Incontinence Associated Dermatitis: Relationship to Urinary Incontinence

Purpose: Incontinence-associated dermatitis (IAD) is postulated to arise from prolonged contact with stool or urine,¹ based on histopathologic analysis and clinical experience². Evidence consistently demonstrates an association between fecal incontinence and IAD, but evidence for the association with urinary incontinence (UI) is mixed. This study evaluated the prevalence of IAD in a group of community-dwelling patients experiencing UI alone. Specific study aims included determining the prevalence of IAD in a community-based sample with UI alone, and describing the clinical characteristics of IAD such as candidiasis.

Methods:  Data were collected using a prospective, descriptive study design.  Sequential patients presenting for videourodynamic testing or conservative management of UI were assessed. The principal investigator (MG) inspected the perineal skin and perigenital skin, including skin folds, for inflammation, skin erosion and candidiasis.

Results:  Two hundred sixty subjects who met inclusion criteria participated in the study. Their mean age was 55.77± 18.55 years; 64.1% were male.  Sixty-two subjects were found to have IAD yielding a prevalence rate of 23.7%; 7.6% had erosion, and 10.3% had candidiasis.   Logistic regression analysis revealed that male gender (OR=3.62), obesity, defined as a BMI ³ 30, limited mobility (OR=4.86), and use of 4 or more absorptive products per day (OR= 814) were significantly more likely to have IAD when compared to patients who did not have these associated factors.

Conclusions: Findings from this study suggest that UI alone acts as an etiologic factor in the pathogenesis of IAD. Logistic regression reveals that male gender, limited mobility, obesity, use of more than 4 absorptive incontinence products per day are associated with an increased likelihood of IAD in patients with UI alone.