What are the symptoms of incontinence-associated dermatitis. How is IAD diagnosed and treated. What are the risk factors for developing IAD. How can IAD be prevented in people with incontinence.

Understanding Incontinence-Associated Dermatitis (IAD)

Incontinence-Associated Dermatitis (IAD) is a common skin condition that affects many individuals who experience urinary or fecal incontinence. This condition, particularly prevalent among older adults, occurs when the protective barrier of the skin is compromised due to prolonged exposure to urine or stool. The result is a painful and uncomfortable rash that can significantly impact a person’s quality of life.

IAD is sometimes referred to by other names, such as perineal dermatitis, irritant dermatitis, or moisture lesions. While these terms are often used interchangeably, it’s important to note that they may describe slightly different conditions. For instance, diaper rash is a similar but distinct condition that primarily affects infants and young children.

The Impact of IAD on Skin Health

Healthy skin serves as a crucial barrier between our internal systems and the external environment. When this barrier is compromised by IAD, it can lead to a range of uncomfortable and potentially serious symptoms. Understanding how IAD affects the skin is key to recognizing the condition and seeking appropriate treatment.

Recognizing the Symptoms of Incontinence-Associated Dermatitis

Identifying IAD early is crucial for effective management and treatment. The symptoms of IAD can vary in severity and may include:

• Skin redness, ranging from light pink to deep red
• Inflammation, either in patches or as a continuous area
• Warm and firm skin in the affected areas
• Visible lesions or skin breakdown
• Pain or tenderness
• Burning sensation
• Persistent itching

These symptoms typically appear in areas that are frequently exposed to urine or stool, such as:

• Perineum
• Labial folds (in women)
• Groin (in men)
• Buttocks and gluteal cleft
• Upper thighs
• Lower abdomen

Factors Influencing Symptom Severity

The intensity of IAD symptoms can be influenced by several factors:

1. Overall skin condition and tissue health
2. General health and nutritional status
3. Exposure to potential allergens
4. Frequency and severity of incontinence episodes

Individuals with more frequent or severe incontinence may experience more intense IAD symptoms due to increased exposure to irritants.

The Root Causes of Incontinence-Associated Dermatitis

IAD is directly linked to incontinence, but several factors contribute to its development:

Skin pH Imbalance

Exposure to urine and feces can alter the skin’s natural pH level, making it more susceptible to irritation and breakdown.

Ammonia Production

When urine and feces are left on the skin, bacteria can convert urea into ammonia, which is highly irritating to the skin.

Enzymatic Activity

Enzymes in feces can break down the skin’s protective proteins, leading to erosion and increased vulnerability.

Improper Cleaning Techniques

Paradoxically, attempts to clean the affected area can sometimes exacerbate IAD. Common issues include:

• Overhydration of the skin from excessive washing
• Friction caused by absorbent products or cleaning materials
• Harsh soaps that strip the skin’s natural oils
• Frequent cleaning with soap and water, which can disrupt the skin’s pH balance

Ineffective Management of Incontinence

Poor management of incontinence can significantly increase the risk of IAD. This may involve:

• Prolonged exposure to urine and feces
• Inadequate cleaning of affected areas
• Improper use of thick ointments that can trap moisture against the skin
• Use of abrasive washcloths or cleaning materials

Diagnosing Incontinence-Associated Dermatitis

Accurate diagnosis of IAD is crucial for effective treatment. If you suspect you have IAD, it’s important to consult a healthcare professional. The diagnostic process typically involves:

Physical Examination

Your doctor will carefully examine the affected areas, looking for characteristic signs of IAD such as redness, inflammation, and skin breakdown.

Medical History Review

A thorough discussion of your medical history, including your incontinence experiences and any previous skin conditions, will help your doctor understand the context of your symptoms.

Differential Diagnosis

In some cases, your doctor may need to rule out other conditions that can mimic IAD, such as:

• Pressure ulcers (bed sores)
• Heat rash (miliaria)
• Erythrasma
• Psoriasis
• Herpes infections
• Other forms of dermatitis

Distinguishing IAD from these conditions is crucial for determining the most appropriate treatment approach.

