TL;DR
The Reality: If you’re managing bladder leaks and feel burning or itching, you aren't imagining it. Incontinence-Associated Dermatitis (IAD) affects up to 30% of women who wear pads daily.
The Culprits: It’s a combination of moisture (which raises skin pH) that builds up on the surface of pads that don’t properly wick away the urine and chemicals (fragrance, dyes, chlorine bleach, petroleum-based plastics and other harsh ingredients) found in many conventional pads.
The Science: A 2024 meta-analysis found that certain plant-derived ingredients used in skincare formulations were associated with reduced redness and improved skin hydration compared to synthetic controls
The Fix: For thousands of women, switching to Attn: Grace Skin-Safe™ Pads has helped reduce ongoing irritation while supporting skin comfort.
If you've ever felt burning, itching, or painful redness after wearing an incontinence pad, you're far from alone—and you're not imagining it. The discomfort you're experiencing is real, and it has a name: incontinence-associated dermatitis (IAD).
According to a 2025 review published in Drugs & Aging by researchers at Charité-Universitätsmedizin Berlin, IAD affects between 3% and 30% of people who rely on absorbent products daily. This isn't just minor irritation—it's painful inflammation caused by moisture exposure combined with the very products meant to help you manage leaks.
Here's what many women don't realize: the pads they’re using to manage their leaks can be just as much of a problem as the leaks themselves. The materials, chemicals, and treatments used in many conventional pads can interact with moisture and urine in ways that contribute to skin irritations that leave you uncomfortable, self-conscious, and constantly searching for relief. But there's good news. When you understand what's actually causing the irritation and know to look for truly Skin-Safe™ products, you can finally get the leak protection you need without the pain and discomfort.
The Hidden Culprits Behind Pad-Related Skin Irritation
When your skin burns or turns red after wearing a pad, you're likely dealing with one of two issues (or sometimes both): irritation from moisture that builds up on the surface of the pad when it doesn’t dry quickly enough, causing your skin's protective barrier to break down, or a reaction to the chemicals in the pad itself, particularly when combined with urine.
How Moisture Breaks Down Your Skin Barrier
Moisture from bladder leaks isn’t caused by harmless water — it’s caused by urine. Urine’s acidic-to-alkaline pH and high salt content compromise the skin’s natural pH balance on contact. Prolonged exposure can raise the skin’s pH above its normal range, often compromising barrier function. It also accelerates barrier damage, increases friction, and creates an environment where irritation and skin breakdown can occur more easily. As the Charité research team explains, urine hydrates your skin's outer protective layer (the epidermis), causing it to swell and weaken.
Here's the thing: Natural bacteria on your skin produce enzymes which can raise skin pH above its normal acidic range. This can disrupt the skin’s protective barrier, weaken cell cohesion, and increase vulnerability to irritation and inflammation.
But moisture alone doesn't explain why so many women struggle with "pad rash”.
Absorbency and breathability matter just as much as ingredients
Quickly drawing urine away from the skin limits how long moisture and irritants sit on the surface, which helps support skin barrier function and reduces prolonged moisture exposure associated with irritation. At the same time, breathable materials let heat and moisture vapor escape instead of trapping them against your body, which lowers friction, keeps the area more comfortable, and supports healthier skin with repeated or long-term wear.
The Chemical Ingredients That Trigger Allergic Reactions
Many conventional incontinence pads contain ingredients that were never selected with long-term skin health in mind. You're wearing these products 12 to 16 hours a day (or sometimes 24/7) against some of the most sensitive skin on your body, and many contain ingredients that have been identified in dermatology research as harsh chemicals, potential irritants and contact allergens for some individuals.
According to research published in Dermatitis by the North American Contact Dermatitis Group (NACDG), which analyzed patch test results from 4,121 patients tested between 2019 and 2020, synthetic fragrance tested positive in 12.8% of patients—making it the third most common contact allergen identified.
The researchers also found that hydroperoxides of linalool (a fragrance that forms when natural linalool oxidizes in air) tested positive in 11.1% of patients. These synthetic fragrances are routinely used in scented incontinence products to mask odors. Yet, for sensitized individuals, they have been shown to cause delayed allergic reactions that cause redness and itching, sometimes even spreading beyond where the pad directly touches the skin.
The problem goes far beyond fragrance. Here are the most common irritants hiding in conventional pads:
Synthetic fragrances: Added to neutralize urine odor, these chemical compounds can cause allergic reactions that develop over time, even if you've used the same product for months without issues.
