Pressure Ulcer (Bedsore)

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KEY POINTS

• A pressure ulcer, also called a bedsore, is damage to an area of skin and the tissue under it from constant pressure or rubbing on the skin.
• Treatment includes keeping pressure off the area, keeping the pressure ulcers clean and protected, and in some cases, surgery.
• If you think you are developing a pressure ulcer, see your healthcare provider right away. Pressure ulcers need prompt and ongoing care in the early stages to try to prevent more damage and infection.

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What is a pressure ulcer?

A pressure ulcer is damage to an area of skin and the tissue under it from constant pressure or rubbing on the skin. The pressure ulcer can be small or it can get quite large. It may even go down to the bone. Pressure ulcers happen most often on the tailbone, shoulder blades, side of the hip joint, ankle, knee, elbow, and back of the heel.

Pressure ulcers may also be called bedsores, or decubitus ulcers.

What is the cause?

Constant pressure on the skin squeezes and closes the tiny blood vessels that normally bring nutrients and oxygen to the skin. When this happens, the skin can die, and a pressure ulcer forms.

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

• Having to stay in bed or a chair for long periods of time
• Having thin, frail skin and poor blood flow
• Not being able to move without help, such as after a stroke, leg, or back injury
• Not being able to control bowel movements or urine (the bowel movements or urine can irritate the skin)
• Not eating a healthy diet
• Not having enough fatty tissue over bony areas such as the shoulders, hips, heels, and ankles
• Having numbness in some part of your body that keeps you from feeling when there is too much pressure on the skin or the skin is getting sore. This is common in people with diabetes.

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, or peels.
• Stage 3: The skin opens up and may ooze or drain. The pressure ulcer is completely through the skin and is getting deeper. You may see some yellow tissue in the pressure ulcer.
• Stage 4: A deep pressure ulcer develops. You may see muscle or even bone inside the pressure ulcer.

Some pressure ulcers may cause only a small red or black area on the surface of the skin while there is a much larger area of damage underneath the skin. The area under the skin may feel soft and spongy.

How is it diagnosed?

Your healthcare provider will examine your skin, looking for any sore spots and other areas where it looks like pressure ulcers may develop.

How is it treated?

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 think you may be getting a sore spot or have symptoms of a pressure ulcer:

• Tell your healthcare provider right away.
• Keep pressure off the area. For example, if the pressure ulcer is on your back, try to lie on your stomach or side.
• Keep the pressure ulcer clean and protect it from urine and bowel movements. Ask your healthcare provider about products that can help you with this.
• Wash your hands before and after caring for your pressure ulcer. Wash your hands often and especially after using the restroom, coughing, sneezing, or blowing your nose. Also wash your hands before eating or touching your eyes.
• If the skin is broken, your healthcare provider can recommend ways to help the pressure ulcer heal. Small pressure ulcers may need only a padded dressing, plus not putting any pressure on the area around the pressure ulcer. Do not use any ointment or cream on the pressure ulcer unless directed by your healthcare provider.
• Larger pressure ulcers often need special care. You may be sent to a treatment center or clinic for care.

Pressure ulcers can take a long time to heal, especially if they are deep. How fast the broken skin heals depends on your health, diet, and care. You may need surgery for a deep pressure ulcer.

Call your healthcare provider right away if you have a pressure ulcer and:

• You start having a fever.
• You notice a smell or a change in the color of drainage from a pressure ulcer.
• The skin around the pressure ulcer is getting larger, redder, or more painful.

How can I help prevent pressure ulcers?

Ways to lower the risk of pressure ulcers include:

• Take care of your skin. Be extra careful about bony parts of your body where the skin is thin.
• Change positions often--at least every 1 to 2 hours. Shift your position every 15 to 20 minutes if you sit for a long time in a chair or wheelchair.
• Take other precautions to relieve pressure, like putting a pillow under your lower legs to relieve pressure on your heels.
• Raise your legs to reduce swelling in your feet and legs when you sit. Ask your healthcare provider about this.
• Avoid rubbing, chafing, or sliding across sticky, rough, or hard surfaces.
• Avoid sitting or lying on wrinkles or seams in your clothing and bed linens.
• Eat a healthy diet to give your skin the nutrition it needs.