permeable to microbial growth

Physical and chemical irritants Frequent washing significant source of both to skin Soaps and cleansers- most contain surfactants to

lower skin surface tension making it easier to loosen + wash away contaminants

Ph often very alkaline

Stool, enzymes and pH Proteolytic and liptolytic enzymes deactivated GT Faeces + urea mix and release ammonia Shifts acid mantle skin towards alkalinity This alkaline ph reactivates the digestive enzymes If barrier function compromised more likely to be

attacked by bacteria 60% faecal matter comprised bacteria 4–500

species micro organisms These pathogens destroy epidermal layer Bacteria, yeast + fungus invade Skin taut, painful, erythematous IAD

Vicious feedback cycle results in IAD If person’s condition further compromised

by pressure, poor nutrition or disease, major breakdown can easily occur

Quality of life is of primary importance Add in cost of treating PU can range 5-40k Advantageous to invest in good skin care

regime rather than treat resulting breakdown

Cycle of events

Impaired acid protection mantle Diminished lipid production Diminished sweating Reduced regeneration potential Ability to fight bacteria + fungi weakened In a nutshell often malnourished, slow to

regenerate and the affects of incontinence stress skin further

Elderly skin

Skin cleansed asap after every episode FI

No soap as cleanser – already dry skin

Soap astringent effect (alkaline ph) dries skin further

Soap also has surfactants which act as irritants, cause further damage

If not rinsed off skin completely damage continues

Even water removes acid protection mantle short term

No rinse skin cleansers better – mild, gentle surfactant, soothing

Emulsify and loosen faeces to cleanse skin- no rubbing

Skin cleansing

PH balance to strengthen acid protection mantle

Replenish moisturising substances Support skin’s own lipid production Speed up skin’s reproduction Most products cleanse, moisturise and

protect Hartmann’s Menalind also focus on

REGENERATION

No rinse cleansers should:

Skin affected by FI may require extra protection and nutritional support for regeneration.

Products used must :• provide optimum protection without

inhibiting the absorption capacity of incontinence products

NO ZINC + CASTOR OIL, FATTY CREAMS in pad area

Skin protection

Support epidermal barrier function Strengthen acid mantle protection Replenish moisturising substances Support skin’s own lipid production Help to speed up skin’s reproduction Remove and reapply after each episode FI Creams must be water based Liquid films contain polymer + solvent If skin already compromised film may irritate dermis

Skin protection products ideally:

Provide superior leakage protection Rapid fluid absorption and safe storage Keep skin dry and prevent stratum corneum

swelling Reduce ammonia production Stabilise ph skin - support skin’s

antibacterial effect Maintain healthy skin temperature

Incontinence aids

Minimise episodes FI Select right continence product that provides

superior leakage protection while helping to prevent IAD

Ensure skin cleansing regimes ASAP after every episode FI

Protect at risk skin from damage Prevent skin damage that so easily can lead to

pressure ulcers or moisture lesions Prevention better than cure

Conclusion