Perineum: Proper Skincare of the Perineal Area
Guest: Lynette Franklin – Urology Services, MUSC
Host: Dr. Linda Austin – Psychiatry – MUSC
Dr. Linda Austin: I’m Dr. Linda Austin, talking, today, with Lynette Franklin, who is an advanced practice nurse with the urology clinic here at MUSC. Lynette, one of your areas of interest, and specialty, is perineal skincare. Lots of people, for starters, don’t know what the perineum is. What part of the body is that?
Lynette Franklin: The perineum is your privates. In women, it’s the area between your legs. That includes the labia, the vaginal area, and all the way back to between your buttocks. In men, the perineum includes the penis, scrotum, and the buttocks.
Dr. Linda Austin: Now, why would skincare of that area of the body be of particular concern? Are there different kinds of rashes and problems unique to that area?
Lynette Franklin: Well, as children, until they’re toilet trained, this area is very prone to breakdown, for a number of reasons. Being exposed to urine and feces, as babies, and then being diapered, this area can break down and you can have diaper rashes or yeast infections. And, for any parent who has had a child cry every time their diaper is changed, there can be a high level of frustration with trying to calm them.
As people age, typically, we’re able to keep this area of skin intact. But, if you have a problem with incontinence; meaning that you’re not able to hold your urine or your stool, your skin down there can be very sensitive and break down. This can be not only painful, but it can cause other infections, difficulty working. Even just walking can continue to aggravate it.
Dr. Linda Austin: So, when you do a diagnostic evaluation, then, of someone who has had perineal irritation, what are some of the things you look for, and some of the questions you ask?
Lynette Franklin: First of all, depending on their developmental age; if it’s a child or an adult, I would ask what their typical skincare regimen is. Healthy skin has a pH of 5.5, and that is slightly acidic. And that is our goal, to keep the skin acidic. But a lot of the things that we, as consumers, do to our skin are actually detrimental, for example, using soap. A lot of soap is alkaline, so repeated application to the perineal area can actually change the pH of your skin, which makes it more likely to break down, become infected, and cause pain. Bacteria and yeast, which live on our skin all the time, can’t reproduce in an acidic environment, but can reproduce in an alkaline environment. So, by applying different chemicals to our skin, we change the environment, actually making it easier for those microbes to grow. Talking to patients about what makes their skin worse can help us develop a plan to help protect their skin.
Dr. Linda Austin: So, what do you recommend, then, for cleansing, if not soap?
Lynette Franklin: I’m not saying not to use soap. Many people need to use soap at least once a day to remove excess debris from the area. But if somebody is incontinent, or requires multiple diaper changes, soap can change the environment. So, we recommend that you choose a product that has a pH as close to 5.5 as possible, or just plain water. There are many commercially available perineal cleansers, if you’re looking after somebody who is incontinent. These are much better products for maintaining the natural environment, by keeping that acid shield intact.
Dr. Linda Austin: Are you ever in a position of prescribing or suggesting medications, if there is a bacterial infection, or a fungal infection?
Lynette Franklin: If the skin does break down, you may have a yeast infection. This, typically, when you’re looking at the skin, is a reddened area. And, on the edge of it, the border looks like somebody took a red magic marker and made a whole bunch of dots. That could be a yeast infection. There are many over-the-counter yeast products in cream and lotion form, and also powder products. Two percent miconazole powder is an excellent product to help absorb the excess fluid, treat the yeast, and, also, it’s soothing. It covers the area and helps it to heal.
Also, if somebody has diaper rash from being exposed to urine, you want to apply a protective barrier with each diaper change. You might have a dermatitis or broken down skin from exposure to moisture in the perineal area. This can be from incontinence of stool or feces. Or, if you have a lot of sweat or water in that area from external sources, your skin can break down. So, it’s best to protect before it breaks down, using products, over-the-counter, like petrolatum; which is in Vaseline, dimethicone; which is like a liquid goretex for the skin, or zinc; a white powder. These three products actually repel fluid away from the skin and protect the skin.
There’s also a group of products called skin barriers, which are sort of like a liquid plastic that can be sprayed or applied to the skin and protect the skin from future breakdown. If the skin is already broken down, and these products aren’t quite strong enough, there are some prescriptive products that your healthcare provider can offer to be used for this area also.
Dr. Linda Austin: Lynette, what recommendations do you have for caregivers who are taking care of someone who is bedbound and can’t get up to go to the bathroom?
Lynette Franklin: I would recommend that you protect the skin with each washing, and not allow the person you’re caring for sit in wet. That is sometimes easier said than done. I recommend investing in products that pad the bed; so the mattress doesn’t get wet, and are breathable; something that doesn’t have a plastic backing, so that the water can evaporate. If they can walk around, they need to wear a diaper, which should be checked every two hours, and changed, so that they’re not sitting in wet. Then, select a product that will protect the skin from breakdown.
Dr. Linda Austin: You mean selecting a type of diaper?
Lynette Franklin: No. I mean selecting a moisture barrier, like a petrolatum product, a zinc-based product, or a dimethicone-based product, and applying that liberally to the perineal skin. It’s also important, when cleansing someone who is incontinent; a child or adult, to roll them to their side, separate their buttocks to wipe; and lift up the scrotum and wipe, so that all the debris is removed. A lot of times, people just pick up their legs and wipe below; especially with children, and sometimes that incontinence can get caught in the creases of their anatomy; between their buttocks or, in males, behind the scrotum. In these two areas, that soiled area, the skin can break down.
Dr. Linda Austin: Are there any diapering products that you would particularly recommend, or not recommend?
Lynette Franklin: There are so many different products available and you have to find what works best for you and your family that’s within your budget. You want a product that wicks the fluid away. A lot of people will use menstrual products; feminine hygiene products, for incontinence. But these two fluids are completely different, and the way the product reacts is different. So, for urinary incontinence, it’s very important that you use a urinary incontinence product. Or, if you’re incontinent of feces, you need to use a stool incontinence product.
A lot of people find it hard to sort of tease out what will work best for them, and there are a lot of different options. By coming to the Bladder and Pelvic Health Program, we can help you assess and find a product that will work best for you. Home Delivery of Incontinence Supplies: www.hdis.com, is a wonderful organization, with trained professionals that evaluate the different products, assess you, and help you find the products that work best for you. I strongly suggest getting samples of different products to see which can best hold fluid and wick it away from the skin.
You also want to be careful to avoid an allergy. Dermatitis can sometimes be an allergic reaction to a product that you’re using. If it becomes worse, it may be the product you’re using, and you need to try something else. Sometimes, your perineal skin breakdown can be secondary to a food allergy. A lot of times, parents will notice that when they introduce a new food to their child, the child will develop a rash around the bottom, or a ring around their anus. This is very indicative of a food allergy. And the best way to treat that is to eliminate that food. This is especially true with the introduction of fruits and different milk products. You need to be aware that no cream is going to fix that. You just have to get rid of the source.
Dr. Linda Austin: Lynette Franklin, thank you so much for talking with us today.
Lynette Franklin: Thank you.
If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you’d like to schedule an appointment with one of our physicians, please call MUSC Health Connection at: (843) 792-1414.