Effective Treatment Strategies for Incontinence-Associated Dermatitis

Treating IAD requires a multifaceted approach that addresses both the underlying incontinence and the skin irritation. Modern treatment strategies have moved away from the traditional method of cleaning with soap and water, which can further dry and irritate the skin.

The IAD Treatment Process

An effective IAD treatment regimen typically includes the following steps:

1. Gentle Cleansing: Use soft, non-abrasive materials to clean the affected areas.
2. pH-Balanced Cleansing: Apply a cleanser specifically designed to maintain the skin’s natural pH balance.
3. Moisturizing: Restore skin hydration using products like hydrogels or petroleum-based moisturizers.
4. Skin Protection: Apply barrier products containing zinc oxide to create a protective layer on the skin.
5. Incontinence Management: Use appropriate absorbent or containment products to minimize skin exposure to urine or feces.

All-in-One Products

Some healthcare providers may recommend all-in-one products that combine cleansing, moisturizing, and protective properties. These can simplify the treatment process and ensure consistent care.

Treating Secondary Infections

If a secondary infection has developed as a result of IAD, your doctor may prescribe additional treatments:

• Topical antifungal medications for fungal infections
• Oral antibiotics for bacterial infections

Preventing Complications: The Link Between IAD and Pressure Ulcers

Individuals who develop IAD are at an increased risk of developing pressure ulcers, also known as bed sores. This risk is particularly high for older adults or those with limited mobility.

Recognizing Pressure Ulcers

Pressure ulcers share some similar symptoms with IAD, including:

• Broken skin
• Inflammation
• Pain or tenderness

However, pressure ulcers typically develop over bony prominences and are caused by prolonged pressure on the skin, rather than exposure to moisture.

Prevention Strategies

Preventing pressure ulcers in individuals with IAD involves:

• Regular repositioning to relieve pressure on vulnerable areas
• Use of pressure-relieving surfaces and devices
• Maintaining good skin hygiene and moisture management
• Ensuring adequate nutrition and hydration

Long-Term Management and Quality of Life Considerations

Living with incontinence and managing IAD can be challenging, but with proper care and attention, it’s possible to maintain skin health and overall well-being.

Ongoing Skin Care

Establishing a consistent skin care routine is crucial for preventing recurrence of IAD. This may include:

• Regular use of barrier creams or ointments
• Frequent changes of incontinence products
• Gentle cleansing after each episode of incontinence

Addressing Underlying Incontinence

Working with healthcare providers to manage the underlying incontinence can significantly reduce the risk of IAD. This may involve:

• Pelvic floor exercises
• Bladder training techniques
• Medication to control overactive bladder
• Surgical interventions in some cases

Psychological Support

The emotional impact of dealing with incontinence and IAD should not be overlooked. Many individuals benefit from:

• Counseling or therapy to address anxiety or depression
• Support groups for individuals with incontinence
• Education on coping strategies and self-care techniques

By addressing both the physical and emotional aspects of IAD, individuals can maintain a higher quality of life and prevent the condition from significantly impacting their daily activities and social interactions.

Innovations in IAD Prevention and Treatment

As our understanding of IAD continues to evolve, new approaches to prevention and treatment are emerging. These innovations offer hope for more effective management of this challenging condition.

Advanced Skin Care Products

Researchers are developing new formulations of skin care products specifically designed for individuals with incontinence. These may include:

• Smart fabrics that can detect moisture and signal when changes are needed
• Nanoparticle-based barrier creams that provide longer-lasting protection
• Probiotic-infused skin care products to promote a healthy skin microbiome

Improved Incontinence Management Devices

Advancements in incontinence products are helping to reduce the risk of IAD:

• Super-absorbent materials that quickly wick moisture away from the skin
• Breathable fabrics that allow for better air circulation
• Sensor-equipped products that alert caregivers when changes are needed

Telemedicine and Remote Monitoring

The rise of telemedicine is making it easier for individuals with IAD to receive ongoing care and support:

• Virtual consultations with dermatologists and wound care specialists
• Remote monitoring of skin condition through smartphone apps
• AI-powered tools for early detection of skin changes

These technological advancements are particularly beneficial for individuals with limited mobility or those living in rural areas with limited access to specialized care.

