Continence Coach: Calling on Cotton for Innovative Perineal Care

New Orleans testing lab studies, advances cotton's role

December 2012
From: Ostomy Wound Management
By: Nancy Muller, PhD, MBA


Innovation in product design can sometimes happen in small, evolutionary steps or in huge, discontinuous leaps. It can be heralded by new technology or by new understanding of the product’s use or user needs. Innovation may involve something greater than the user, such as sustaining a stronger environment. One of many definitions of innovation describes it from the commercial perspective as a replicable idea that has value in the marketplace.1 For me, a primary reward of working in the healthcare sector is its openness to change through innovation and the dogged determination of its highly diversified, interdisciplinary players — clinicians, researchers, educators, policy makers, and market makers — to improve the quality of care through innovative creativity.

Case in point: Much of the functionality of disposable adult absorbent products for incontinence is determined by quantifiable characteristics that can be measured with inline testing during the manufacturing process. These include such standards as rewet rate (the amount of wetness returned to the surface of an absorbent product onto an absorbent filter paper) and retention capacity (a measure of the product’s capacity to retain a certain amount of liquid after centrifugation). However, these measures lack precision and fail to reflect how the product protects delicate human skin against repeated insults or incontinent episodes. Even adding a collagen film to the absorbent testing surface to simulate artificial skin in measuring rewet rate for testing has shortcomings. Meanwhile, absorption capacity is merely a proxy for how skin might be affected by an absorbent product; this measure tells us nothing about product fit or the likelihood of urine or watery stool leakage. With leakage, sensitive perineal skin becomes even more vulnerable to redness, swelling, itching, irritation (generally referred to as dermatitis2), and fungal infection.

For several decades, recognizing the vulnerability of the perineum in the patient with incontinence, specialty nurses developed and championed structured protocols for care.3 Sensitive skin appears to be far more prevalent than many people suspect. In a study4 published in 2011 based on a telephone survey of a representative sample of the US population (994 Americans, 495 men and 499 women), 44.6% self-reported having “sensitive” or “very sensitive” skin. Subjects with “slightly” sensitive or “not sensitive” skin were differentiated from those with self-described sensitive skin. Women were more concerned than men (50.9% versus 38.2%) with skin problems. No significant differences were noted related to geographic localization, age, or ethnic distribution. Persons with sensitive skin had mainly dry (34.5%) or mixed skin (35.7%), fair phototypes, dermatological disorders, and higher skin reactivity to cosmetics and various environmental factors compared to persons who reported having only a “slightly” sensitive or not sensitive skin. A dermatologist has a strong influence on subjects with “sensitive” or “very sensitive” skin and can prescribe skin care products, but other product choices are left entirely to the consumer. This is especially true for community-dwelling persons.

Individuals with bladder or bowel control and sensitive skin are vulnerable to perineal dermatitis if their skin is easily irritated by the synthetic films and bleached, wood-based fibers common to nonwoven absorbents. Enter innovation. Incontinence products from Italy that target the unmet need of sensitive skin and vulnerable perineum epidermis are now available in the US: under the Elyte brand. Made from 100% organic cotton, these products can be found under the brand Organyc along with the company’s feminine hygiene line of pads, liners, and tampons.

Private label versions of these products are available in some natural food store outlets and from at least one national mail-order service in the US specializing in incontinence supplies. The biodegradable and compostable products make them far more environmentally friendly than traditional nonwovens.

Cotton, Incorporated, the global trade and research council for cotton, recently completed consumer research5 in the US with guidance from the National Association For Continence on survey structure and target audience. Among users of disposable absorbent products, 95% are not aware there is no cotton in the nonwoven products they use for bladder control, 61% said they preferred their products be made of cotton, and 78% said they would be willing to pay more to obtain cotton-containing products. Between 66% and 75% of these consumers associate cotton with softness (74%), comfort (71%), absorbency (68%), and the prevention of skin irritation (68%), underscoring the positive perception associated with cotton.

When providing nursing care, don’t forget to think about the design, construction, and performance of absorbent products. Patients with particularly sensitive skin may be encouraged to consider a retail product whose components are as gentle as they need to be.


1. Business Dictionary. Available at: Accessed November 22, 2012.

2 . Contact Dermatitis, Medical Student Core Curriculum in Dermatology, American Academy of Dermatology. Available Accessed November 7, 2012.

3. Lyder CH, Clemes-Lowrance C, Davis A, Sullivan L, Zucker A. Structured skin care regimen to prevent perineal dermatitis in the elderly. J Enterstomal Ther Nurs. 1992;19(1): 12-16.

4. Misery L, Sibaud V, Merial-Kieny C, Taieb C. Sensitive skin in the American population: prevalence, clinical data, and role of the dermatologist. J Int Dermatol. 2011;50(8):961–967.

5. Cotton, Incorporated. Available at Accessed on November 22, 2012.

Dr. Muller is the Executive Director, National Association For Continence (NAFC). The NAFC is a national, private, nonprofit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence. This article was not subject to the Ostomy Wound Management peer-review process.


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