The Correct Skincare Routine for Incontinence-Associated Dermatitis Prevention
Most skin breakdown from incontinence is genuinely preventable with the right routine done consistently. The mistake we see most often isn't a lack of effort, it's the wrong products or technique, like scrubbing with soap and a towel when something far gentler does the job better. Here's exactly what the evidence supports, step by step.
Why Technique Matters as Much as Product Choice
A cluster-randomised trial in acute care settings found that a structured cleanser-and-protectant routine measurably improved Incontinence-Associated Dermatitis (IAD) outcomes compared with standard care. The mechanism matters: surfactant-based, no-rinse cleansers loosen and lift irritants away from skin without needing scrubbing or rinsing, which avoids the friction damage that vigorous washing and towel-drying can cause. Nurses in that study who used basic wipes alone, without a proper cleanser, reported more difficulty fully removing residue and sometimes resorted to extra rinsing or friction, which is exactly the pattern that worsens skin integrity over time.
Step 1: Cleanse, Gently and Promptly
Clean the affected area as soon as practical after an episode of incontinence, ideally using a pH-balanced, no-rinse cleanser rather than standard soap and water. Clinical guidance generally recommends a cleanser pH in the range of 4.0 to 6.8, close to skin's natural acidity, and explicitly avoiding products with alcohol, added fragrance, or strong chemical colourants, all of which can worsen irritation on already-stressed skin.
Apply with a soft cloth or wipe rather than rubbing. Gentle blotting or a light tapping motion is the technique consistently recommended in clinical guidelines, since rubbing and vigorous wiping cause mechanical friction damage on top of the moisture-related irritation already present.
Step 2: Moisturise to Support the Skin Barrier
After cleansing, a fragrance-free moisturiser helps replenish the skin's natural lipid barrier, which prolonged moisture exposure and frequent cleaning can deplete over time. This step is often skipped, but it's part of what separates a genuinely protective routine from one that's just managing the immediate mess.
Skin that's already showing redness or irritation needs gentler handling, not more aggressive cleaning. If you notice broken skin or signs of infection, such as increasing redness, warmth, or odour beyond what's expected, this needs clinical assessment rather than continued self-management. Speak with a GP or continence nurse.
Step 3: Barrier Protection, Applied as the Final Layer
Finish with a dedicated barrier cream or ointment, ideally containing zinc oxide, petroleum, or dimethicone, all of which form a physical layer that protects skin from ongoing moisture exposure between changes. Our washes and barrier cream range is built around this same three-step sequence, with products designed to work together rather than against each other.
One genuinely common mistake worth avoiding: don't remove all the barrier cream at every change. Clinical guidance suggests gently cleaning away only the soiled portion and topping up the layer, rather than stripping it back and reapplying from scratch each time, which causes unnecessary friction for no real benefit.
For Bowel Incontinence Specifically
Bowel matter is considerably more aggressive on skin than urine, due to digestive enzymes that actively break down skin's protective barrier. Faster cleaning after a bowel incontinence episode matters more here than with urinary leakage alone, and a more robust barrier product may be appropriate. If you're managing frequent bowel incontinence, it's worth discussing a specifically suited barrier product with us rather than assuming a standard urinary-focused cream will be enough.
Using NDIS funding? Skin care products including barrier creams, wipes, and cleansers are funded under NDIS Core Supports — Consumables alongside your continence products. As a registered NDIS provider (Provider No: 4050 144 759), we can combine these into one regular order.
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Try the Pharmacist Incontinence Recommender →Frequently Asked Questions
Is soap and water actually fine, or do I need a special cleanser?
Clinical guidance generally favours pH-balanced, no-rinse cleansers over standard soap and water for incontinence care, since soap can be more drying and alkaline, and the rinsing and towel-drying process introduces more friction. A dedicated cleanser is worth the small extra step.
How often should I do the full three-step routine?
Cleansing should happen as promptly as practical after each episode of incontinence, with the moisturiser and barrier cream steps following each time. This is most important after bowel incontinence specifically, given how much more aggressive bowel matter is on skin.
Should I remove all the barrier cream at every change?
No, generally just clean away the soiled portion and reapply where needed, rather than stripping the whole layer back every time. This reduces unnecessary friction on the skin.
What does early skin irritation actually look like?
Early signs are usually redness, warmth, or mild discomfort in the affected area, before any broken skin appears. Catching it at this stage with a more consistent routine is far easier than managing it once skin integrity is compromised.
When does this need a GP or continence nurse rather than continued self-care?
If you notice broken skin, increasing redness, unusual warmth, odour, or any sign of infection, this needs proper clinical assessment rather than continued home management. Don't wait if something seems to be getting worse.
References
- Effectiveness of skin cleanser and protectant regimen on incontinence-associated dermatitis outcomes in acute care patients: A cluster randomised trial, PMC — pmc.ncbi.nlm.nih.gov
- Prevention and Care for Incontinence-Associated Dermatitis Among Older Adults: A Systematic Review, PMC — pmc.ncbi.nlm.nih.gov
This article is for general information only and does not replace individual clinical advice. If skin breakdown is present or worsening, please speak with a GP or continence nurse.
Nadim Assaf is a registered pharmacist (AHPRA PHA0001624849) and co-founder of Connect Mobility, an NDIS-registered assistive technology provider in Picton, NSW. Connect Mobility is run entirely by registered pharmacists.