The Role of Nutrition in IAD Prevention and Management

While often overlooked, nutrition plays a crucial role in maintaining skin health and resilience, which can help prevent and manage IAD.

Key Nutrients for Skin Health

Several nutrients are particularly important for maintaining healthy skin:

• Vitamin A: Supports skin cell turnover and repair
• Vitamin C: Essential for collagen production and skin barrier function
• Vitamin E: Acts as an antioxidant, protecting skin cells from damage
• Zinc: Aids in wound healing and skin repair
• Omega-3 fatty acids: Help maintain skin hydration and reduce inflammation

Hydration

Proper hydration is crucial for maintaining skin elasticity and promoting overall skin health. Individuals with incontinence should aim to:

• Drink adequate water throughout the day
• Consume hydrating foods like fruits and vegetables
• Avoid excessive caffeine and alcohol, which can contribute to dehydration

Dietary Considerations

Some dietary changes may help manage incontinence and reduce the risk of IAD:

• Limiting bladder irritants such as spicy foods, citrus fruits, and artificial sweeteners
• Increasing fiber intake to promote regular bowel movements and reduce the risk of fecal incontinence
• Consuming probiotic-rich foods to support a healthy gut microbiome, which may indirectly benefit skin health

Working with a registered dietitian can help individuals develop a nutritional plan that supports both overall health and skin resilience.

Incontinence-Associated Dermatitis: Symptoms, Treatment, and More

Overview

Many people who have incontinence will experience incontinence-associated dermatitis (IAD) at one point or another. This is especially common in older adults.

Incontinence refers to your body’s inability to control the release of urine or stool. IAD occurs when the protective barrier created by your skin is damaged.

Exposure to the bacteria in urine or stool can result in painful symptoms, such as burning and itching. The condition primarily affects the area around your genitals, thighs, and abdomen.

You should have your doctor review any area you suspect is affected by the condition. Your doctor will help you determine how to best manage and treat your incontinence and IAD. In most cases, IAD is temporary and will clear up with treatment.

IAD may also be referred to as perineal dermatitis, irritant dermatitis, moisture lesions, or even diaper rash, though these are all different conditions.

Keep reading to learn how to identify IAD, options for treatment, and more.

Healthy skin works as a barrier between the environments outside and inside your body. IAD can erode this barrier, causing severe and uncomfortable symptoms.

Symptoms of IAD include:

• redness, ranging from light pink to dark red, depending on skin tone
• patches of inflammation or a large, continuous area of inflammation
• warm and firm skin
• lesions
• pain or tenderness
• burning
• itching

IAD can affect skin on many parts of your body, including the:

• perineum
• labial folds (in women)
• groin (in men)
• buttocks
• gluteal cleft
• upper thighs
• lower abdomen

The severity of your symptoms depends on several factors, including:

• the condition of your skin tissue
• overall health and nutrition
• allergen exposure

If you have a form of incontinence that makes you more prone to leakage or accidents, you may also experience more severe IAD. This is because your skin is more frequently exposed to urine and stool.

This condition is directly related to incontinence. The skin, when exposed to urine or feces regularly, can become inflamed. The condition is worse for those with fecal incontinence, as stool can irritate the skin more than urine.

In many cases, IAD is caused by:

• an increase in the skin’s pH level
• the creation of ammonia by urinary and fecal incontinence
• skin erosion from bacteria breaking down protein in keratin-producing cells

Attempts to clean the area may result in IAD due to:

• overhydrating the skin
• friction caused by absorbent pads or other materials, including underwear and bed linens
• frequent cleaning of the affected area with soap and water

Ineffective or poor condition management can also lead to IAD. This includes:

• prolonged exposure to urine and feces
• inadequate cleaning of the exposed area
• the application of thick ointments
• the use of abrasive washcloths

Your individual symptoms can help your doctor determine the exact cause of your IAD.

