42
WOUND CARE TODAY
2015,Vol 2, No 1
FOCUS ON MOISTURE LESIONS
i
i
Sensation
i
Thermoregulation
i
Excretion
i
Communication.
The skin is made up of distinct
layers — epidermis, dermis and
hypodermis — that function as one
unit. Sebum is an oily substance
produced by the sebaceous glands
and which helps prevent hair and
skin from drying out. The production
of sebum enables the skin to
maintain an acidic pH of between
4.5–6.2.
However, incontinence can result
in a mixing of urine and faeces which
in turn creates an alkaline (ammonia),
raising the pH of the skin. This
raised pH increases protease and
lipase activity, thereby causing skin
irritation (Le Lievre, 2001). The skin
becomes more permeable and allows
for fluid to be retained, thus leading
to excoriation (damage or removal of
part of the surface of the skin).
The increased moisture combined
with this bacterial and enzymatic
activity leads to breakdown of the
skin and the development of moisture
lesions (
Figure 1
). This is particularly
seen in the very young or elderly.
The skin is our body’s main
line of defence against potential
environmental hazards, with intact
skin playing a major part in our
body’s immune system. Therefore, it is
vital that any break in the skin, such
as a moisture lesion, is prevented.
URINARY INCONTINENCE
Urinary incontinence affects
between three to six million people
in the UK (Irwin et al, 2006). The
incidence increases with age and
it is known that a high proportion
of residents in nursing homes have
incontinence problems (Bale et al,
2004). Urinary incontinence in the
general population affects 31% of
older women and 23% of older men
(Bale et al, 2004), with the incidence
of faecal incontinence also rising with
age and affecting about 12% of older
people (Goode et al, 2005).
With people living longer through
medical advances, continence is
a problem that is only going to
increase. However, it should also be
said that incontinence is not an issue
restricted to the older population
and it can affect anyone at any age.
As such, nurses must not assume
incontinence in old age is inevitable
and should always ensure that they
investigate the causes of a patient’s
incontinence rather than attributing
it to his or her age.
Any episode of incontinence
needs to be accurately recorded to
establish the severity, with advice
sought from a continence specialist
where possible.
ASSESSMENT
There are several assessment tools
that can be used to identify moisture
lesions, including
i
The ‘perineal assessment tool’
(Nix, 2002)
i
The ‘perirectal skin assessment
tool’ (Storer-Brown, 1993)
i
The National Association of Tissue
Viability Nurses Scotland’s ‘skin
excoriation tool’ (NATVNS, 2008).
The ‘perineal assessment tool’
(Nix, 2002) is a picture guide with
score for specific characteristics and
Top tip:
Use a barrier film or cream
to protect the skin from
excess moisture.
THE SCIENCE —
WHAT IS INCONTINENCE?
People can suffer from both urinary and faecal
incontinence. Urinary incontinence is more
common and up to six million people in the UK
are thought to experience urinary incontinence,
which is defined as the unintentional passing
of urine. There are several types of urinary
incontinence, but the most common are:
i
Stress incontinence: urine leaks when
the bladder is under pressure, such as during
coughing or laughing
i
Urge incontinence: a sudden, intense urge to pass urine
i
Mixed: a mixture of both stress and urge urinary incontinence.
Faecal incontinence is an inability to control bowel movements, resulting
in the involuntary passage of stools. The most common causes are:
i
Rectal problems: severe constipation (resulting in overflow diarrhoea)
or diarrhoea itself mean that stools cannot be retained properly
i
Sphincter muscles: events such as childbirth can damage the muscles
at the base of the rectum
i
Nerves: nerve damage through conditions such as diabetes or
multiple sclerosis may mean that nerve signals sent from the rectum
may not reach the brain in time.
Source: NHS Choices:
Credit: Nicolas Alejandro @flickr
Figure 1.
The development of a moisture lesion.
Normal
skin pH
4.5–6.2
Mixing of
urine and
faeces
makes
ammonia
Prolonged
moisture
Skin
breakdown
