Prevention of Pressure Ulcers due to Incontinence

Prevention of Pressure Ulcers due to Incontinence Must Be a Priority

Incontinence is a common risk factor for pressure ulcers. If you have worked in aged care or with elderly patients, you will know this to be true. Wet, moist skin can lead to rapid skin breakdown and the development of a pressure ulcer. There are many strategies that can reduce the risk of pressure ulcer formation.

Cleanse the skin regularly– the skin should be cleansed regularly using a pH neutral product or soap. The skin may be patted gently dry using a soft cloth (scrubbing of the skin should be avoided!). Cleanse the skin whenever the incontinence product is changed or whenever it is known that soiling has occurred.

Change incontinence products regularly- incontinence products are expensive, but treating a pressure ulcer will cost far more in the long term. Incontinence products are designed to wick moisture away from the skin, but they still need to be changed with some regularity. Once they become saturated, incontinence products provide the perfect conditions for the development of a pressure ulcer.

Examine the skin routinely– it is important that the skin covered by incontinence products be examined regularly for signs of redness, irritation or skin breakdown. This includes the coccyx, the buttocks and the perineum. Any signs of irritation or redness should be addressed immediately and monitored carefully for progression.

Use a barrier cream– barrier creams do exactly as their name implies- they provide a barrier between the skin and moisture, preventing the skin from contacting urine and or feces. There are many barrier creams on the market. Just remember that they should not be rubbed into the skin.

Address incontinence– this may perhaps be the most obvious strategy to prevent pressure ulcer formation resulting from incontinence- try to reduce incidents of incontinence. How? There are many ways in which incontinence can be reduced, including:

• review medications- medications may contribute to incontinence by increasing the amount and/or frequency of urination or decreasing awareness of the need to void. Medications such as diuretics, blood pressure medications, sedatives, hypnotics and opioids may affect continence. Although it may not be possible to stop all of these meds, a medication review may reveal the likely culprit and a better alternative may be available.
• avoid constipation- incontinence can be worsened by constipation. When the colon is full of hard stool, pressure is placed on the bladder and urethra, which may increase incontinence. A good bowel routine can help to reduce episodes of incontinence.
• monitor fluid intake- drinking too little fluids can lead to concentrated urine, which may increase the urge to void, in addition to making urine more alkaline and likely to damage the skin. Conversely, drinking too much fluid, especially right before bed, can increase incontinence and lead to skin breakdown.
• encourage Kegel exercises- many patients can learn to perform Kegel exercises, which strengthen pelvic floor muscles. In women, weak pelvic floor muscles from pregnancy, childbirth and menopause can contribute to incontinence. Kegel exercises are easy to teach and perform and, over time, can improve continence.
• scheduled toileting/bladder training- whether individuals live in aged care facilities or at home, regularly scheduled bathroom breaks can “train” the bladder. For individuals who are cognitively intact, the length of time can be gradually increased between bathroom breaks until the individual can hold their urine for a reasonable amount of time.
• screen for conditions that may contribute to incontinence- if incontinence is new or worsening, it may be worthwhile to screen the individual for conditions that might influence continence, such as a bladder infection, stones in the urinary tract or diabetes.

Although incontinence is a risk factor for pressure ulcer formation, pressure ulcers due to incontinence can be easily avoided using the above strategies. Want to learn more about the prevention of pressure ulcers? View our wound care certification courses  to learn how you can achieve wound care certification.

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