Incontinence Associated Dermatitis in Community-Living Adults with Fecal Incontinence: Incidence and Severity Manifestations

Introduction: Dermatitis is a consequence of fecal incontinence (FI) yet little is known about the incidence or severity of incontinence associated dermatitis (IAD) in community-living adults.

Purpose: To describe the incidence and severity manifestations of IAD in community-living adults with fecal incontinence (FI) and the relationship of IAD with FI severity, gender and age.

Methods: This study had a prospective descriptive design. Adults with FI (n=98, 76% female, 93% White, aged 58(13) years (mean(sd), 59% with urinary incontinence (UI) also) from a study of fiber supplementation self-assessed/reported any IAD daily for 52 days. IAD damage= redness, breakdown, rash/fungal infection, soreness, amount, location; a total IAD severity score (type+areas+amount, 0-13 possible score) was also calculated. Analyses included frequencies and percentages, relationships by Pearson or Spearman correlations, and differences by t-test or chi-square test.

Results: Incidence of IAD= 42% (41/98).  Those developing IAD were 71% female, 90% White, aged 57(17) years, and 56% had UI also. Time to IAD onset=18.2(15.1) d; IAD duration = 6 d (1-52 d) (median(range)). IAD manifested as redness in 58% subjects, rash in 12%, skin breakdown in 2%, and soreness in 76%. IAD occurred in 1, 2 and 3 body areas in 73%, 20% and 25% of subjects respectively. Between the buttocks was the most common area (93% subjects) and thighs the least common (2%) damaged. 31% subjects reported a small amount of IAD, 30% a medium amount and 6% a large amount. IAD severity = 3.1(0.9) (mean(sd)) and had moderate association with FI severity ( r=.29, p<.001).  IAD incidence and severity did not differ between males and females or older (≥65 years) and younger people (p>05).

Conclusions: IAD is common in community adults with FI and is of mild/moderate severity. Soreness was the most common manifestation which may reflect the difficulty in self-assessing the perineal area.