Chlorine bleach residues: Pads that are made without elemental chlorine bleaching may be better tolerated by people with sensitive or already irritated vulvar skin, because chlorine‑based processes can leave reactive residues that have the potential to irritate compromised skin.
Petroleum-based plastics: Many mass-market pads use petroleum-derived synthetic materials for their top sheets and backing layers. A 2024 case report published in Cureus documented severe allergic contact dermatitis caused by acrylates—plastic compounds commonly found in medical pads and adhesives. When worn continuously, certain synthetic compounds used in pads and adhesives have been documented to cause sensitization in susceptible individuals through repeated contact.
Adhesives and dyes: The colorful patterns on many pad top sheets require artificial dyes, and the sticky strips that hold pads in place contain acrylate adhesives. Both are known contact allergens.
What Medical Research Says About Skin-Safe™ Incontinence Care
The past few years have brought real clarity on how to prevent pad-related skin damage as you’re managing bladder leaks. The evidence now points to three essential elements: managing moisture effectively, choosing pads made with the right materials, and protecting your skin barrier.
The Skin-Safe™ Product Framework
In a study published in the International Wound Journal, Australian researchers tested an evidence-based care approach across 18 hospital wards. The impact was substantial: hospital-acquired IAD fell by 36.3% among incontinent patients, dropping from 6.71% to 4.27%.
What contributed to the improvement? Instead of ad‑hoc continence care, staff followed a standardized bundle: they used a structured continence assessment, applied barrier cream cloths consistently, reduced unnecessary bed layers, and ensured continence pads were the right type, size and absorbency for each patient.
What Makes a Pad "Skin-Safe"?
A 2024 meta-analysis published in the Journal of Cosmetic Dermatology analyzed eight randomized controlled trials of topical products containing plant extracts and found that these botanical formulas improved key skin markers of aging—including reducing erythema (redness), lowering melanin levels, and boosting overall elasticity—compared with their control products.
The analysis showed that in six of the eight studies, no adverse events were reported, and the remaining two did not note any safety concerns. Now, it's worth mentioning that this research focused on facial and body skincare products, not incontinence pads. While these studies did not evaluate incontinence pads directly, they support a broader principle: when choosing products that will directly touch your skin for extended periods, look for thoughtfully formulated, plant-based ingredients instead of harsh synthetic chemicals.
Skin often responds more favorably to gentler materials, with improved comfort and hydration reported in skincare research
Choosing Incontinence Pads That Won't Hurt Your Skin
You don't have to settle for products that hurt. When you're shopping for leak protection, here are the evidence-backed features that protect your skin while also effectively managing moisture.
Look for These Key Ingredients and Materials
Plant-based top sheets: Instead of petroleum-derived plastic top layers, look for pads with top sheets made from gentle, renewable materials (like Attn: Grace's Skin-Safe ™ Design). These pads are designed to be ultra-gentle on your skin and quick-drying – designed to promote airflow and reduce occlusive moisture buildup
No synthetic fragrances or dyes: If a pad is scented—even if it's labeled "fresh"—it's introducing synthetic allergens to vulnerable tissue. The same is true for synthetic dyes found in the top layers of many of the conventional brands.
Chlorine-free (TCF): Choose pads explicitly labeled as Totally Chlorine Free to avoid irritating chemical residues.
High absorbency: A pad that stays dry on top is critical. Look for pads with rapid-wicking cores that pull moisture away from the skin immediately.
Together, these are the core features of Attn: Grace’s Skin-Safe™ pads, so you’re not just getting a plant-based label—you’re getting fragrance-free, TCF, ultra-absorbent protection that is actually designed for sensitive skin.
The Complete Skin-Safe™ Leak Care Routine
Medical evidence supports a three-step approach for preventing irritation associated with managing bladder leaks: cleanse gently, protect your skin barrier, and use a pad that absorbs leaks quickly and effectively.
Gentle cleansing: After each leak, cleanse the area with a pH-neutral, fragrance-free wipe or a hypochlorous acid spray. Avoid traditional soaps, which can strip away protective oils.
Barrier protection: Apply a thin layer of all-natural, zinc oxide barrier cream to create a physical shield between your skin and any future moisture.
Skin-Safe™ absorption: Choose an ultra-absorbent Skin-Safe™ pad. It is recommended to change your product 4-6 times a day, or whenever an incontinence pad is saturated and wet. Note that this will change depending on one’s unique needs.
