Pressure Ulcer (Bedsore)

What is a pressure ulcer?

A pressure ulcer is a breakdown of an area of skin and the tissue under it. It is caused by constant pressure on the skin. The ulcer can be small or it can get quite large and work its way under nearby areas of normal skin.

Pressure ulcers used to be called bedsores. They may also be called decubitus ulcers.

What is the cause?

You may get pressure ulcers if you lie in bed or sit in a chair for long periods of time without changing positions. They may also be caused by rubbing or friction on the skin. Pressure ulcers happen most often on the tailbone, top of the pelvis, side of the hip joint, back of the heel, ankle, knee, and elbow. Constant pressure on the skin squeezes the tiny blood vessels that bring nutrients and oxygen to the skin. When an area of skin does not get enough nutrients and oxygen, the skin can die, and a pressure ulcer forms.

Pressure ulcers can happen to anyone with enough pressure for enough time. People with thin, frail skin have the most problems with pressure ulcers, so they need to pay attention to prevention. The thinner your skin is, the higher your risk is of developing sores.

The following risk factors increase your chance of getting pressure ulcers:

• having to stay in bed or a chair for long periods of time
• not being able to move without help
• not being able to control bowel movements or urine (the moisture from bowel movements or urine may irritate the skin)
• not eating well (your skin needs proper nutrition)
• not having enough fatty tissue over bony areas such as the hips, heels, and ankles

What are the symptoms?

The symptoms develop in stages:

• Stage 1: A reddened or darkened area of skin appears and does not go away within 30 minutes after you change your position to put less pressure on the area.
• Stage 2: The skin cracks, blisters, peels, or breaks.
• Stage 3: The skin opens up and may ooze or drain. The sore is completely through the skin and is becoming a deeper sore. You may see some yellow tissue.
• Stage 4: A deep sore develops. Muscle is visible. You may also see bone.

How is it diagnosed?

Your healthcare provider will examine your skin.

How is it treated?

Treatment depends on how severe the sore is. Pressure ulcers need prompt and ongoing care in the early stages to try to prevent more damage and infection.

Here are some things to do if you have symptoms of an ulcer:

• Tell your healthcare provider right away.
• Keep pressure off the area. For example, if the sore is on your back, try to lie on your stomach or side.
• Keep the sore clean and protect it from urine and bowel movements. Ask your healthcare provider about products that can help you with this.
• Do not massage the area. Massage may hurt the skin more. Do not massage any of the bony parts of your body.
• If the skin is broken, your healthcare provider can recommend ways to help the sore heal. Small sores may need only a padded dressing, plus changes that you can make to stop putting any pressure on the area around the sore. Larger sores often need special nursing care – often called wound care. You may be sent to a specialized center or treatment clinic.

The worst sores may not heal at all. In some cases plastic surgery, such as a skin graft, may be done to cover the ulcer hole.

Call your healthcare provider right away if:

• You start having a fever.
• You notice an odor or a change in the color of drainage from a sore.
• The skin around the sore is getting redder or more painful.

How long will the effects last?

Pressure ulcers can take a long time to heal if they are completely through the skin. The rate at which the broken skin heals depends on your health, diet, and home care. It is best to try to prevent pressure ulcers.

How can I help prevent pressure ulcers?

• Inspect your skin daily for areas that are reddened, warmer than other areas, spongy or unusually firm. Pay special attention to areas that are bony, such as your spine, tailbone, heels, and elbows. Let your healthcare provider know about any changes in your skin.
• Keep pressure off any areas that are reddened or discolored.
• Do not massage any reddened area. Massage may hurt the skin more. Also, do not massage any of the bony parts of your body.
• Change positions often.
• Eat a healthy diet. Talk with your healthcare provider and a dietitian about your diet and whether you need any diet supplements.
• Ask your provider about products that can help reduce pressure on the skin. Ask about mattress and chair cushions that can reduce pressure. Do not use doughnut cushions to reduce pressure. They may make the condition worse.
• If you are unable to move easily, pillows may be placed under your legs from midcalf to ankle to keep your heels off the bed. Never place pillows under your knees because it puts too much pressure on your heels.
• Exercise your body by tensing and relaxing your muscles, wiggling your fingers and toes, and rotating your wrists and ankles to keep them as flexible as possible. If you cannot do this, have someone bend and straighten your arms and legs every day to keep you from getting stiff. Exercise will improve your circulation, build up your muscles and strengthen your body.
• Lightly powder your sheets to reduce friction. Someone helping you to change position can use a sheet to lift you so you don't have to slide on the bed.
• Try not to raise the head of your bed more than 30 degrees except when you eat or drink. When your bed is at high incline, there is an increased chance that you will slide down, causing a friction injury.