If you’re experiencing symptoms of IAD, consult your doctor. Often your doctor will be able to make a diagnosis after reviewing the affected areas and discussing your medical history.

Your doctor will ask you about your incontinence, as well as discuss other factors that may be contributing to your skin condition.

If your symptoms are unclear or if you have extenuating health factors, your doctor may wish to rule out certain look-a-like conditions.

This includes:

• pressure ulcers
• heat rash, or miliaria
• erythrasma
• psoriasis
• herpes
• another form of dermatitis

Once your doctor makes a diagnosis, they will go over your treatment options. Depending on the cause of your IAD, they may make additional recommendations on how to effectively manage incontinence.

If you need help finding a primary care doctor, you can browse doctors in your area through the Healthline FindCare tool.

Historically, incontinence has been managed by cleaning affected areas with soap and water. Soap can dry and rub the skin, leading to inflammation. This can result in IAD and is no longer a standard practice of care.

Treating IAD is a multiple-step process, outlined here.

Treating IAD

• Use gentle linens to clean the area.
• Wash the area with a cleanser that balances your skin’s pH level.
• Add moisture back into your skin with hydrogel or petroleum-based products.
• Protect the area with products containing zinc oxide.
• Wear absorbent or containment pads to help manage any urine leakage.

Was this helpful?

Your doctor may be able to recommend an all-in-one product that cleanses, moisturizes, and protects.

If you’ve developed any secondary infection, your doctor may prescribe a topical antifungal or oral antibiotic medication.

People who develop IAD are more likely to develop pressure ulcers, or bed sores. This is typically seen in older adults or people who have a medical condition that limits their ability to switch positions.

The symptoms for bed sores are usually the same as for IAD:

• broken skin
• inflammation
• pain or tenderness

If you think you’re developing bed sores, see your doctor. Mild bed sores can be successfully treated over time. Treatment for more severe bed sores focuses on symptom management.

IAD can also lead to other secondary skin infections. These are typically caused by Candida albicans, a fungus that comes from the gastrointestinal tract, or Staphylococcus, which is bacteria from the perineal skin.

If you develop a secondary infection, you may experience:

• itching
• burning
• pain during urination
• rash
• unusual discharge

These infections require different treatment from IAD and should be diagnosed by a doctor.

Learn more: Overactive bladder vs. urinary incontinence and UTI »

Managing IAD goes along with managing incontinence. You should see your doctor to discuss management plans for both conditions.

If you do have IAD, treating the condition is essential to controlling its severity. If left untreated, IAD can lead to additional complications. Using proper prevention techniques will lessen your chances of experiencing IAD flare-ups in the future.

The only way to reduce your risk for IAD is to be diligent in incontinence management. You should protect your skin, clean it with appropriate products, and change absorbent or containment pads regularly. However, even with proper care, it’s still possible to develop IAD.

Keep reading: What you should know about adult incontinence »

Incontinence-Associated Dermatitis: Symptoms, Treatment, and More

Overview

Many people who have incontinence will experience incontinence-associated dermatitis (IAD) at one point or another. This is especially common in older adults.

Incontinence refers to your body’s inability to control the release of urine or stool. IAD occurs when the protective barrier created by your skin is damaged.

Exposure to the bacteria in urine or stool can result in painful symptoms, such as burning and itching. The condition primarily affects the area around your genitals, thighs, and abdomen.

You should have your doctor review any area you suspect is affected by the condition. Your doctor will help you determine how to best manage and treat your incontinence and IAD. In most cases, IAD is temporary and will clear up with treatment.

IAD may also be referred to as perineal dermatitis, irritant dermatitis, moisture lesions, or even diaper rash, though these are all different conditions.

Keep reading to learn how to identify IAD, options for treatment, and more.

Healthy skin works as a barrier between the environments outside and inside your body. IAD can erode this barrier, causing severe and uncomfortable symptoms.

