When people are unable to move independently while in a bed, or chair – they have an increased risk of developing many types of skin problems.
If you are helping care for a friend or loved one while they are unable to move on their own, then you need to keep reading.
Have you ever had problems moving around? Perhaps due to an acute injury, such as a broken bone? The cause of immobility in this case would be pain, secondary to the broken bone. Hypothetically, you would find a comfortable position and stay in that position, in an effort to decrease the pain. However, staying in the same position for an extended period of time has an impact on your entire body – but let’s talk about what it does to your skin.
Your body creates a lot of heat even when you’re not moving. This heat generation combined with the decrease in airflow to the skin contacting the chair or bed, and your body begins to sweat. If you can’t move at all, then this moisture begins to accumulate – especially in the areas where there are skin folds, such as the buttocks, between the thighs, in the groin areas, under arms, behind the knees, etc.
The moisture on the skin can cause multiple types of skin problems, such as weakened skin strength, rashes that are itchy and uncomfortable, decreased sensations, and pressure ulcers. Moisture combined with immobility changes the pH of the skin. The normal bacteria on the skin begins to change in composition, which can penetrate the weakened outer skin layers. You may note pain to the touch, redness and/or rashes.
When the skin layers are weakened, it is hard for it to do its job – which is to protect the body from outside sources of infection that lead to an inflammatory response. Think about a piece of paper, paper will serve as a barrier when dry. When the paper is wet, it falls apart very easily and loses strength.
We sometimes describe the skin using the analogy of a brick house. A brand new, properly built, brick house is a highly protective structure. It will serve as a protector, keeping the vermin out of the house, because they cannot penetrate the walls. Your home experiences storms, wind, rain, ice, snow and heat year after year. This weakens the brick and mortar which holds the masonry in place. When the mortar begins to crack and crumble, the vermin now have access to your house. They crawl in through the cracks and begin infesting your home.
This is very similar to what happens to the structure of your skin when exposed to moisture, combined with immobility. The normally occurring bacteria that lives on the outside of your skin is the “vermin” you want to keep out. Sweat, trapped as moisture, causes the skin cells to swell and macerate, or soften. Now the structure of your skin is weakened and the bacteria have a pathway into your skin layers. Your body responds with inflammation to the area. This begins a cycle of inflammation that continues to cause weakening of the structure.
What can you do to prevent skin problems related to moisture and immobility?
- Keep the skin clean and dry
- Develop a schedule to help your loved one make position changes
- Use pH balanced products for cleansing the skin, protecting the skin and moisturizing the skin & develop a schedule to ensure this is done consistently.
- Check the skin in areas that are in contact with the surface of the bed or chair at least daily, more frequently if needed.
- Use handheld mirror to see between skin folds or hard to reach areas.
- Use bed linens that are moisture wicking.
- Offer liquids at least hourly during waking hours
- Use a bowel and bladder diary to individualize scheduled bathroom breaks and assist them to bathroom, bedside commode, or provide incontinent care as soon as possible.
For more information regarding preventing pressure ulcers and skin problems, visit Medline Plus here.
Remember the skin is our largest organ and it is our body’s first line of defense!