Diaper Basics: Another Look at Incontinence Skincare – Part 2 – Rules, Essentials and then some…

In the second part of our excursion into the wonderous world of incontinence-related skincare I will run you through some basic procedures as well as must-have and would-be-nice products that can help you with achieving the best possible results. Some of the info will appear double and feel redundant, but since many products share common ingredients it can’t be entirely avoided. I have tried to list the products in a sensible order to minimize those redundancies.

For this article I’m mostly focusing on generic grocery store/ drugstore products. While due to my selection of some higher quality major brand products this might not qualify as “skincare on a budget”, it still should get my point across that it’s not always necessary to buy super-expensive stuff to get through your daily routine.

Rules and even more Rules

Before we even begin, we need to establish a few simple rules for dos and don’ts. Yes, more boring stuff that should be self-evident, but not only do I like to play it safe, it may also remind you of a few things you should know and perhaps have forgotten about.

  • It’s only for the outside! – All products discussed here have no place inside any of your orifices or other bodily cavities. While most of them aren’t poisonous, they can have negative effects when getting in contact with e.g. the mucosa of your rectum just like they may taste terribly when you swallow them, cause you to sneeze when they get in your nostrils or burn in your eyes.

    It should not need mention that even more crazy things like intentionally injecting certain substances into your urethral tract are not so smart. Of course accidents can happen and you may inadvertently expose your innards to harmful chemicals, but copious amounts of water and the use of paper towels/ dry wipes can fix most of these issues. If you suffer from long-term effects or have allergic reactions go see a doctor ASAP.

  • Keep it out of open wounds!– As an extension of the previous point it should not take too much of a stretch of imagination to realize that you may not want many products to come into contact with open wounds or hyper-sensitized sore skin regions, either. In those cases the common strategies are to of course simply avoid those regions or cover them up. Unfortunately, when you suffer incontinence issues sometimes neither of the two is sometimes possible.

    You may not be able to cover a wound with a plaster, patch or bandage just like you may not be able to entirely avoid applying some substances, if only unintentionally. You know, your favorite barrier cream working itself into some areas as you move or bandages coming off. There are some products that can help like liquid plaster (up to very expensive highly sterile surgical products), but here’s my tip:

    In such situations it can be a great help to just let the wound coagulate, seal and dry by allowing enough air to get through. So it may sound like a weird notion, but after you may have e.g. cut yourself during an intimate close shave, it may be a good idea to walk around in your flat with a loosely fixated and open diaper or just lay still in similar fashion for half an hour. As always: For more serious issues go see an MD.

  • Keep it dry! – One of the most underestimated rules is the simple necessity to keep things dry in some parts of your nether regions. I’m not going to tell you that from now on you need to change your diaper more often, but among other things it is worth considering. More critical, however, is actually letting things “dry”, very similar to the previous point regarding wounds.

    A very common mistake is to put on a fresh diaper too soon after skincare products have been applied. This doesn’t give them enough time to be absorbed by the skin and thus may have some ill effects. One of those is that the products will rub off more quickly than intended onto the absorbent portions of your incontinence product. This reduces their effectiveness and protection factor, but also has the side-effect of making the surface less penetrable, possibly reducing overall absorption and definitely impacting absorption rate.

    The other way around, especially when using foil-based diapers, you may create an unhealthy micro-climate with too much moisture exuding from your skincare product. Conversely, having lots of greasy, smeary stuff on your skin may serve as a perfect ground for bacteria, yeasts and other fungae, increasing the risk of collateral infections or at least irritations.

    To avoid both issues, I would recommend you allow your skincare products to settle for at least three to ten minutes, depending on what you actually use. Brushing your teeth naked sometimes isn’t a bad idea, after all. Since some products are also difficult to apply in the right amount, it may at times also help to dab off excess with a dry paper towel or similar.

  • Your butt-crack is a safe zone! – As my fecal incontinence developed over the years I had to learn some lessons the hard way and one of those is that your butt-crack or Rima ani , as it’s called scientifically, including the immediate exterior regions around your rectum/ anus, can be a hyper-sensitive area that can cause you lots of agony. In practice this means that you need to find a good balance between keeping it clean, but also not overdoing it. That, plus avoiding to rub on skincare products where they do the least good.

    Yupp, friends, this is a zone you should mostly leave out until you have to, the prime reason for this being that once trapped between your butt cheek even the most well-intended and seemingly harmless products can do damage simply because as per the previous point moisture accumulates, which in combination with already irritated skin from fecal excretions indeed can feel like someone powdered your butt with chili.