Symptoms of IAD include:

• redness, ranging from light pink to dark red, depending on skin tone
• patches of inflammation or a large, continuous area of inflammation
• warm and firm skin
• lesions
• pain or tenderness
• burning
• itching

IAD can affect skin on many parts of your body, including the:

• perineum
• labial folds (in women)
• groin (in men)
• buttocks
• gluteal cleft
• upper thighs
• lower abdomen

The severity of your symptoms depends on several factors, including:

• the condition of your skin tissue
• overall health and nutrition
• allergen exposure

If you have a form of incontinence that makes you more prone to leakage or accidents, you may also experience more severe IAD. This is because your skin is more frequently exposed to urine and stool.

This condition is directly related to incontinence. The skin, when exposed to urine or feces regularly, can become inflamed. The condition is worse for those with fecal incontinence, as stool can irritate the skin more than urine.

In many cases, IAD is caused by:

• an increase in the skin’s pH level
• the creation of ammonia by urinary and fecal incontinence
• skin erosion from bacteria breaking down protein in keratin-producing cells

Attempts to clean the area may result in IAD due to:

• overhydrating the skin
• friction caused by absorbent pads or other materials, including underwear and bed linens
• frequent cleaning of the affected area with soap and water

Ineffective or poor condition management can also lead to IAD. This includes:

• prolonged exposure to urine and feces
• inadequate cleaning of the exposed area
• the application of thick ointments
• the use of abrasive washcloths

Your individual symptoms can help your doctor determine the exact cause of your IAD.

If you’re experiencing symptoms of IAD, consult your doctor. Often your doctor will be able to make a diagnosis after reviewing the affected areas and discussing your medical history.

Your doctor will ask you about your incontinence, as well as discuss other factors that may be contributing to your skin condition.

If your symptoms are unclear or if you have extenuating health factors, your doctor may wish to rule out certain look-a-like conditions.

This includes:

• pressure ulcers
• heat rash, or miliaria
• erythrasma
• psoriasis
• herpes
• another form of dermatitis

Once your doctor makes a diagnosis, they will go over your treatment options. Depending on the cause of your IAD, they may make additional recommendations on how to effectively manage incontinence.

If you need help finding a primary care doctor, you can browse doctors in your area through the Healthline FindCare tool.

Historically, incontinence has been managed by cleaning affected areas with soap and water. Soap can dry and rub the skin, leading to inflammation. This can result in IAD and is no longer a standard practice of care.

Treating IAD is a multiple-step process, outlined here.

Treating IAD

• Use gentle linens to clean the area.
• Wash the area with a cleanser that balances your skin’s pH level.
• Add moisture back into your skin with hydrogel or petroleum-based products.
• Protect the area with products containing zinc oxide.
• Wear absorbent or containment pads to help manage any urine leakage.

Was this helpful?

Your doctor may be able to recommend an all-in-one product that cleanses, moisturizes, and protects.

If you’ve developed any secondary infection, your doctor may prescribe a topical antifungal or oral antibiotic medication.

People who develop IAD are more likely to develop pressure ulcers, or bed sores. This is typically seen in older adults or people who have a medical condition that limits their ability to switch positions.

The symptoms for bed sores are usually the same as for IAD:

• broken skin
• inflammation
• pain or tenderness

If you think you’re developing bed sores, see your doctor. Mild bed sores can be successfully treated over time. Treatment for more severe bed sores focuses on symptom management.

IAD can also lead to other secondary skin infections. These are typically caused by Candida albicans, a fungus that comes from the gastrointestinal tract, or Staphylococcus, which is bacteria from the perineal skin.

If you develop a secondary infection, you may experience:

• itching
• burning
• pain during urination
• rash
• unusual discharge

These infections require different treatment from IAD and should be diagnosed by a doctor.

Learn more: Overactive bladder vs. urinary incontinence and UTI »

Managing IAD goes along with managing incontinence. You should see your doctor to discuss management plans for both conditions.

If you do have IAD, treating the condition is essential to controlling its severity. If left untreated, IAD can lead to additional complications. Using proper prevention techniques will lessen your chances of experiencing IAD flare-ups in the future.

