Overview and assessment essentials
Understanding continence
Maintaining continence and healthy skin is vital to preserving dignity, wellbeing and quality of life. Incontinence is a symptom rather than a disease and should always be assessed alongside skin health. All healthcare professionals share responsibility for its prevention, assessment and management. Continence and skin integrity are closely linked, changes or challenges in one area can influence the other. Moisture-Associated Skin Damage (MASD) includes conditions such as Incontinence-Associated Dermatitis (IAD), which is painful but largely preventable with effective management.1 Early, comprehensive assessment of both continence and skin condition supports proactive, person-centred care and helps maintain comfort, confidence and overall wellbeing.2
Assessment essentials
- Take a full bladder/bowel history and encourage use of diaries to monitor frequency, volume and leakage
- Conduct baseline and daily skin inspections, increasing frequency for those incontinent of urine or faeces
- Look for erythema, pain, or maceration (note that redness may appear purple or darker in black and brown skin tones)
- Document findings clearly and reassess regularly
- Ask open-ended “trigger” questions rather than yes/no prompts: “How often do you need to rush to the toilet?” or “Have you ever had small leaks or accidents?”
Management principles
Shared responsibility
All members of the multidisciplinary team share accountability for continence care. Coordination between nurses, AHPs and medical staff promotes continuity and dignity.
Cleansing and protection
- Gently cleanse after every episode of incontinence using pH-balanced, low-irritant cleansers3
- Avoid soap, antiseptics and baby wipes; use wipes formulated for incontinence
- Dry skin carefully, no vigorous rubbing
- Apply a barrier product (spray, cream or wipe) sparingly to protect at-risk areas4
- Avoid talcum powder and excessive use of zinc products that can trap moisture.
Preventing and managing IAD
Incontinence-Associated Dermatitis arises from prolonged exposure of skin to urine and/or faeces. Anyone who is incontinent is at risk, but risk is higher with double incontinence, diarrhoea and frequent episodes of urinary incontinence.
Recognising IAD
- Erythema (may appear purple-black on dark skin)
- Maceration and oedema
- Pain, itching or burning
- In chronic stages: thickening, scaling or hyperpigmentation
Assessment tool
Use the Ghent Global IAD Categorisation Tool (GLOBIAD) to assess and document severity consistently.5
Risk factors
Poor mobility, occlusive pads, cognitive impairment, poor nutrition, fever, antibiotics, diabetes or obesity.
Continence aids and sustainability
Product choice must be based on individual assessment one size does not fit all.
- Continence pads are designed for rapid urine flow; menstrual or procedure pads are unsuitable
- Avoid over-reliance on pads to prevent dependency and skin damage
- Support alternatives: toileting programmes, pelvic-floor exercises, bladder training.
Types of absorbent products
There are several types of absorbent products available, each offering secure, comfortable protection with different fixation methods. These include examples such as male products worn with close-fitting underwear, and pull-on, wrap-around, or belted designs that combine the absorbent core, waterproof backing, and fixation system into a single product secured by elastic fits, side tabs, or an adjustable belt.
Sustainability considerations
- Correct product selection reduces waste and cost
- Consider reusable or washable products where appropriate
- Dispose of used products responsibly according to local policy.6
Practical advice for practitioners
Communication and education
- Approach continence sensitively and without judgement
- Ensure privacy and adequate time for discussion
- Encourage openness, normalise the conversation to reduce stigma.
Person-centred care
- Integrate continence and skin assessments, they should not be separate processes
- Record all MASD and IAD within existing pressure-ulcer and skin-integrity frameworks
- Provide regular staff training; competence in continence care should be mandatory
- Promote mobility, hydration and balanced nutrition.
Maintaining continence and skin integrity demands coordinated, compassionate and evidence-based care. Integration of both domains will improve outcomes, preserve dignity and enhance quality of life for adults across all care settings.
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