Bedsores: A Guide to Treating and Preventing Pressure Ulcers (2024)

Bedsores (also called pressure ulcers) happen as a result of prolonged pressure on the skin. They typically occur in areas where there are bony prominences. Bedsores usually occur in people who are immobile or have decreased nerve sensation. When there is too much pressure in a bony area, the skin starts to break down. The skin first turns red, and then skin and tissue loss occurs.

People most at risk for bedsores include those who are immobile, such as older adults, and those who have recently had surgery. Bedsores can also occur in people who have decreased sensation due to nerve damage, such as people with diabetes or those who have had a traumatic injury.

You can prevent bedsores by changing positions often, using a pressure-relieving mattress or chair pad, eating a nutritious diet, and quitting smoking.

This article provides an overview of bedsores, including symptoms, stages, treatment, prevention, and when to call a doctor.

Bedsores (also called Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source pressure sores, pressure ulcers, and decubitus ulcers) are areas of skin breakdown that result from prolonged pressure. Bedsores can be shallow or deep. Without treatment, bedsores worsen and can cause serious infections.

People who cannot move around easily due to disease, disability, or recovery from surgery are at increased risk for bedsores.

Individuals who have experienced nerve damage (due to a spinal cord injury or long-term diabetes, for instance) are also at risk for bedsores. This is because they may not be able to feel extra pressure on body parts and may not shift position as often as necessary.

Signs and symptoms of bedsores range from persistent red areas on the skin to open, gaping wounds. Seek medical care if you notice an open area on the skin, especially if the sore is getting worse.

Seek immediate medical care if you notice signs of infection, including fever or foul odor. Without treatment, a local infection can progress to sepsis, a life threatening, full-body infection.

The first symptom of a bedsore is usually a persistent red or darker-than-normal area on the skin. People with dark skin may see blue or purple patches. The area may feel cooler or warmer than usual.

The most common symptoms of bedsores are:

• discolored skin
• unusual changes in skin texture
• skin that is cooler or warmer or spongy or harder than the surrounding areas
• blisters on the skin
• breaks in the skin or an open skin wound

Bedsores can become infected. Severe bedsores can also interfere with blood flow and may threaten the blood supply of a limb (an arm or foot, for example). Without treatment, serious disability or death may result.

Seek immediate medical care (call 911) for any of these life threatening symptoms:

• persistent high fever (higher than 101°F or 38°C)
• unusual confusion
• rapid heartbeat
• visible muscle or bone

Without treatment, bedsores get worse over time. There are four stages:

The skin remains unbroken and intact. A persistently discolored area of skin is classified as a stage 1 bedsore. The skin contains the presence of non-blanchable redness. This means the red area does not turn white when you press on it.

The skin is open. A stage 2 bedsore is shallow. It may look like a cut or blistered area of skin.There is partial-thickness skin loss that involves the epidermis and dermis. The area may be painful.

A stage 3 bedsore looks a bit like a crater. It is deeper than a stage 2 bedsore because the sore extends through both the outer and inner layers of skin.There is full-thickness skin loss that extends to the subcutaneous tissue but not the muscle beneath it. This type of lesion may be foul-smelling and painful.

Stage 4 bedsores extend down to the muscle. In some cases, bone is visible.There is considerable tissue loss with possible involvement of tendons or joints. This is the most serious stage.

Like all parts of the body, the skin needs a constant supply of blood and oxygen to remain healthy. Prolonged pressure decreases blood and oxygen supply to the skin and tissues beneath, increasing the risk of a bedsore.

Without adequate blood and oxygen supply, cells die and the skin can break down, leaving it exposed and vulnerable to infection.

Bedsores typically occur in areas of bony prominences that are not padded by muscle and fat. These areas include the:

• hip bones
• tailbone (base of the spine)
• heels of the feet
• ankles
• shoulder blades
• sides of the knees
• back of the head
• buttocks

Decreased mobility is the biggest risk factor for bedsores. Other risk factors Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source include:

• Decreased sensory perception: People with spinal cord injuries, diabetes, or other medical conditions may not feel pain and discomfort due to nerve damage. As a result, they may not change positions often enough to avoid bedsores.
• Incontinence: Skin that is frequently exposed to urine or stool is more likely to break down.
• Poor nutrition and hydration: Proper nutrition is essential for skin health. People who do not get enough calories, fluids, or essential nutrients are prone to bedsores.
• Medical conditions affecting blood flow: Peripheral arterial disease, venous insufficiency, and diabetes are a few of the medical conditions that can decrease blood flow and oxygen supply to the skin, increasing the risk of bedsores.

