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Pressure Sores Overview
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.
People most at risk of bedsores are those with a medical condition that limits their ability to change positions, requires them to use a wheelchair or confines them to a bed for a long time.
Bedsores can develop quickly and are often difficult to treat. Several things can help prevent some bedsores and help with healing.
What causes Pressure Sores?
Things that cause pressure sores include:
- Pressure on the skin and tissues. This is the most common cause.
- Sliding down in a bed or chair, which can cause the skin to fold over itself (shear force).
- Being pulled across bed sheets or other surfaces, which can cause friction burns.
- Excess moisture, such as from sweat, urine, or feces. Skin that is often wet is more likely to break down and form pressure sores.
What increases the risk of getting Pressure Sores?
Things that make a person more likely to get pressure sores include:
- Not being able to move easily. This often happens because of a spinal injury, paralysis, coma, or surgery.
- Poor bladder or bowel control.
- Poor nutrition. A diet that doesn’t have enough protein can lead to unhealthy skin and slow healing.
- Decreased alertness, which may be due to a health problem or taking certain medicines. People who are not alert may not take the steps to prevent pressure sores or understand why prevention is important.
- Aging. As people age, their skin becomes thinner, drier, and less elastic, so it is more easily injured.
- Smoking. Smoking dries out the skin and reduces blood flow to the skin.
- Having a health problem that interferes with healing, such as diabetes.
Symptoms of Pressure Sores
Bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization that promotes the prevention and treatment of pressure ulcers, defines each stage as follows:
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.
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.
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.
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.
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.
Deep tissue injury
A deep tissue injury may have the following characteristics:
- The skin is purple or maroon but the skin is not broken.
- A blood-filled blister is present.
- The area is painful, firm or mushy.
- The area is warm or cool compared with the surrounding skin.
- In people with darker skin, a shiny patch or a change in skin tone may develop.
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
How Pressure Sores treated?
Treatment focuses on preventing a sore from getting worse and on making the skin healthy again. These steps can help a pressure sore heal:
- Take pressure off the area. Change positions often. Spread body weight evenly with special mattresses, pads, or other support.
- Keep the sore clean and covered with a bandage. The doctor will tell you what type of bandage to use. You will probably be told to keep the wound a little moist and not let it dry out between bandage changes.
- Keep the healthy tissue around a pressure sore clean and dry.
- Eat a healthy diet with enough protein to help the skin heal.
To promote healing, your doctor may remove dead tissue from the wound. Bacteria can grow in dead tissue and cause infection. If you get an infection, you may need antibiotics.
Severe pressure sores may be treated with surgery. For example, a skin graft may be done to help new skin grow at the site of a sore.
How can you prevent pressure sores?
There are many things you can do to help prevent pressure sores if you’re at risk. It’s also important to use these steps to help an existing sore heal. If you can’t do them yourself, ask a family member or friend for help.