Bowel & Bladder Incontinence In Elderly
Skin Management Perspective
Alex Khan RN BSN CWCN CFCN
Jesse Lewis RN CWCN & Deanna Andel RN BSN CWCN
Objectives
Upon 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 Incontinence
Bowel & 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