Pressure ulcers, also known as bedsores or pressure sores, are injuries to the skin and underlying tissue usually caused by unrelieved pressure.
While they can affect anyone, people most at risk of pressure ulcers are those that are bedridden, use a wheelchair, or have a medical condition that limits their ability to change positions.
Symptoms and stages of pressure ulcers
Pressure sores can occur on any part of the body that is under too much pressure for too long.
However, they mostly form on skin that covers bony areas of your body, such as the elbows, heels, ankles, hips, shoulder blades, and tailbone/coccyx.
Bedsores fall into one of four stages based on severity, with Stage (I) being the mildest and Stage (IV) the worst.
- Stage I: The affected area appears red, feels warm, and does not turn white when pressed. For people with darker skin, the discolored patch appears blue or purple. The area may also be itchy or painful.
- Stage II: Characterized by a painful, open sore. Additionally, the skin around the wound may be red.
- Stage III: The tissue below the skin is damaged, causing a crater-like wound.
- Stage IV: The wound becomes so deep, and possibly infected, that it may affect the muscles, bones, tendons, and joints.
Moreover, there are pressure ulcers that don’t fall in either of the four main stages.
- Sores that are covered in yellow, tan, green, or brown dead skin, making it hard to tell how deep they are. Such a pressure sore is said to be “unstageable.”
- Bedsores that develop in the deep tissues of the skin, but present as a Stage I or II sore on the skin surface.
When to see a doctor
If you notice the warning or early signs of a pressure ulcer, change your position to relieve the pressure on the area. Contact your doctor if there’s no improvement in 24 to 48 hours.
Seek immediate medical care if you show signs of infection, such as:
- Increased redness, warmth, or swelling
- A temperature of 38C (100.4F) or above
- Pus coming from the sore
- Severe or increased pain
- A foul odor from the sore
Treatment of pressure ulcers
Having being diagnosed with pressure sores, your doctor will try to stage the wound to determine your treatment options.
These options involve reducing or relieving pressure on the affected skin area, wound care, pain management, preventing infection, and maintaining a healthy diet. In some cases, you may require surgery.
Proper care of a pressure sore requires a multidisciplinary healthcare team that includes:
- A primary care physician responsible for overseeing the treatment plan
- A physician or nurse specialized in wound care
- Nurses or clinical assistants that provide both wound care and educate on wound management
- A clinical social worker that helps you and or your family access resources and address emotional stress resulting from a long recovery time
- A physical therapist to assist with improving mobility
- An occupational therapist to help ensure appropriate seating surfaces
- A dietitian to assess your nutritional needs and develop a meal plan for you
- A dermatologist, a medical practitioner that specializes in treating conditions of the skin
- A neurosurgeon, orthopedic surgeon or plastic surgeon
Discussed below are the treatment options.
The first step in treating an already developed pressure ulcer is relieving the pressure that caused it.
Doing so also prevents pressure ulcers from developing. Ways for achieving pressure relief include:
- Repositioning: change your position regularly if you have pressure sores. How often you need to reposition will depend on your condition and the quality of the surface you are on. For some, it may be as often as every 15 minutes, while others may need to move once every two to four hours.
- Support surfaces: these include, but are not limited to, mattresses, cushions, beds, overlays, and chairs. Your healthcare team will recommend the appropriate pressure-redistribution surface depending on the severity of your bedsores.
Cleaning and dressing the wound
Wound care for bedsores depends on how deep the sore is. If it’s a Stage (I) sore, wash it with mild soap and water and dry it gently. Clean open sores with water or a saline solution and keep the sore covered with a special dressing.
Dressing the wound speeds up healing by maintaining a moist environment, preventing infection, and keeping the surrounding healthy skin dry.
Depending on the size and stage of the sore, you may use gauze, film, gel, foam, antimicrobial, or some other type of dressing.
Additionally, barrier creams and ointments may be needed for protecting skin that has been damaged or irritated, allowing it to heal quickly.
Removing damaged tissue
For a wound to heal well, it should be free of any dead, damaged, or infected tissue. The removal of damaged tissue is medically known as debridement.
A small amount of necrotic tissue can be removed using specially designed dressings like hydrogel dressings. Large amounts may be removed using:
- High-pressure water jets that flush the wound
- Surgical instruments, such as scalpels and forceps to cut out the damaged tissue
- Ultrasound through microstreaming and cavitational effects
If debridement is not being done using a dressing, a local anesthetic should be used to numb the affected area so that the process isn’t painful.
Antibiotics may be prescribed to treat infected pressure sores that aren’t responding to other treatments.
These antimicrobials may also be used to treat severe infection, such as blood poisoning (sepsis), a bacterial skin infection (cellulitis), or an infection of the bone (osteomyelitis).
A healthy, balanced diet promotes wound healing as it contains an adequate quantity of the nutrients that we require in a day.
You should also stay hydrated as dehydration can slow the healing process. A dietitian can help you formulate a meal plan that meets your dietary needs.
A severe pressure sore might not heal on its own, necessitating surgery to seal the wound, speed up healing, and minimize the risk of infection. Surgical repair may involve:
- Cleaning the wound and closing it by sewing/stitching the ends of the ulcer together
- Cleaning the wound and using a skin flap or skin graft to cover it.
Risks of pressure ulcer surgery include:
- Flap necrosis from the implanted tissue flap not getting enough blood circulation and dying
- Blood poisoning also called septicemia
- Bone infection, otherwise known as osteomyelitis
- Deep vein thrombosis (DVT)
Risk factors for pressure ulcers
Anyone can get bedsores, but these factors increase their likelihood of forming:
- Immobility. It can be brought on by being bedridden, paralyzed, obese, et cetera.
- Old age. People over 70 are more likely to have mobility issues, and their skin is more susceptible to damage from incontinence and other factors.
- Loss of sensation. Peripheral neuropathy, spinal cord injuries, stroke, and other conditions can leave you with an inability to feel pain or discomfort, making you unaware of warning signs and the need to change position.
- A poor diet. An adequate, well-balanced diet is needed to maintain healthy skin.
- Medical conditions affecting blood circulation. Conditions like diabetes, peripheral arterial disease, kidney failure, heart failure, and Parkinson’s disease increase the risk of tissue damage or cause movement problems.
Preventing pressure ulcers
There are some things that you can do yourself or with the help of your healthcare team to reduce the risk of developing pressure sores. These include:
- Reposition yourself regularly. Change positions every two hours if you’re in bed. If you’re in a wheelchair, try shifting your weight every 15 minutes, and ask for help changing position hourly.
- Take good care of your skin by washing routinely, protecting the skin from irritants, and conducting a daily inspection for early signs and symptoms of pressure ulcers.
- Eat a healthy, balanced diet. Consult a dietitian if you need help drawing up a meal plan.
- Quit smoking as it affects blood circulation.
- Exercise regularly.
- Stress management.
- Mayo Clinic Staff. Bedsores (pressure ulcers). March 09, 2018
- Pressure ulcers (pressure sores) and treatment (n.d) https://www.nhs.uk/conditions/pressure-sores/
- How to care for pressure sores, 5, December, 2018. https://medlineplus.gov/ency/patientinstructions/000740.htm
- Bedsores diagnosis and treatment, March 09, 2018 https://www.mayoclinic.org/diseases-conditions/bed-sores/diagnosis-treatment/drc-20355899