The only way to reduce your risk for IAD is to be diligent in incontinence management. You should protect your skin, clean it with appropriate products, and change absorbent or containment pads regularly. However, even with proper care, it’s still possible to develop IAD.

Keep reading: What you should know about adult incontinence »

Rash in a child: what organs should be treated?

It is possible to accurately establish the relationship between skin rashes and disorders in the functioning of internal organs only on the basis of laboratory tests and hardware diagnostics. However, there are “wake-up calls” that can alert the attentive parent to a possible pathology. The localization of rashes and their nature have been proven to be affected by a number of diseases and malfunctions in the work of organic systems. But if a child has allergic diathesis, the appearance of vesicles and crusts indicates, rather, the presence of a disorder than its causes.

Remember: if the rash is accompanied by fever, a doctor should be contacted immediately!

Possible causes of rash in children

1. Microbial imbalance. Most often in children there are dermatological problems that provoke dysbacteriosis. The child’s digestive system is vulnerable to unbalanced and irregular nutrition, infectious and parasitic diseases. Violations and rashes can be caused by:

• artificial feeding or too early introduction of overfeeding;
• the use of antibiotics or hormonal drugs for the treatment of a child or nursing mother;
• maternal infectious diseases, mastitis;
• reduced gastrointestinal fermentation;
• helminthic infestation;
• diabetes mellitus;
• other reasons that lead to a decrease in the number of lactobacilli and bifidobacteria in the child’s digestive system.

2. Diabetes. Over 30% of children suffering from this disease also complain of characteristic rashes that may appear:

• on the face;
• in the armpits;
• in the groin and genitals;
• on the buttocks.

3. Kidney diseases. In case of renal insufficiency, the rash is due to intoxication. In the congenital form of the disease, the foci may “fade out” or disappear during remission, and then return or appear in other places.

4. Diseases of the liver. Liver dysfunction is accompanied by the accumulation of cholesterol, decreased immunity and deterioration of the hematopoietic functions of the organ. Often it is associated with viral diseases, hepatitis, thrombosis, cysts and other diseases.

In the form of small pink spots, the first symptoms of measles, scarlet fever, chickenpox and even meningitis may appear. Sometimes the cause of the rash can be contact with poisonous plants, allergies to animal saliva, insect bites. And yet, food allergies, wearing uncomfortable clothes, increased sweating, photodermatitis are the most common reasons for visiting a dermatologist among children of primary and primary school age. In this case, the most serious danger is the infection of combs with staphylococcus and other bacteria.

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Violation of bilirubin metabolism

Violation of bilirubin metabolism or hyperbilirubinemia – is a congenital condition caused by an imbalance between the formation and release of bilirubin.

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Erythrocytes – red blood cells contain a complex protein called hemoglobin. It is necessary for the transport of oxygen through human tissues. Having served its time, it enters the liver, spleen, bone marrow, where it is destroyed. Among the decay products is indirect bilirubin, which is pathogenic for the body. Therefore, under the influence of other components, it goes through the next stage of transformation, and being released along with the bile of the liver, it leaves the body naturally.

If the neutralization of bilirubin does not occur, or the process does not affect most of the substance, it turns into biliverdin, an oxidation product. The increased content leads to jaundice. In some cases, the skin may become greenish in color. This is due to the high concentration of direct bilirubin in the blood, since in this form it is oxidized faster.

Causes of hyperbilirubinemia

• Accelerated decay and / or reduction in the life of red blood cells.
• Violation of the production of substances necessary for the breakdown of bilirubin.
• Decreased uptake of bilirubin by liver cells.
• Decreased excretion of pigment from the liver into bile.
• Difficulty in the outflow of bile and its penetration into the blood.

There are many causes of bilirubin metabolism disorders, among them cholelithiasis, liver diseases, including cirrhosis, tumors and chronic hepatitis. Hyperbilirubinemia can also be caused by parasites that reduce the body’s ability to remove bilirubin, exposure to toxic substances, anemia, and more.