    It goes without saying that everything I wrote about nasty bacteria and chemicals possibly inadvertently getting in touch with your interior parts also applies. In addition, moisture down there can cause or exacerbate issues with hemorrhoids and ulcers, which is something you don’t want as well. Therefore nice and dry is the way to go.

  • Wash your hands – often and thoroughly! SRSLY!– It is a matter of some debate (which I will not get into here) whether or not you always need to wear rubber gloves when cleaning up your intimate regions. It makes perfect sense when you really have made a poopy mess, but a lot of times perhaps not so much, considering that pretty much any incontinence product has chemicals that inhibit bacterial growth and urine is almost perfectly sterile to begin with (unless of course you have a bladder infection).

    A similar argument could be made for applying creams and ointments. It may be nice not having to deal with white stuff under your fingernails, but unless you have specific reasons, it’s perhaps not even particularly comfortable to wear that thin layer of latex, nitrile or vinyl on your hands. In fact some of those are even sensitive to lipids and may dissolve when getting in contact with greasy substances.

    Regardless of your preference in the matter, one thing you should definitely do is to wash your hands a lot. This means you should wash them intensely before you begin and then again and again through the whole procedure such as after you have removed your old diaper and done the cleaning. Likewise it may even be necessary to wash your hands after every use of a different skincare product.

    Why all the fuss? To avoid all sorts of infections, of course. You do not want to eat your food with dirty hands and you just as well have to avoid contaminating your skincare products or for them to  show unexpected reactions when they come into contact with one another. Did I mention that having Penaten-Cream in your face also looks kinda funny in a weird sense? ;-) So by all means, make it a point to wash your hands based on a sensible pattern. And no, desinfecting agents have no place in this nor won’t they save your behind.

  • No double takes!– It may come as a surprise, but when it comes to skincare there is such a thing as too much of a good thing. Your skin is a living, breathing organ and it can only take so much, both in the good and negative sense. Too much scrubbing, rubbing and peeling can be just as bad as trying to make up for bad practices with too much of a skincare product or too many of them.

    Therefore it is necessary to develop a feeler for when enough is enough and avoid situations where you possibly end up piling one substance of a certain kind on top of another that serves the same purpose. As an example it makes for instance absolutely no sense to immerse yourself in a creamy, oily bath for half an hour and then add yet another ton of moisturising body lotion on top. Similar analogies can be drawn for other cases.

    As always – which combinations work will of course depend on your individual parameters. Dry, coarse skin may actually benefit more from multiple treatments, greasy skin not so much. In reverse, dry skin may suffer from using too many cleaning products when you can rub a dry wipe on oily skin all day without doing any harm. It really depends and only you know what’s best for you. It may even be useful to consult a dermatologist or consult with a cosmetics person to find a good combination.

After this little lecture let’s move on to some actual products. Please note that everything depicted are just stand-ins based on what I actually use. If you use other products that have proven their worth and “just work” for you, there is no need to change anything as long as you have all departments covered.

Products Primer

Washing Gel/ Shower Gel

Face WashSince everything starts with providing a clean base to work on, you will need some reasonably good washing or shower gel or soap. Personally I’m not a big fan of products with heavy scents, so you won’t find fruity flavors or herbal essences in my bathroom. I like to keep things “neutral” so yes, I buy the cheap blue shower gel that supposedly smells like a sea breeze. The only real luxury I’m affording myself is a dedicated face wash gel (shown here), which helps to avoid acne.

Regardless of this, it doesn’t really matter much what you use, as long as you make it a point to rinse it off thoroughly to provide a clean base. That being the case, I would also recommend that you don’t overdo with expensive products containing rich oils. It isn’t necessarily improving matters and may get in the way.

Foam Bath/ Bathing Essence

Foam BathI have to admit that I’m bathing a lot. Going for a swim in my bathtub helps to relax my muscles, which these days seem to be under permanent spasms and cramps (despite medication), it helps me to breathe more easily (for a while at least), soothes my nerves and is even helpful to calm down intestinal problems, not to mention the positive effects of a steamy bath during a cold.

When I do, I almost exclusively use oily foam bath from Nivea, which also only has a mild almond scent, and only mix in small amounts of the other stuff as needed since e.g. too much of that stingy Eucalyptus oil makes me cough like crazy.

Note that this is also a perfect example for not using too many products at once – when I bathe, I bathe and don’t use anything else after that. I used to use extra lotion, but after many a night spent with that sticky, sweaty feeling on my skin I stopped and things went much better after that.

