Pressure sores can affect people who spend a long time in one position, for example, because of paralysis, illness, old age, or frailty.
Also known as pressure ulcers and bedsores, pressure sores can happen when there is friction or unrelieved pressure on one part of the body.
People who cannot make even small movements are at risk of pressure sores.
The sores can affect any part of the body, but the bony areas around the elbows, knees, heels, coccyx, and ankles are more susceptible.
Bedsores are treatable, but, if treatment comes too late, they can lead to fatal complications.
The prevalence of pressure sores in intensive care units in the United States (U.S.) is estimated to range from 16.6 percent to 20.7 percent.
Fast facts on pressure sores
Here are some key points about pressure sores. More detail and supporting information is in the main article.
- Pressure sores, pressure ulcers, or bedsores commonly affect people who cannot move easily.
- They are more likely to affect the bony parts of the body.
- The sores develop in stages. Identifying them in the early stage enables treatment and reduces the risk of complications.
- Moving patients frequently is key to preventing pressure sores.
There are varying stages of severity of pressure sore.
Pressure ulcers can affect patients who are unable to move because of paralysis, illness, or old age.
Bed-bound patients are most at risk of developing bedsores on the bony parts of their body, such as the ankles, heels, shoulders, coccyx or tailbone, elbows, and the back of the head.
Patients who use a wheelchair have a higher risk of developing pressure sores on their:
- buttocks and tailbone
- shoulder blades
- back of arms or legs
Pressure sores develop in four stages.
- The skin will look red and feel warm to the touch. It may be itchy.
- There may be a painful open sore or a blister, with discolored skin around it.
- A crater-like appearance develops, due to tissue damage below the skin’s surface.
- Severe damage to skin and tissue, possibly with infection. Muscles, bones, and tendons may be visible.
An infected sore takes longer to heal, and the infection can spread elsewhere in the body.
Causes and risk factors
Anyone who stays in one place for a long time and who cannot change position without help is at risk of developing pressure sores. The ulcers can develop and progress rapidly, and they can be difficult to heal.
Sustained pressure can cut off circulation to vulnerable parts of the body. Without an adequate supply of blood, body tissues can die.
According to Johns Hopkins Medicine, a sore can develop if blood supply is cut off for more than 2 to 3 hours.
Pressure ulcers are usually caused by:
Continuous pressure: if there is pressure on the skin on one side, and bone on the other, the skin and underlying tissue may not receive an adequate blood supply.
Friction: For some patients, especially those with thin, frail skin and poor circulation, turning and moving may damage the skin, raising the risk of bedsores.
Shear: If the skin moves one way while the underlying bone moves in the opposite direction, there is a risk of shearing. Cell walls and minute blood vessels may stretch and tear.
This can happen if a patient slides down a bed or a chair, or if the top half of the bed is raised too high.
Injured tissue can develop an infection. This can spread, leading to serious illness.
Pressure sores mainly affect those who are less mobile, or restricted to one position, such as older people or those with mobility impairments.
Pressure ulcers are more common among those who:
- are immobilized because of injury, illness, or sedation
- have long-term spinal cord injuries
Patients with long-term spinal cord injuries or neuropathic conditions, including diabetes, have reduced sensation.
They may not feel a bedsore developing, so they continue to lie on it, making it worse.
Patients who cannot move specific parts of their body unaided have a greater risk of developing pressure ulcers.
Factors that increase the risk include:
- Older age as skin gets thinner and more vulnerable with age
- Reduced pain perception, due, for example, to a spinal cord or other injury, as they may not notice the sore
- Poor blood circulation, due to diabetes, vascular diseases, smoking, and compression
- Poor diet, especially with a lack of protein, vitamin C, and zinc
- Reduced mental awareness, due to a disease, injury, or medication, can reduce the patient’s ability to take preventive action
- Incontinence of urine or feces can cause areas of permanently moist skin, increasing the risk of skin breakdown and damage
A low or high body mass index (BMI) increases the risk.
