Incontinence Associated Dermatitis (IAD) Guide

Incontinence Associated Dermatitis, or IAD, is a condition that can arise when bodily fluids aggravate the skin. Risks of the condition can lead to severe discomfort and infection, but there are ways to spot immediate symptoms and to prevent and manage IAD from occurring further. Making adjustments to cleaning regimes and lifestyle choices, for example, are always recommended.

A primary step in caring for IAD is being proactive and ensuring incontinence aids are used effectively, preventing bodily fluids from trapping up against the skin.

In this guide, I’ll take you through the definition of IAD, what causes it and how it is diagnosed, potential complications, and what you can do to treat and prevent the condition from recurring.

What Is Incontinence-Associated Dermatitis (IAD)? 

IAD is an inflammatory skin condition that is typically caused and aggravated by exposure to bodily fluids. While generally mild, failing to manage IAD can lead to further inflammation, severe irritation, and skin infections. It is so-called because it commonly affects incontinence sufferers who improperly manage their aids and skin hygiene.

More than 7.2 million Australian residents are incontinent, with seven out of ten people being younger than 65. Therefore, IAD is a major health concern for around a quarter of the population.

It is also suggested that around 20% of people experiencing incontinence may already be suffering from IAD, according to research undertaken in North America:

“Nearly 1 in 5 incontinent patients had IAD documented. Incontinence-associated dermatitis prevalence in the entire patient population was 4.3% while incontinence prevalence was 18%. Of incontinent patients, prevalence of IAD ranged from 8.4% in long-term care facilities to 19% in acute care facilities.”

Kayser et al.

What Causes IAD and Its Risk Factors?

IAD is typically caused by skin reacting to prolonged exposure to fecal or urinary moisture, with bacteria and ammonia in urine being the predominant causes of damage.

Let’s break down IAD causes into primary triggers and exacerbating factors.

Primary Causes

IAD is usually caused when:

• Urine and/or faeces are left in contact with skin for prolonged periods

• High ammonia levels cause the skin’s pH level to rise and break down

• Older skin has an already elevated pH level, making it more susceptible to IAD

• Bacteria in fecal matter and urine break down cell proteins

Crucially, the longer that bodily fluids are left to interact with the skin (i.e., going uncleaned or left moist), the greater the risk a person has of developing IAD, and the condition worsens.

Key Risk Factors

IAD can occur and worsen if someone:

• Is incontinent and fails to, or cannot, clean and dry themselves regularly

• Leaves incontinence aids unchanged for long periods

• Suffers from pre-existing skin conditions

• Regularly suffers from stomach illnesses or diarrhea

• Is taking prescripted medication such as diuretics

• Has skin folds or thinning skin

• Fits incontinence aids improperly, causing friction and skin damage

• Cannot move freely or has limited mobility

• Washes and dries themselves too abrasively

• Is nutritionally deficient due to poor diet and lifestyle habits

• Uses thick ointments or spreads creams too thickly on affected skin

• Does not have adequate caregiver support

Having helped many people with incontinence during my career, I understand that the condition can be difficult to talk about. However, at the first signs of IAD, it is crucial to seek preventive treatment.

Signs and Symptoms of IAD

General signs and symptoms of IAD include skin reddening, tingling, and burning sensations, wet and discoloured skin, peeling, warmth, and general tenderness.

IAD typically starts as skin reddening, though as it progresses, it may become discoloured, and while initially moist, it may become dry and start to peel. It is common to notice lesions, itching, and even pain to the touch.

IAD can affect various areas of your skin, from groin and buttock areas to upper thighs, the perineum, folds in the labia, and the lower abdominal areas.

In some cases, IAD may be mistaken for other skin conditions, such as psoriasis, heat rashes, and even pressure ulcers. In fact, pressure ulcers can also arise as a result of IAD going untreated.

Complications and Outcomes of Untreated IAD

If managed poorly or left untreated, IAD may lead to a greater risk of skin infections, causing patients’ illnesses to worsen. Sufferers may also find that they experience additional pain and discomfort, worsening for as long as the condition persists.

Increased risk of infection can lead to additional illnesses and conditions developing, which in turn can lead to higher care costs and extended treatment.

Persistent, untreated IAD can also harm sufferers’ quality of life, losing confidence in socialising, entering into relationships, and being intimate with partners.

Pressure ulcers and bed sores, too, are painful and uncomfortable complications that can arise from untreated IAD, as are fungal conditions.

How IAD Is Detected

Healthcare professionals detect and diagnose IAD through careful examination of potentially affected skin, consultation of medical histories, and skin pH and microbial testing. Following a step-by-step procedure ensures that IAD is diagnosed effectively and not mistaken for similar conditions.