Zinc (Cream or Emulsion)

Zinc CreamZinc, or more to the point, Zinc oxide is an important constituent of a huge fraction of all the creams, ointments and salves out there as well as many other products. The only difference really is the amount used. There are of course some simple reasons for this. Its color makes it ideal for making products look shiny white and opaque. Since it’s also comparably cheap, it can be used in relatively huge quantities in favor over the more expensive Titanium dioxide.

Along that line of thinking it also makes for a good way of stabilizing the volume of a product and keep it from un-mixing and decomposing back into its original components due to some physical effects at the microscopic level. None of that of course should matter much to us – for all we care it could be black or any other color, as long as its medical effects are the same – and that’s where it get’s interesting.

Zinc oxide is one of the oldest known anti-inflammants and wound healing accelerants and thus historically has been used for anything from treating pimples to serious burns among a gigazillion other things. A lot of those use cases exploit the fact that this ingredient dries out the wounds by binding moisture and the material itself, while being chemically neutral and non-toxic, has antiseptic properties that are beneficial to the process.

When it comes to incontinence skincare, it is a prominent part of many more conventional barrier creams and the like, with an important factor being that it tends to adhere to the skin very well, again due to that thing with its reaction to (skin) moisture and its microscopic structure. Naturally, its anti-inflammatory qualities are useful, too. Recently however, this has come under fire somewhat for a few reasons that make quite a bit of sense once you think about it.

Due to its opaqueness the product may cover up things a bit all too well, making it more difficult to gauge the severity of wounds. This is a widely discussed issue in professional healthcare circles, in particular when it comes to care for the elderly, where things like Decubitus figure into the equation. Along those lines there’s a second argument that you would not apply a product that dries out skin on top of already fragile skin, such as older people, bedridden patients or diabetics may have.

Personally I use this stuff in its plain form extremely rarely and then really only in small areas like when I got in contact with poisenous plants and have blistering on my skin or I was dumb enough to scratch open a mosquito bite. So arguably my main use of it really only extends to barrier creams.

Panthotene/ Panthenol (Cream, Emulsion, Foam)

Panthenol CreamPanthotene is a naturally occurring substance produced by your body. For cosmetic purposes most of the time its more stable and common, synthesized form (Dex-)Panthenol is used, which then acts as some kind of precursor that is being processed into Panthotene. Similar to Zinc oxide, the positive effects of this ingredient have been known rather long and thus it is also being used widely in all kinds of skincare and cosmetics products.

In contrast to what the image may suggest, my preferred way of applying this substance remains the use of foams, however. I even mentioned that briefly in my old article. My rationale here is that it is easier to get an even coat and not to apply too much. While it has positive effects on skin regeneration, the skin is actually only able to absorb very tiny amounts of it at a time, so there is not much point to oversaturate things. Applying too much won’t accelerate the process. It also doesn’t have any “cool” secondary effects, making it even less of a necessity to apply thick layers.

Film-forming Barrier Product

Penaten CreamAt last we are getting somewhere after all the theoretical stuff and are finally discussing your favorite “film-forming barrier product”. that’s quite a mouthful, but really describes perfectly what those products are about – forming an (ideally) impenetrable barrier. To that end there are many different approaches by manufacturers and unless you count specific advanced medical products like Cavilon, most of them revolve around creating a sticky layer of greasy substances or an equally durable layer of zinc oxide with a lot of variations inbetween that try to blend both methods to get the best of both worlds.

First off some bad news: Despite having tried out quite a few products over time, so far I haven’t found the perfect one yet. Most of the time the issues revolve around the products being difficult to apply or not lasting long enough while then at the same time being a total pest when you try to wash them off again. Even the good old Penaten-Cream is a prime example for that.

Since it is based on greases that only melt around your body temperature, you have to dig a lump from the tin and then work it pretty hard to get it to spread evenly. After a short while then the zinc oxide kicks in and it will become even more sticky, especially on your fingers. I typically then have to use two passes of hand washing to get it off, especially under my fingernails. Luckily, such an application will last throughout a whole day (or night for that matter), so you have to suffer the procedure only once before at the end another round of rubbing hard and using lots of shower gel may ensue to get it off again. I’m not saying that it’s bad, it’s just pretty inconvenient.

That said, you can’t possibly avoid some of those annoyances. Even I, who has rather greasy, resilient skin, have days where it’s necessary to add some extra protection. I’m usually judging things by my gut feeling and don’t have a specific pattern. This often has to do with how irritated my skin already is and what I think it would need most based on my experience. So on a day where I know I’ll be out & about for a long time e.g. for a doctor’s appointment in another city I may want to use a heavy zinc cream and then use a lighter, lipid-only product after my evening shower for the night.