A person with a low body weight will have less padding around their bones, while those with obesity can develop sores in unusual places. Studies show that people with a BMI of 30 to 39.9 have a 1.5 times higher rate of developing pressure ulcers.
Diagnosis, treatment, and management
Placing a pillow under the affected area can help to alleviate pressure and symptoms.
A doctor will diagnose a pressure ulcer through a visual examination.
The physician will ask about recent medical history and they will check the size and shape of the sore, and if there is any oozing or weeping.
If the patient is not in residential care, a doctor may teach them how to carry out regular daily checks on themselves.
People should report any sign of a pressure sore to the doctor.
Treating pressure ulcers is not easy.
An open wound is unlikely to heal rapidly. Even when healing does take place, it may be inconsistent, because of the damage to skin and other tissues.
Less severe pressure ulcers often heal within a few weeks with proper treatment, but serious wounds may need surgery.
The following steps should be taken:
- Remove the pressure from the sore by moving the patient or using foam pads or pillows to prop up parts of the body.
- Clean the wound: Minor wounds may be gently washed with water and a mild soap. Open sores need to be cleaned with a saline solution each time the dressing is changed.
- Control incontinence as far as possible.
- Remove dead tissue: A wound does not heal well if dead or infected tissue is present, so debridement is necessary.
- Apply dressings: These protect the wound and accelerate healing. Some dressings help prevent infection by dissolving dead tissue.
- Use oral antibiotics or antibiotic cream: These will can help treat an infection.
In the early stages, people may treat ulcers at home, but more severe ulcers will need dressing by a health care professional.
Negative pressure wound therapy
Also known as vacuum-assisted therapy, this procedure involves the attachment of a suction tube to the bedsore. The tube draws moisture from the ulcer, drastically improving the healing time and reducing the risk of infection.
Wounds heal within around 6 weeks at half the cost of surgery.
Some bedsores may become so severe that surgical intervention is necessary.
Surgery aims to clean the sore, treat or prevent infection, reduce fluid loss, and lower the risk of further complications.
A pad of muscle, skin, or other tissue from the patient’s body is used to cover the wound and cushion the affected bone. This is known as flap reconstruction.
Even with excellent medical and nursing care, bedsores can be hard to prevent, especially among vulnerable patients.
Preventing bedsores is easier than treating them, but this too can be challenging.
Tips to reduce the risk of a bed sore developing include:
- moving the patient at least every 15 minutes for wheelchair users and at every 2 hours for people in bed
- daily skin inspections
- keeping the skin healthy and dry
- maintaining good nutrition, to enhance overall health and wound healing
- quitting smoking
- exercises, even if they must be carried out in bed, with assistance, as they improve circulation.
Patients should mention any possible bed sores to their health care worker or doctor.
A physical therapist can advise on the most appropriate positions to avoid pressure sores.
Cellulitis is a possible complication of bed sores.
Without treatment, bed sores can lead to serious complications.
Cellulitis is a potentially life-threatening bacterial infection of the skin, from the surface to the deepest layer of skin. Cellulitis can result in septicemia, or blood poisoning, and the infection can spread to other parts of the body.
Bone and joint infections can arise if a pressure ulcer spreads to the joints or bones. This can result in damage to cartilage and tissue, and a reduction in limb and joint function.
Sepsis, in which bacteria can enter through sores, especially advanced ones, and infect the bloodstream. This can lead to shock and organ failure, a life-threatening condition.
There is a higher risk of developing an aggressive Cancer in the skin’s squamous cells if the patient has bedsores.
Stage 2 bedsores can heal within 1 to 6 weeks, but ulcers that reach stage 3 or 4 may take several months, or they may never heal, especially in people with ongoing health problems.
With the appropriate measures, patients and medical staff can significantly reduce the risk of developing pressure ulcers.