Clinical Assessments

Diagnosis and assessment of IAD typically begin with a general visual examination, where a doctor or physician may look for signs of skin reddening, moisture, or other symptoms as detailed earlier in this guide.

From there, doctors will typically enquire about other conditions a patient may be experiencing and about their medication history. If they are concerned that IAD may be present, a skin pH test is usually recommended, followed by extra microbial tests should there be any underlying microorganisms.

Differentiating IAD From Other Conditions (Differential Diagnosis)

Given that IAD shares some symptoms with other skin conditions, doctors will carefully consider the possibility of other sources of irritation, particularly if incontinence and aids appear to be managed effectively.

For example, pressure sores are commonly mistaken for IAD by the naked eye, and in my professional experience, it’s crucial to ensure which condition is present so that effective treatments can be sought.

Indicators of pressure sores rather than IAD, for instance, include more defined rash edges, pain symptoms but little irritation, and evidence of skin loss (IAD does not always present with much loss of skin).

Prevention Strategies of Incontinence-Associated Dermatitis

To prevent IAD, it’s important to practice daily skin care routines, carefully compare aid product choices, adjust lifestyle choices, and consult healthcare professionals if conditions worsen.

Learning how to stop incontinence or at least manage the condition is a crucial part of recovering from IAD.

Crucially, it’s just as important for incontinent people and caregivers to understand the long-term risks and prevention strategies associated with IAD, too. Recommended preventive strategies include:

• Adopting a daily skin care regimen, covering gentle cleaning, washing with a pH-balancing cleanser, and protecting with recommended ointments (used thinly)

• Carefully choosing well-fitting and comfortable incontinence aids, learning how to wear them properly, and changing or adjusting them as manufacturers (and doctors) recommend

• Choosing comfortable, non-restrictive clothing, and sensibly considering when clothing changes may be necessary when heading out in public

• Immediately cleaning and padding skin dry after episodes of incontinence, or as soon as possible if episodes occur during sleep

• Avoiding harsh or abrasive chemicals and fragrances around affected areas

• Using skin protectants and moisturisers as recommended by doctors

• Regularly consulting with doctors and care physicians if you are concerned about the condition, or if you ever need to know more about treatment and management from an unbiased source

Treatment and Management of IAD

In cases where IAD requires immediate treatment, I recommend carefully cleaning and padding dry affected skin and doing so as part of a regular regimen - after each incident of incontinence, for example. It is also wise to regularly use a moisturiser and skin barrier to aid healing, as directed by your doctor.

Specialist intervention is recommended should IAD sores worsen, and if symptoms change or persist after following medical advice and changing lifestyle choices. This may typically be the case after two weeks, though your doctor may recommend a different timescale. Continence management in aged care or sensitive cases may mean timescales vary.

Regardless, it’s very important to follow up with a doctor, whether you are experiencing the condition or are caring for someone with IAD, so they can tailor further treatment, recovery, and prevention. 

Crucially, effective long-term management of IAD revolves around choosing the right incontinence aids and learning how to use them, and asking for help from someone you trust.

Final Thoughts

Incontinence-associated dermatitis is an uncomfortable and sometimes painful condition that, with preventive care and gentle cleaning, can be easily managed over time.

With millions of people across Australia experiencing incontinence, you don’t have to feel embarrassed about asking for help. Explore MedShop’s range of Abena incontinence products and aids to support healthier skin and help build confidence.

Sources

Cumper, S. (2024). How To Stop Incontinence: Solutions You Can Live With. In Medshop Australia. Medshop. https://www.medshop.com.au/blogs/news/how-to-stop-incontinence

Cumper, S. (2025). Continence Management in Aged Care. In Medshop Australia. Medshop. https://www.medshop.com.au/blogs/news/continence-management-in-aged-care

Kayser, S. A., Phipps, L., Catherine A VanGilder, & Lachenbruch, C. (2019). Examining Prevalence and Risk Factors of Incontinence-Associated Dermatitis Using the International Pressure Ulcer Prevalence Survey. In Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society (Vol. 46, Number 4, pp. 285–290). Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society. https://doi.org/10.1097/WON.0000000000000548

Key statistics on incontinence. (n.d.). In Continence Health Australia (formerly the Continence Foundation of Australia). Retrieved February 19, 2026, from https://www.continence.org.au/about-us/our-work/key-statistics-incontinence

Shop Abena Incontinence Products. (n.d.). In Medshop Australia. Retrieved February 19, 2026, from https://www.medshop.com.au/collections/abena-incontinence