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Gluten & Dairy
Life With Bile Acid Diarrhoea
Many of us at times continue to have problems with sore skin around the perianal area (anus and vaginal areas) and sometimes groins. This can occur during a “flare up”, episodes of incontinence (accident) or soiling of the skin when bowels are opened.
Skin has a very fine slightly acidic film on the surface called acid mantle. This film acts as a barrier to bacteria, viruses and other potential contaminants that might penetrate the skin. Urine and faeces are alkaline which can disturb PH balance. Faeces, also contains digestive enzymes which can causes erosion of the skin. Thus, when the skin is exposed to urine and faeces the PH balance around perineum changes which decreases the skins natural barrier function and the skin can become inflamed or break down.
For people with BAD when bowel motions are loose, there will be a larger amount of digestive enzymes (bile salts) being passed so it is likely that at times you skin may become sore. Therefore, it is really important to protect your skin by keeping it clean and dry. However, it is also very important that skin cleansing is undertaken correctly because if undertaken incorrectly it can cause further aggravation.
The following are 3 basic principles that will help care for your skin
- Skin should be cleansed after every episode of incontinence or if soiling of the skin has occurred whilst opening your bowel
- Where possible use a non scented skin cleansing product formulated to maintain the natural PH balance of skin. Traditional soaps and shower products are alkaline based and can further increase the levels of alkaline when they come into contact with faeces and urine. They can also dehydrate the skin and contain surfactants which can all irritate the skin causing it to be more vulnerable to inflammation, breakdown and growth of bacteria
- Increasingly there are many products now available which may be very confusing to choose. If you do find it confusing your pharmacist or practice nurse will be able to help advise you on which products would be suitable. Where possible when heavy soiling has occurred it is best to shower, bathe or use a bidet
- If this is not convenient or only a small amount of soiling has occurred use a soft wet cloth rather than flannels and sponges. Flannels and sponges are rough which can cause increased friction and are difficult to keep clean which increases the risk of bacteria. Warm water rather than hot water should be used
- Cleansing should always be performed from front to back to avoid contamination of your urine tract
- When out and about moistened toilet paper / cotton wool or a toilet wipe. When using a wipe it is important to use one than does not contain alcohol as this can dry your skin and one that is formulated to maintain the natural PH balance of skin
- It is very important to ensure your skin is kept dry as moisture can cause the skin to become fragile and increase the risk of inflammation and breaking down
- When drying the skin avoid rubbing as this can cause friction.
- Gently pat the area dry with a soft towel / toilet paper or leave the area to air dry.
If you are routinely undertaking the above cleansing and drying steps but still experiencing sore or itching skin in your perianal area it is important that you do not ignore these symptoms. If you are experiencing heavy soiling, frequent incontinence, persistent itching and / or patches of broken skin then we would advise that you discuss with your GP or practice nurse your symptoms. It is important not to be embarrassed about talking about symptoms "down there", your GP and Practice Nurse will want to support you with managing your skin and they will also consider whether there is any other reason for you symptoms such as thrush or other bacterial infections.
However, if the frequency of soiling / incontinence is low and itching is minimal or none existent then you may find it beneficial to use an over the counter skin protection product which are available as a cream, spray, foam or wipe. There are two types of protection products conditioning barrier products which lock in moisture to hydrate and protect the skin and Barrier Products which provide a protective coating to minimise the skins contact with urine, faeces and sweat. our pharmacist can help you decide which would be best for you.
If you feel unsure about how bad the condition of your skin is then take a look using a hand held mirror.
If you do use a conditioning or barrier product it is important that you:
- Follow the instructions on the product
- If you have sensitive skin then be cautious with products that contain dimetnicone, lanolin or zinc oxide as these additives may cause irritation to sensitive skin
- The product should be applied thinly to the skin. Large amounts stop the skin from breathing and can make the area sweaty and uncomfortable
- Ensure that the product is allowed to dry completely before replacing clothing or a pad as it can stick. This can take 30 -
60 seconds depending on the type of product you use
- Applying too many layers of barrier products may make the are feel stiff and cracking can occur which will allow moisture to penetrate through the barrier onto your skin
- Cream based protection products should be cleansed off after each episode of incontinence to avoid a build up of cream and faeces
Other things to generally consider in helping to keep your skin healthy is to not wear too tight clothing, wear cotton underwear and consider wearing stockings or hold ups rather than tights.