Pads, Odor and Sore Skin: Caring for Skin When You Leak

Pads and protective underwear help you get on with your day, but skin that stays damp can get red, sore and smelly. Clinicians call this incontinence-associated dermatitis, and it’s one of the most common skin problems in adults who leak.¹ It becomes more common with age.²

What the evidence says about cleaning

A Cochrane review of 13 trials with nearly 1,300 adults found:¹

• Soap and water performed poorly for preventing and treating this rash.
• A gentle skin cleanser worked better than soap and water in one trial.
• A cleansing cloth that also moisturized and protected worked better than soap and water in another.
• Leave-on products, such as moisturizers, skin protectants or both, seemed to work better than using nothing.

The evidence was low quality overall, mostly from nursing homes and hospitals, and the authors noted that results depend on the product’s ingredients and how much you use.¹ A review focused on older adults suggested cleansers with a pH between 4.0 and 6.8, closer to skin’s natural acidity than many bar soaps.²

A simple skin routine

1. Change wet pads promptly so skin isn’t sitting in moisture.
2. Clean gently with a no-rinse cleanser or a mild, pH-balanced wash instead of bar soap.¹²
3. Pat dry. Don’t rub.
4. Apply a thin barrier layer, such as a zinc oxide or petrolatum-based protectant, especially overnight.¹
5. Choose products made for urine leaks. Menstrual pads aren’t designed for urine. Our article on period underwear in perimenopause covers the difference in absorbency.

About odor

Keeping skin clean and dry, changing products often and treating the leak itself all help with odor. A strong new smell, cloudy urine or burning can mean an infection. See our guide to strong-smelling urine.

Treat the cause too

The older-adult review placed managing the incontinence itself at the center of care.² Our guides to bladder diaries and pelvic floor exercises are good places to start, and our HSA and FSA guide for leak pads covers paying for supplies.

When to see a clinician

Get checked if skin breaks open, blisters, bleeds or shows a bright red rash with small spots at the edges, which can signal yeast.

Try: “My skin under my pads is red and sore most days. What cleanser and barrier cream would you suggest, and can we work on reducing the leaks?”

Arms Up includes a Fresh Log and a zone-by-zone match. Use them to track which products you use, how your skin responds and any odor changes. See the book.