Depending on the stage of violation of the conversion and withdrawal process, an increase in the level of one of the fractions is diagnosed in the blood. If the total bilirubin is high, this indicates liver disease. The growth of indirect bilirubin means excessive destruction of red blood cells or a violation of the transport of bilirubin. The level of direct is high – problems with the outflow of bile.

Hereditary disorders

• Gilbert’s syndrome. Non-dangerous form with a favorable course. The reason is a violation of the capture and transportation of bilirubin by liver cells. Unconjugated (unbound) bilirubin rises in the blood.
• Rotor syndrome. It is expressed in violation of the capture of bilirubin and, as a result, its excretion from the body. It manifests itself at an early age, does not lead to serious consequences.
• Dubin-Johnson syndrome. A rare form of conjugated hyperbilirubinemia. The transport system is disrupted, which causes difficulties in removing bound bilirubin. The syndrome does not lead to dangerous conditions, the prognosis is favorable.
• Crigler-Najjar syndrome. Severe form of unconjugated hyperbilirubinemia. The reason is the lack or complete absence of glucuronyl transferase, a substance necessary for the conjugation of bilirubin in the liver. Causes damage to the nervous system, can lead to premature death.

Timely diagnosis, pathogenetic therapy, adherence to proper nutrition, work and rest regimen can improve the quality of life of most patients with hereditary hyperbilirubinemia.

Blood bilirubin norm

The level of bilirubin depends on the age and condition of the person.
In newborns, the maximum level of bilirubin reaches 3-5 days of life, the so-called physiological jaundice. Sometimes it reaches 256 µmol/l. The level should return to normal by 2 weeks of age. Exceeding the rate of 256 µmol / l requires an immediate examination of the child. This condition can lead to brain damage.
No less dangerous is the increase in the level of bilirubin during pregnancy. This can cause premature birth, anemia and fetal hypoxia.

Symptoms

Violation of the chemical reactions of bilirubin is detected by determining its level in the blood. If the concentration is above the norm, but does not exceed 85 µmol/l, this is a mild form of hyperbilirubinemia, up to 170 µmol/l is moderate, from 170 µmol/l is a severe form of the disease. External signs manifest themselves in different ways, depending on the cause of the increase in the concentration of bilirubin.

Liver problems expressed in the following symptoms:

• Discomfort and heaviness due to liver enlargement.
• Change in color of urine (it becomes like dark beer), clarification of feces.
• Heaviness after eating, drinking alcohol, frequent belching.
• Periodically occurring dizziness, general weakness, apathy.
• If the cause of the pathological condition is viral hepatitis, then fever is added to the symptoms.

Violation of the outflow of bile:

• Jaundice of the skin and sclera.
• Skin itching.
• Intense pain in the right hypochondrium.
• Flatulence, constipation or diarrhea.
• Dark urine, light stool.

Common cause is cholelithiasis. The list functions normally, neutralizes the incoming bilirubin, but its excretion from the body is difficult.

Prehepatic jaundice is a condition caused by the rapid destruction of red blood cells.

Expressed by the following symptoms:

• Anemia.
• Dark stools with normal urine color.
• Extensive hematomas that form without external causes.
• Skin itching, aggravated at rest and after warming.
• Yellowish skin color.

Also, sometimes, regardless of the cause, symptoms such as bitterness in the mouth, changes in taste, weakness, impaired memory and intelligence can be noted.

Diagnostics

Doctors are faced with the task of reducing the level of bilirubin to normal limits, and this can only be done by knowing the reason for its increase. Therefore, after a blood test to determine the concentration of bilirubin, tests are also carried out:

• on the level of alkaline phosphatase;
• alanine aminotransferase activity;
• the presence of glucuronyltransferase and other studies.

An ultrasound of the liver is also prescribed to determine its condition. Among the laboratory tests: a general blood and urine test, the level of total coproporphyrin in daily urine, a test with phenobarbital, a bromsulfalein test, a test for markers of hepatitis viruses.

The purpose of diagnosis is not only to determine the level of bilirubin, but also its shape. For example, an increase in direct bilirubin occurs when there is a violation of the waste of bile (dyskinesia). The concentration of indirect bilirubin rises due to problems with the liver and with excessive destruction of red blood cells. Having established the form of bilirubin, it is necessary to differentiate a specific disease (pathology).

