Cleanse, Protect and Soothe: Your Complete Guide to Skin Care and Incontinence
Skin irritation is one of the most common and preventable complications of managing incontinence. This guide walks through the clinical evidence, the three-step approach to skin care, how to use barrier products effectively, and when it is time to escalate.
What Is Incontinence-Associated Dermatitis?
Incontinence-Associated Dermatitis (IAD) is a form of moisture-associated skin damage (MASD) that develops when skin is repeatedly or prolonged exposed to urine or stool. It is classified as a chemical and inflammatory skin injury, not a pressure injury; though the two can co-exist and are frequently confused in clinical settings.
IAD occurs because urine and faecal matter alter the skin's natural pH. Healthy skin sits at a pH of approximately 4 to 5.5; the acid mantle that protects against bacterial colonisation and friction. Prolonged exposure to urine raises this pH, softening the stratum corneum and breaking down the skin's barrier function. Faecal matter is additionally damaging due to the presence of proteolytic and lipolytic enzymes that actively degrade skin tissue on contact.
Signs and symptoms of IAD to recognise
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Redness, pinkness or warmth in skin areas covered by continence products; particularly the groin, perineum, inner thighs, buttocks and perianal area
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Burning, stinging, itching or a feeling of rawness; particularly when skin contacts moisture
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Skin that appears shiny, wet or macerated despite appearing dry on the surface
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Shallow skin erosions, weeping, or crusting in moderate to severe presentations
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Satellite lesions or pustules where secondary fungal or bacterial infection has developed alongside IAD
The Three-Step Approach: Cleanse, Protect, Soothe
The gold standard for IAD prevention and management is built on three consistent steps; endorsed by the Global IAD Expert Panel, the Wound Ostomy and Continence Nurses Society, and the European Wound Management Association. The steps are sequential but form a daily cycle, not a one-time treatment.
Cleanse
Remove urine, stool and residue from the skin gently and completely after every episode of incontinence or product change. Choose a pH-balanced, no-rinse cleanser; never soap.
Protect
Apply a barrier product to create a protective layer between skin and moisture. This can be a cream, ointment, paste, film or barrier wipe; depending on the degree of exposure and skin condition.
Soothe and Relieve
When skin is already irritated or broken, support healing with targeted products. Address inflammation, restore the skin barrier, and manage any secondary infection with clinical guidance.
How to Cleanse Correctly
Cleansing is the foundation of the entire skin care routine. Done well, it removes chemical irritants from the skin before they cause damage. Done poorly; with soap, harsh wipes, or vigorous rubbing; it strips the skin's acid mantle and accelerates the very breakdown it is meant to prevent.
What to use
- pH-balanced, fragrance-free skin cleanser (pH 4-5.5)
- No-rinse formulas that don't require towel drying
- Soft cloths or barrier wipes for gentle application
- Foam or spray cleansers to reduce friction on sensitive skin
What to avoid
- Soap; alkaline pH disrupts the skin's acid mantle
- Standard wet wipes with fragrance, alcohol or preservatives
- Rubbing or scrubbing; pat gently only
- Hot water; rinse with lukewarm or use a no-rinse product
Research consistently shows that switching from soap and water to a pH-balanced, no-rinse skin cleanser significantly reduces IAD incidence, particularly in aged care and continence care settings. The change requires minimal effort but delivers measurable results.
How to Protect the Skin Effectively
After cleansing, a barrier product is applied to protect the skin from the next episode of moisture exposure. Barrier products work by creating a water-repellent film over the skin surface; preventing urine and stool from making direct contact with the skin between changes.
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Barrier creams and ointments Zinc oxide or petroleum-based formulas provide a thick, durable barrier suited to moderate to heavy incontinence exposure. Applied after cleansing, before the new product is put on. Particularly effective for faecal incontinence due to the enzyme barrier they provide.
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Barrier films and sprays Liquid polymer films that dry quickly on the skin, forming a transparent protective layer. Less occlusive than creams; better suited to light incontinence or as a preventive measure on intact skin. Can be applied over broken skin without stinging.
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Barrier wipes Combine cleansing and barrier protection in a single step; ideal for carer-assisted changes, patients with limited mobility, or where time efficiency matters. Clinically validated formulas provide both skin cleansing and a leave-on barrier film in one application.
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Skin protectant pastes Thick, adherent products providing very high-level barrier protection where skin is already compromised. Used in more severe IAD presentations or where exposure frequency is very high. Should be applied in a thin, even layer; over-application can trap moisture.
Barrier Wipes: Cleanse and Protect in One Step
What makes barrier wipes clinically valuable
Barrier wipes have become one of the most widely recommended products in continence care precisely because they merge two essential steps; cleansing and barrier application; into a single, efficient product. This is particularly significant in high-volume care environments and for people who change frequently throughout the day.
