Bedsores — also called pressure sores or pressure ulcers — are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone.
Symptoms
Bedsores fall into one of four stages based on their severity.
Stage I
The beginning stage of a pressure sore has the following characteristics:
- The skin is not broken.
- The skin appears red on people with lighter skin color, and the skin doesn’t briefly lighten (blanch) when touched.
- On people with darker skin, the skin may show discoloration, and it doesn’t blanch when touched.
- The site may be tender, painful, firm, soft, warm or cool compared with the surrounding skin.
Stage II
At stage II:
- The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
- The wound may be shallow and pinkish or red.
- The wound may look like a fluid-filled blister or a ruptured blister.
Stage III
At stage III, the ulcer is a deep wound:
- The loss of skin usually exposes some fat.
- The ulcer looks crater-like.
- The bottom of the wound may have some yellowish dead tissue.
- The damage may extend beyond the primary wound below layers of healthy skin.
Stage IV
A stage IV ulcer shows large-scale loss of tissue:
- The wound may expose muscle, bone or tendons.
- The bottom of the wound likely contains dead tissue that’s yellowish or dark and crusty.
- The damage often extends beyond the primary wound below layers of healthy skin.
Unstageable
A pressure ulcer is considered unstageable if its surface is covered with yellow, brown, black or dead tissue. It’s not possible to see how deep the wound is.
Common sites of pressure sores
For people who use a wheelchair, pressure sores often occur on skin over the following sites:
- Tailbone or buttocks
- Shoulder blades and spine
- Backs of arms and legs where they rest against the chair
For people who are confined to a bed, common sites include the following:
- Back or sides of the head
- Rim of the ears
- Shoulders or shoulder blades
- Hip, lower back or tailbone
- Heels, ankles and skin behind the knees
When to see a doctor
If you notice early signs or symptoms of a pressure ulcer,
change your position to relieve the pressure on the area.
If you don’t see improvement in 24 to 48 hours, contact your doctor.
Seek immediate medical care if you show signs of infection,
such as fever, drainage or a foul odor from a sore,
or increased heat and redness in the surrounding skin.
Causes
- Sustained pressure
- Friction & Shearing forces
- Excessive moisture
Risk factors
- Immobility
- Inactivity
- Fecal or urinary incontinence
- Poor nutrition
- Decreased level of consciousness
- Low body weight
- Smoking
- Corticosteroid use
- Alcoholism
Some medical condition that put you at risk:
- Anemia
- Infections
- Edema
- Diabetes Mellitus
- Stroke
- Dementia
- Fractures
- Cancer Malignancies
Tests and diagnosis
Evaluating a bedsore
To evaluate a bedsore, your doctor will:
- Determine the size and depth of the ulcer
- Check for bleeding, fluids or debris in the wound that can indicate severe infection
- Try to detect odors indicating an infection or dead tissue
- Check the area around the wound for signs of spreading tissue damage or infection
- Check for other pressure sores on the body
Tests
Your doctor may order the following tests:
- Blood tests to check your health
- Tissue cultures to diagnose a bacterial or fungal infection in a wound that doesn’t heal with treatment or is already at stage IV
- Tissue cultures to check for cancerous tissue in a chronic, nonhealing wound
Treatments and drugs
Reducing pressure
The first step in treating a bedsore is reducing the pressure that caused it. Strategies include the following:
- If you have a pressure sore, you need to be repositioned regularly and placed in correct positions. If you use a wheelchair, try shifting your weight every 15 minutes or so. Ask for help with repositioning every hour. If you’re confined to a bed, change positions every two hours.
- Using support surfaces. Use a mattress, bed and special cushions that help you lie in an appropriate position, relieve pressure on any sores and protect vulnerable skin. If you are in a wheelchair, use a cushion.
Cleaning and dressing wounds
Care that helps with healing of the wound includes the following:
- It’s essential to keep wounds clean to prevent infection. If the affected skin is not broken (a stage I wound), gently wash it with water and mild soap and pat dry. Clean open sores with a saltwater (saline) solution each time the dressing is changed.
- Applying dressings. A dressing promotes healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry. Dressing choices include films, gauzes, gels, foams and treated coverings. A combination of dressings may be used.
Removing damaged tissue
To heal properly, wounds need to be free of damaged, dead or infected tissue. Removing this tissue (debridement) is accomplished with a number of methods, depending on the severity of the wound, your overall condition and the treatment goals.
- Surgical debridement.
- Mechanical debridement.
- Autolytic debridement.
- Enzymatic debridement.
Other strategies
Other important strategies that can help decrease the risk of bedsores include the following:
- Quit smoking.
- Stay active.