Elevated direct bilirubin

The direct enzyme begins to accumulate in the blood due to a violation of the outflow of bile. Instead of entering the stomach, it enters the bloodstream. This condition occurs with hepatitis of bacterial and viral etiology, chronic, autoimmune, drug-induced hepatitis. It can occur with cholelithiasis, cirrhosis, oncological changes in the liver, gallbladder or pancreatic cancer. Become a consequence of congenital Rotor syndrome (a milder form of a defect in bilirubin excretion) or Dubin-Johnson syndrome (a more severe form).

Increased indirect bilirubin

The reason is the rapid breakdown of erythrocyte cells. May occur as a complication of sepsis, acute intestinal infection, congenital anemia, toxic, acquired autoimmune.

An increase in the indirect form of bilirubin also occurs with Gilbert’s syndrome. It is a benign, chronic disease caused by impaired intracellular transport of bilirubin. Among the causes of hyperbilirubinemia, Crigler-Najjar syndrome is a violation of the process of combining bilirubin with glucuronic acid, which is formed during the oxidation of D-glucose.

The symptom of Lucy-Driscoll is unusual. It occurs exclusively in infants due to breastfeeding. With mother’s milk, an enzyme enters, leading to a violation of the conjugation of bilirubin. With the transition to artificial feeding, the disease disappears. However, indirect bilirubin is very dangerous, so the occurrence of jaundice after 3-5 days of life requires an urgent medical examination.

Infant diagnosis

If in adults jaundice means the presence of diseases, then in children hyperbilirubinemia can be physiological or pathological. In the first case, it is noted by the 4th day of life, in Asian children by the 7th, it passes on its own, without reaching critical values ​​​​of the level of bilirubin.

Pathology may be the result of liver dysfunction, a high concentration of beta-glucuronidase in breast milk, occur with a low-calorie diet or dehydration. Both the infant and his mother are subject to examination.

The anamnesis, external signs are studied. It is important to rule out or diagnose kernicterus as soon as possible. Warning signs include: jaundice on the first day of life and after 2 weeks, an increase in total bilirubin and the rate of its rise, respiratory distress, the presence of bruises or a hemorrhagic rash. The child is measured by the level of bilirubin, blood culture, urine and cerebrospinal fluid. It is necessary to exclude the presence of TORCH infections in the mother.

Treatment

Therapy for hyperbilirubinemia depends on the causes of its causes, i.e., etiotropic treatment aimed at the underlying disease.

Violation of the passage of the bile ducts. Stones and obstructing tumors are removed. In some situations, bile duct stenting is performed – a frame is installed that preserves the lumen.

Hemolysis of erythrocytes. Assign phototherapy, infusion therapy to prevent or correct pathological losses. The composition of the infusion solutions includes glucose and albumin. These treatments help convert toxic bilirubin into a form that can be excreted from the body.

Nuclear jaundice (bilirubin encephalopathy) in newborns. Pathology occurs in the first week of life. First, it is expressed by the following symptoms: inhibition of the sucking reflex, vomiting, lethargy, monotonous cry. If not, the signs will be mild, if the risk of discharge from the maternity ward without medical assistance. Usually the disease manifests itself on the 4th day of life, requires an urgent exchange transfusion. This prevents the development of irreversible consequences.

After a few weeks of the development of the pathological condition, symptoms such as stiff neck, “stiff” limbs, a convulsive posture with arching of the back, bulging of the large fontanel, hand tremors, convulsions, and a sharp brain cry appear.

Since the picture of the disease is formed slowly from several days to weeks, irreversible consequences in the central nervous system often occur during this time. The disease finally manifests itself by 3-5 months of life, leads to paralysis, cerebral palsy, deafness, mental retardation. To prevent the development of pathology, it is necessary to monitor the level of bilirubin. If necessary, reduce the number of breastfeeding sessions. Administer phototherapy or exchange transfusion.