Bowel & Bladder Incontinence In ElderlySkin Management Perspective

Alex Khan RN BSN CWCN CFCNwww.woundcarenurses.org

ObjectivesUpon completion of this presentation, all participants will be able to:

• Assess incontinence in patients• Identify potential issues related to incontinence• Identify skin conditions related to incontinence• Appropriately prevent and mange issues related to

incontinence

Definitions:

• Urinary incontinence is defined as the involuntary leakage of urine.

• Fecal incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly.

Epidemiology

• Community-dwelling older adults (>65) with bowel or bladder incontinence:– 35% of women– 20-30% of men

• Assisted living environments– 30-50% of women– 30% of men

• Long-term care (nursing home)– > 50-78% of men and women

Effects of IncontinenceBowel & Bladder incontinence has significant negative impact on

both overall and health-related quality-of-life.– Social isolation, Depression, Psychological distress– Increased caregiver burden, Skin inflammation / breakdown– Sleep disturbance, Increased risk urinary tract infection

(UTI), Cost related to management of incontinence– Increased risk of falls and fractures related to urgency /

frequency, nocturia, impaired mobility and vision changes– Increased risk of mortality associated with falls, fractures

and skin breakdown

Issues Associated with Incontinence Management• Incontinence briefs hold moisture against the skin causing

maceration and breakdown/excoriation.• Prolonged use of catheters increases the risk of bladder

infections.• Increased cost associated with frequent diapers and

incontinence pad changes.• Incidence of contact dermatitis / yeast infection

associated with incontinence.

Incontinence Associated Dermatitis

Skin condition commonly associated with incontinence. Skin irritation and inflammation related to exposure to urine and feces. Additional risk factors:• Diaper use• Bed bound / immobility

Incontinence Associated Dermatitis

Incontinence associated dermatitis in dark skin patients is difficult to identify, it has the appearance of deep dark discoloration.

Moisture Associated Skin Damage

Skin maceration is a sign of increased moisture exposure. Skin maceration leads to skin breakdown. This condition is also referred to as Moisture Associated Skin Damage (MASD).

Shear & Friction

Erosion of the skin occurs frequently and probably attributable to friction created by moving moist or saturated pads or clothing over irritated skin; or to damage from digestive enzymes present in liquid or solid stool.

Unstageable Pressure Ulcer

Incontinence, immobility, increased moisture, pressure and malnutrition causes serious skin conditions/wounds.

Prevention & Management

• Frequent checks for incontinence episodes• Turning and repositioning schedule• No-rinse skin cleansers are preferable to soap and water• Low air loss / pressure distribution surface• Change cloth pads frequently• Breathable pads must be utilized on air mattress• No diapers while in bed• Moisture barrier creams / Antifungal creams• Skin protectant sprays

Skin Treatment Products