Hi! I have a super embarrassing question to ask. If you shouldn’t use soap, how do you clean up if you have light bladder leaking issues?

-Instagram

Short Take…

A cleanser is the best way to clean your vulva when you have incontinence. Limit wipes for when you are out of the house and using a cleanser isn’t feasible. Use the right incontinence products to minimize the contact of urine with the vulva. 

Go One…

Incontinence is a common problem and rarely discussed, so I am so glad you asked because we need to talk about it more. About 25% of younger women, 50% of middle aged women, and 75% of older women have some degree of urinary incontinence and many go without care and that needs to change. Many also don’t know how to care for their skin when they have incontinence, and that matters because urine is an irritant and so incontinence can lead to irritation and even skin breakdown. In addition, the combination of menopause and aging affects vulvar skin making it drier and less resilient, meaning irritants—like urine—can have more of a negative impact. 

There are 3 basic steps for skin maintenance and incontinence.  

Minimize urine contact. This means using the right incontinence product. Don’t use menstrual pads, as they have a different design and the top layer is more likely to stay wet with urine, thus impacting your skin. Incontinence products are rated by the volume of leaking, so make sure you are using one that meets your needs. 

Cleansing. Water works fine for many people, but when you have incontinence water may not be enough to remove the odor of urine from the skin or to remove the urine itself, and so I recommend a cleanser. A cleanser is not soap. Soap can react with the skin, raising the ph and it also strips away sebum. This can disrupt the acid mantle (an acidic film of sebum and sweat on the skin), which is the very first layer of defense. When the acid mantle is damaged, the skin becomes dry and an irritant, like urine, is more likely to cause inflammation and irritation. Soap can also leave carbonate salts on the skin, which are irritants. A cleanser is much better for the skin as they use surfactants to remove dirt and won’t raise the pH of the skin or or damage the acid mantle. Use an unscented, facial cleanser. I typically recommend one for dry skin, but as long as it is unscented and doesn’t contain salicyclic acid it is probably just fine. Brands I like are CeraVe, Eucerin, and Cetaphil. To wash the vulva, don’t separate the labia minora, just splash some water, apply a little cleanser to your hand and apply to the labia majora (outside lips), mons, and around the anus, and then rinse. Be careful about using a face cloth because you don’t want to scrub. And remember, nothing should be inserted vaginally for cleaning!

A word about wipes. Avoid them if you can because they can be irritating. I see a lot of wipe induced contact dermatitis. However, if you are someone who leaks a lot, having them on hand can be useful when you are out of the house and need to clean up

Moisturizing  Dryness is the enemy of the skin. Using a moisturizer will reduce irritation and itch and keep your skin in better health, so if it is exposed to urine there will be fewer consequences. Coconut oil works well, and it doesn’t matter if any gets in the vagina so you can be liberal. Petroleum jelly, also known as Vaseline, is a great moisturizer and some people like Aquaphor (neither of these should go internally in the vagina). There are a variety of moisturizers sold as “special” vulvar products, but none of them are tested. Most are a combination of various oils and beeswax, but whether the beeswax truly adds anything—especially given how expensive these products are as compared with coconut oil or petroleum jelly—isn’t known. As long as what you are using is fragrance free, feels good and you feel less irritated it is probably fine. Be mindful that natural fragrances can be just as irritating as any synthetic product and should be avoided. If something smells lovely, it has fragrance. And don’t use anything with tea tree oil. 

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One more thing…

Too often women are told incontinence is “not that bad” or “it’s just part of being a woman,” but that is an awful approach on the part of a medical provider. If incontinence is bothersome, it deserves treatment. There are a wide range of therapies, such as physical therapy, vaginal incontinence devices, medications, injections, and even surgery (depending on the type of incontinence), and almost always incontinence can be improved significantly.