And for those who always wanted to know, but never dared to ask: Yes, it does indeed look like the clown make-up in Disney‘s Dumbo movie down there when you apply zinc-based products: A white face with a trunk. I’ll forego bragging rights about the size of my trunk. *giggle* ;-)

Talcum Powder

Penaten PowderThe next item is going to be a bit of an uh-oh thing for some people. Talcum powder has gotten a bit of a bad reputation in recent years for reasons that I find at best dubious, since neither of them has really been proven in a satisfying manner.

The first of those is that it would be “abrasive” to the skin, which in my not so humble opinion is pretty nonsensical. Dried out Zinc cream is probably just as bad, if you were to really put much stock into this. The powder is ground up so finely, I just can’t see how this would happen. Coarse cloth on your underwear is probably worse. That and the particles are actually more like microscopic flakes that slide on one another. That notwithstanding, I could see some theoretical issues for people with thin skin and open wounds, but that would then probably fall more into the category of generic mistakes by care personnel.

The second issue cited is an increased risk of cancer when powder gets in contact with open wounds or inside your body. This goes back to some women having allegedly contracted ovary cancer by use of powder in their intimate regions and suing certain companies for it, but so far there is no scientific evidence that proves or disproves this. If you are the cautious type, you might prefer to err on the safe side and not use powder.

With that out of the way, is there even a good reason to use it? I say yes, but perhaps not in the way you expect. Talcum powder has zero (in numbers: 0) actual effect on your skin. It doesn’t protect anything, nor does it have any cleaning effect or any other magical powers. However, where I find it super useful is to get things “dry” – for a while at least.

With my incontinence there are good days and bad days and on a bad day I may sweat a lot or have very liquid stool and then it so happens that seemingly there is no good way to get rid of the itches despite elaborate cleaning. This is one of the few situations where I’m even willing to disobey my own advise and get more up close and personal in my Rima ani. However, I do so very carefully – instead of shooting large amounts of powder directly from the container, I apply a small dose onto my fingertips and distribute it on the sore areas. Of course it will come off again soon enough, but I find that this procedure really helps, unscientific as it may be.

Generic Body Skincare Product

Body LotionEven if you don’t use it all the time, you should definitely have one of those floating around just in case. As they say “You have to start young (with skincare) for your skin not to look old.” and I definitely have started way too late in my life to appreciate the positive effects of using even the most basic skin cream or lotion.

I’m still not going crazy over this, but there are some use cases. Naturally I’m using it quite a bit during summer to soothe my skin after having exposed it to the sun. In part this has to do with my defunct Vitamin D metabolism being dependent on some sun exposure and thus sunblockers not being ideal, in part I simply forget to put on some protection when running my errants here in our little village and then underestimate the sun’s intensity and how long I’m outside.

The other case where I would use it occasionally is when my intimate regions simply feel extremely dry after wearing diapers for a long time. This in particular includes the upper parts of the thighs, the outsides of your buttocks, parts of the back and belly – regions that you normally don’t apply protective products on, yet may still be sensitive to the carrier tissue of your incontinence product.

As far as the specific properties of your lotion or cream are concerned, your emphasis should be on moisture with only a touch of oils, at least in the context that is relevant here. If you overdo with the greasy stuff, you might again minimize the efficiency of your incontinence product for the same reason laid out earlier for the barrier products. Your skin being too smooth and slippy might even affect the physical comfort when wearing your diaper, as it may slide down more easily.

Hand Wash

Hand WashSince I’m advocating frequent hand washing so adamantly, having a sufficient supply of washing gel or soap is crucial. For all intents and purposes, it should be as mild as it can possibly get due to how often you are going to use it. That may sound complicated, but actually isn’t – most mundane products out there fulfill that criteria already, with “active substances” (tensides etc.) often making up less than 3 percent of the product and the rest being glycerine, water and other fillers to make it actually usable.

As a recurring theme, I would advise against using products with too many lipids in them. The risk here is that you may inadvertently touch the sticky side of your adhesive tapes and thus reduce their strength by applying an invisible film of grease. Similarly, there is no need for the hand wash to contain disinfecting agents. As I’ve laid out in my older article, a lot of hygiene has to do with physically removing contaminants rather than trying to make them inert using chemicals.

