If incontinence caused pressure injuries / ulcers we’d see millions of babies and tiny tots with wet nappies and big pressure ulcers on their little bums, clogging up our hospitals; we don’t. Babies get nappy rash and as distressing as that might be nappy rash does not cause a big pus-filled hole to develop, down to the bone.
Where did this idea come from – that incontinence could cause pressure injuries? Well for decades now nurses have used numerical tools to assess patients’ risk of pressure injury / ulcer development. The tools contain parameters such as mobility, incontinence and nutrition. Each parameter gives a score and nurses total the scores to determine patients risk; that could be anywhere from ‘no-risk’ to ‘high-risk.’
If deemed at risk the patient may be given an alternating pressure air mattress if they are bedridden and / or a ‘turning’ regime where nurses will reposition patients every two hours, to relieve the pressure on each part of the body. They may be rolled from side to side for example.
It’s easy to understand how poor mobility / immobility can result in a pressure injury, but incontinence?? Well it can’t and let me tell you why.
Most pressure injury risk screening tools, as well as the studies that have reported on incontinence as a potential risk factor for pressure injury development, do not differentiate between ‘urinary incontinence’ and ‘faecal incontinence’ nor between the different types of, stress or functional incontinence.
Stress incontinence may occur during physical activity for example so it is clear that this type of incontinence is not a cause of pressure injury. But functional incontinence can occur in patients with decreased mobility, that physically cannot get to the toilet in time because they have suffered a stroke, or had a leg amputated, for example. So it is the decreased mobility that puts them at risk of pressure injury, not the incontinence.
Some studies show that pressure injuries developed in patients with indwelling urinary catheters…so wet skin was not the cause of the pressure injury.
Catherine A. Sharp
Founder & CEO
Expert Witness Nurse Consultants Australia
Everything is very open with a clear explanation of the issues.
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