Moving Forward: Prioritizing Skin Health in Your Incontinence Care
If you're currently dealing with irritation, burning, or redness while managing bladder leaks, it may be time to consider an alternative to conventional incontinence pads.. The good news? You now have options. Evidence suggests that effective moisture management, appropriate cleansing, barrier protection, and thoughtfully designed absorbent products can help reduce irritation associated with managing bladder leaks.
Start by taking a close look at your current products. If they contain fragrance, dyes, or plastic top sheets, they are likely contributing to your discomfort. Swap them for a Skin-Safe™ alternative that combines plant-based materials designed to promote airflow and moisture vapor escape. Your skin is your body's first line of defense—it deserves protection that is as gentle as it is effective.
Medical Disclaimer: The information provided here is for educational purposes only and does not constitute medical advice. If you have severe skin breakdown, open sores, or signs of infection, please consult a healthcare provider immediately.
Frequently Asked Questions
What is the difference between pad rash and incontinence-associated dermatitis?
The mechanism is different. Incontinence-associated dermatitis (IAD) is caused by prolonged contact between urine and skin, which creates an inflammatory cascade due to pH changes and bacterial overgrowth—something that becomes much more likely when pads stay damp because they don’t wick leaks away from the skin quickly enough. A "pad rash" is often simple contact dermatitis caused by the pad's materials—like synthetic dyes, fragrances, or petroleum-based plastics—irritating the skin directly. Both can happen simultaneously.
How quickly can IAD develop?
Hours to days. IAD can develop within hours of repeated moisture exposure, particularly if pads are staying damp after a leak and/or aren't changed frequently enough. Women with postmenopausal skin are at the highest risk for rapid onset. Research shows that patients in hospital settings can develop IAD within 24 to 48 hours without proper preventive care.
Why does my skin burn more with some pads than others?
In our view, materials and moisture management often play a role. Redness can also be related to a combination of materials, moisture retention, and individual skin sensitivity. Pads containing synthetic fragrances or dyes, chlorine-bleached fibers, or dense plastic top sheets can irritate sensitive skin. Additionally, pads with poor wicking performance leave moisture sitting against your skin longer, increasing IAD risk. Many people report reduced burning and irritation after switching to fragrance-free pads made with gentler materials.
Is incontinence-associated dermatitis contagious?
No. IAD itself is an inflammatory reaction to moisture and irritants, not an infection. However, when IAD breaks down the skin barrier, it creates entry points for secondary bacterial or fungal infections (like Candida), which can potentially be spread through close contact or shared linens.
Should I stop wearing pads if I develop irritation?
No, upgrade them. If you stop using pads without a plan, you’re likely to end up with leaks, soiling and more moisture exposure. Instead, upgrade to Skin-Safe™ pads and implement a 3-step routine: cleanse gently, apply barrier cream, and use properly absorbent pads. If irritation is severe, consult a healthcare provider.
How do I know if my barrier cream is working?
Visible improvement. An effective barrier cream should create a protective layer on your skin. With consistent use, many women notice improvement in redness, irritation, and discomfort. Some report feeling the difference immediately, though timelines vary. If symptoms worsen after 3-4 days, consult a healthcare provider for prescription-strength treatment.
Does drinking less water help with bladder leaks and skin irritation?
No, it makes it worse. Dehydration concentrates your urine, making it even more alkaline and chemically irritating to your skin. Adequate hydration, as generally recommended by healthcare professionals, helps dilute urine.
Can menopause make my skin more sensitive to incontinence products?
Yes, absolutely. Postmenopausal vulvar skin is thinner, drier, and has a higher pH due to estrogen loss, making it significantly more vulnerable to both contact dermatitis and IAD. Many women develop new sensitivities to products they've used for years during this life stage.
Are plant-based incontinence pads actually better for preventing irritation?
Plant-based pads can be gentler on skin when they use breathable, fast‑wicking plant fibers and avoid chlorine bleaching and synthetic fragrances. But not all plant-based pads perform this way: cotton‑based pads that don’t wick well tend to stay damp, increasing friction and irritation instead of relieving it
What should I do if my skin is already broken down from leaks?
Seek medical help. Broken-down skin indicates advanced IAD requiring professional wound care. Do not try to treat open wounds on your own. Your provider may prescribe antibiotics, barrier films, antifungal creams, or specialized dressings to promote healing.
Can I still prevent IAD if I only have occasional leaks?
Yes. Even occasional leaks benefit from prevention. Use a thin, high-quality liner during times when leaks are likely (like exercise), apply a light layer of barrier cream, and cleanse promptly after any leakage. Prevention is always easier than treatment.