Things you or your care team can do to help prevent bedsores include:

• Change position often. If you cannot move independently, ask someone to help you. If you are caring for someone who cannot move easily, help them readjust their position every hour or so.
• Regularly transfer from your bed to a wheelchair or chair if possible.
• Use a special pressure-relieving mattress or chair pad.
• Keep the skin clean and dry.
• Check the skin daily for early signs of skin changes.
• Exercise, or move your arms and legs, if possible to increase blood circulation.
• Eat a well-balanced diet to get enough protein, vitamins, and minerals.
• Quit smoking to improve blood circulation.

Proper nutrition can aid in preventing and treating bedsores. Make sure you get enough:

• Calories: Too few calories can slow healing. People who have a challenge eating enough may benefit from drinking nutritional supplements.
• Fluids: Aim for six to eight glasses of fluid per day.
• Protein:Wound healing requires extra protein. Meat, beans, nuts, and dairy products are reliable sources of protein.
• Vitamin C: Vitamin C is important for healthy skin and all phases of wound healing. It is found in citrus fruits (oranges, lemons, grapefruit), tomatoes, potatoes, broccoli, and strawberries.
• Zinc: Zinc deficiency is linked to delayed wound healing, so include zinc-rich foods (whole grains, fortified breads or cereals, beans, and nuts) or a zinc-containing multivitamin in your daily diet.

Ask your healthcare professional for guidance before making significant changes to your diet. Also, ask whether a multivitamin and mineral supplement is right for you.

You should see a doctor if a bedsore is getting worse rather than better. If the sore increases in size, looks redder or inflamed, starts to smell, or begins to ooze yellow or greenish pus, schedule an appointment.

Seek immediate medical care if you notice signs of infection, including fever, chills, increased redness, and foul-smelling discharge, or if you see areas of muscle or bone.

Bedsores are diagnosed based upon observation and a physical exam. A healthcare professional will carefully examine the skin.

If sores or areas of redness are noted, the healthcare professional may measure the area. These measurements provide a baseline to track healing or progression of bedsores.

If there is any drainage from the bedsore, a doctor may obtain a sample via a cotton swab and send the sample to a laboratory for analysis. Lab testing can reveal the presence of bacteria in the wound. This information helps healthcare professionals tailor medical treatment.

Stage 1 and stage 2 bedsores require care Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source to protect the skin and prevent the sores from getting worse.

If the affected individual is otherwise healthy, keeping pressure off the affected area and keeping it clean and dry may be sufficient to allow the sore to heal. Special pads can cover and protect pressure points. Egg crate foam mattresses and pads can reduce pressure across a wider area. Silk-based fabrics can help reduce friction on the skin compared to cotton fabrics.

Large stage 2 and stage 3 and 4 bedsores require medical treatment. A doctor or nurse may recommend covering the sore with a protective dressing, such as a hydrocolloid dressing. Dressings can absorb drainage, keep the wound clean, and prevent additional friction to the affected area.

Some bedsores contain dead tissue that can interfere with healing. A doctor may need to remove the dead tissue.

If a bedsore is infected, the doctor may order antibiotic treatment. Antibiotics can be applied topically (via a cream) or administered orally or through a vein (IV).

Infection is the most common complication Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of bedsores. Pressure ulcers can cause:

• cellulitis, or infection of the surrounding skin and soft tissues
• bone or joint infection, which can cause pain and difficulty with movement
• sepsis, a full-body infection that can be life threatening

Proper diagnosis and timely treatment of bedsores can prevent most of these complications.

Bedsores are areas of skin that have broken down due to prolonged pressure. They are most common in people who are immobile and typically occur in areas of bony prominences.

Bedsores are treated by keeping pressure off areas most at risk for bedsores, applying dressings to areas of skin breakdown, and using topical or oral antibiotics to help prevent infection.

You can reduce your risk of bedsores by changing position often, not smoking, and staying active. If you have a bedsore and develop signs of infection such as fever, chills, or yellow, oozing areas of skin, call your doctor right away for medical treatment.