A quality barrier wipe will cleanse the skin gently with a pH-balanced formula, then leave behind an invisible barrier film that repels moisture until the next change. There is no separate cream to apply, no rinsing required, and minimal friction. Products such as Sage Comfort Shield Barrier Cream Cloths are designed specifically for this dual purpose and are widely used in Australian clinical settings.
Key criteria when choosing a barrier wipe: pH-balanced (not standard wet wipes), alcohol-free, fragrance-free, leaves a leave-on barrier film, soft enough to use on compromised skin, and large enough for a full perineal cleanse without multiple applications.
Soothe and Relieve: When Skin Is Already Irritated
When IAD is already established, the skin care routine shifts from pure prevention to active recovery. The cleanse and protect steps continue; but the focus adds in targeted treatment to calm inflammation, support skin barrier restoration, and manage any secondary infection if present.
Managing established IAD: clinical approach
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✓Continue gentle cleansing after every episode; do not reduce cleansing frequency as this allows further chemical exposure
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✓Switch to a thicker barrier product or paste to better protect the already-compromised skin surface
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✓Consider a barrier film over the top of a barrier cream to add an additional layer of protection
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✓If skin is broken, avoid products containing alcohol or high concentrations of zinc oxide directly over open areas
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✓Review continence product; if leakage is frequent, the product may not be the right absorbency or fit, increasing exposure time
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✓If redness persists beyond 48 hours of consistent skin care, or if satellite lesions appear, seek clinical review
A Simple Routine to Follow at Every Change
The IAD prevention routine; at every product change
Recognising IAD Severity: Mild, Moderate and Severe
IAD exists on a spectrum. Identifying severity helps determine whether home management is appropriate or whether clinical escalation is needed. The Global IAD Expert Panel has established a validated classification tool; the GLOBIAD; for clinical use, but a simplified assessment is useful for carers and self-managers.
- Pink or light red skin
- Skin intact; no breaks
- Mild itching or discomfort
- Limited to small area
- Bright red, widespread
- Some skin breakdown present
- Increased pain or sensitivity
- Skin feels raw or wet
- Deep skin erosion or ulceration
- Weeping, crusting or bleeding
- Signs of infection present
- Severe pain; skin very fragile
When to Refer to a Clinician
Many mild IAD presentations can be managed effectively with a structured home routine and appropriate products. However, there are clear clinical thresholds where self-management is no longer sufficient and professional review is essential.
Refer to a continence nurse when
- IAD keeps recurring despite a consistent routine
- Current products may not match output type or volume
- Uncertainty about which barrier product is most appropriate
- NDIS plan review is due and skin care consumables need documenting
- Patient or carer is unsure how to assess skin severity
Refer to a GP or wound nurse when
- Skin is broken, weeping or not healing within 48-72 hours
- Signs of infection; redness spreading, heat, odour, fever
- Suspected fungal infection alongside IAD
- Severe pain beyond what barrier products are resolving
- Any wound overlying a bony prominence that may also be a pressure injury
Need clinical guidance on skin care?
Our Continence Nurse Partnership Program connects you with Michelle Gatt, Clinical Nurse Specialist in Continence, for a personalised whole-person assessment covering skin integrity, product suitability, and your NDIS plan.
Book a Continence Assessment Shop All Skin Care
Scientific References
- Beeckman D, et al. (2015). Proceedings of the Global IAD Expert Panel. Incontinence-Associated Dermatitis: Moving Prevention Forward. Wounds International.
- Gray M, et al. (2011). Incontinence-associated dermatitis: a systematic review. Journal of Wound, Ostomy and Continence Nursing. 38(1), 61-70.
- Beeckman D. (2017). A decade of research on incontinence-associated dermatitis (IAD): evidence, knowledge gaps and next steps. Journal of Tissue Viability. 26(1), 47-56.
- Langemo D, et al. (2011). Incontinence-associated dermatitis: state of the science. Journal of Wound, Ostomy and Continence Nursing. 38(3), 234-246.
- Wound Ostomy and Continence Nurses Society. (2018). Guideline for Prevention and Management of Pressure Ulcers and IAD. WOCN Clinical Practice Guideline Series.
- International League of Dermatological Societies (ILDS). (2026). World Skin Health Day. Retrieved from ilds.org
- Continence Foundation of Australia. (2024). Skin Care and Incontinence Resources. Retrieved from continence.org.au
- National Disability Insurance Agency. (2024). Continence and Consumables Funding Guidelines. Retrieved from ndis.gov.au
Additional Resources
- Continence Foundation of Australia - helpline 1800 33 00 66, resources and clinical guidance
- International League of Dermatological Societies - World Skin Health Day
- NDIS - continence consumables funding information
- Continence Nurse Partnership Program - book a clinical skin and continence assessment
- Shop All Skin Care - full range of cleansers, creams, wipes and barrier products
This article is intended as general clinical and educational information only and does not replace advice from a qualified healthcare professional. For moderate to severe IAD or skin breakdown, please seek review from your GP, wound care nurse or continence nurse. References should be verified prior to publication.