Hand Cream

Even the mildest hand wash takes its toll and seasonal effects like the winter cold contribute to skin breaking up, so there’s nothing wrong with using a hand cream every now and then. Based on what I said, of course you should do it only after you have successfully cleaned up and changed your diaper. I would also recommend you don’t do it too often throughout the day. For one it’s simply impractical trying to hold a coffee cup with slippery fingers, but it may also pose a hygienic problem. People balming their hands e.g. on public trains is simply bad, as it helps spread bacteria. Likewise, even at home you may not want to turn your computer’s keyboard into a Petri dish.

Wet Wipes

Baby WipesThis is going to be controversial like some of what I wrote already, but here’s something to write down for you: When it comes to cleaning, lots of water and a washing cloth are still your best friends. Even the most sophisticated and fancy wet wipes can’t replace that, which of course means that I consider them only a second best alternative.

Aside from environmental considerations, my problem with these wipes is inherent in how they work. In order to retain their moisture, they contain chemicals like Propylene glycol, that have a retardant drying effect. Naturally, some of that comes off when you use them on your skin and this goes against our “keep things dry” rule. That is to say by using these products too heavily, you may introduce a new problem while fixing another, if you don’t allow enough time for the residue to dry off.

As I wrote in my previous article in this series therefore wet wipes can only be considered a complementary product, but you can’t possibly avoid having to properly shower and wash once a day. In my little world I really only use them very sparingly and often even only as a quick way to “freshen up” and at a hint of fresh scent on my skin, because otherwise I don’t use perfumes and deodorants that much, either.

Other Products

Finally let’s have a look at some more products that don’t exactly fit into any other paragraph. The ones mentioned here typically only come into play when you actually have some sort of wound, be that an open scratch or a sore. You wouldn’t normally use them for your daily routine.

Vaseline

Vaseline

The first is plain Vaseline (Petrolatum, Petroleum jelly). It’s already part of many medical and cosmetic products where it is often only used to control the consistency of the product, not so much as an active ingredient.

The reason I’m explicitly mentioning it here is simple: Because it’s pure, it may be an alternative if you suffer specific reactions to other products. This can include allergic reactions e.g. to organic oils (and tiny amounts of pollen etc. contained therein), but also temporary skin irritations. As a byproduct of petrol it does not contain these kinds of things.

Of course it could be argued that the product may contain hydrocarbons that have the opposite effect, but similar to my stance on Talcum powder I consider any “evidence” to that end at best inconclusive. If you allow me: To me it’s more likely you get a reaction to expensive almond oil just because a bird pooped onto one of the nuts.

With that said, the theoretical applications of just Vaseline are endless. It’s insoluble in water, thus allowing it to serve as a barrier product. At the same time it has wound healing properties, making it a candidate for use on small wounds. It’s also perfectly transparent, so it’s utterly inconspicuous in exposed skin areas except for the shiny gloss. The only downside is that it barely gets absorbed into the skin, so you have to be super careful to not dirty up your clothes or let it catch too much dirt.

Specific Wound Treatment

As I promised in the first part of this series, I’m not going to pretend to be a pharmacist and I will avoid those treacherous waters, but regardless, allow me to point out some more specific “medical” products that I find useful.

Bepanthen CreamBepanthen-Cream is an advanced version of standard Panthenol cream discussed earlier and in this case does contain an additional antiseptic component. This particular product is also very liquid-ish, allowing it to get into small crevices, i.e. wrinkly skin regions. I occasionally feel compelled to use it when I messed up a shave (facial or otherwise) or scratched myself too much. Totally unrelated to any of this, it is also my go-to product  when I injured my nail bed during pedicure/ manicure since it so nicely flows under the nail almost by itself.

Hametum CreamWhile rather apparently I have a preference for “pure”, lab-quality ingredients, it goes without saying that there are some natural products based on plant extracts that have similar qualities. Two prominent examples for this are Arnika montana and Hamamelis extracts, the latter represented here by ways of a wound ointment. This specific one can be used to great effect for those pesky inflammatory itches even in the Rima ani, because it is based on a very doughy grease and sticks well.

One thing you have to be warned about, though: Many of these natural products can be extremely toxic when used wrongly. Most of them are ever only meant for topical application for a limited time. You should avoid contact with open wounds and mucous tissue at any cost. Naturally, due to being extracted from real plants they may also contain remnants of the plants themselves and those in turn can cause allergies. Therefore I would advise testing these products under normal conditions first before you rushedly use them in a crunch and suffer side-effects.

After this 5000+ words monstrosity in the next article we will finally get a look at some branded products. Sorry for the long read, but this should give you enough to think about for a while at least. As always – if you have specific questions or commentaries, feel free to make good use of the various feedback options. See you next time!

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