Pressure ulcers - What are pressure ulcers (bedsores)?

By Dr Ananya Mandal, MD

Pressure ulcers are commonly called bed sores or pressure sores. They are skin lesions that may also affect underlying tissues and are caused when the skin or the tissues are put under repeated and regular pressure or stress.

These sores begin as patches of discoloured skin and may slowly progress to open wounds with exposed muscles and bones underneath. (1-7)

Causes of pressure ulcers (bedsores)

The bedsores develop when large amount of pressure is put over a patch of skin over a short period of time.

They can also occur if small amounts of pressure are applied over a patch of skin over a longer period of time.

The amount of pressure causes blood flow to be obstructed and stagnated. Without a blood supply the tissues rapidly become starved of nutrients and oxygen.

As there is accumulation of toxins and by products that the obstructed blood supply is unable to remove, there is a break down, leading to the formation of an ulcer.

Three forces that cause pressure ulcers (bedsores)

Pressure sores are caused by three forces:

  • Pressure – due to weight of the body over the skin
  • Shearing force – The skin layers are pulled and slid against underlying structures as the patient is pulled or dragged over the bed or wheelchair.
  • Frictional force – Rubbing of the skin

Who is at risk of pressure ulcers (bedsores)?

People who are healthy usually do not get pressure ulcers as they keep moving and changing their postures and positions. This means that no part of their body is subjected to excessive pressure.

Those with health conditions like paralysis after stroke or other diseases that make movement difficult, are at risk of pressure ulcers.

In addition, those with type 2 diabetes also have damage to their blood vessels that makes blood flow slow and obstructed making a person prone to pressure ulcers.

Those over 70 years of age are particularly vulnerable. They have an aging skin, reduced and sluggish blood supply due to diabetes and high blood cholesterol as well as thickening of arteries and in addition a low rate of mobility.

How many people are affected by pressure ulcers (bedsores)?

Pressure ulcers affect a large population residing in nursing homes. It is said to be an underestimated health problem in the United Kingdom and worldwide.

Yearly around half a million people in the UK develop at least one pressure ulcer. These people are usually affected by other health conditions.

Around 1 in 20 people who are admitted to hospital with an acute illness will develop a pressure ulcer. Two thirds of pressure ulcers are seen in people aged over 70.

Figures suggest that 11-56% of new nursing home residents develop pressure sores and the incidence among Intensive Care Unit patients is 22-28.6 per 1000 patient days.

Death rates among nursing home residents with pressure sore are 2 to 6 times higher than those without such ulcers.

Treatment and prevention of pressure ulcers (bedsores)

Pressure ulcers are difficult to cure and treat but relatively easier to prevent. Prevention includes regularly changing a person’s position to prevent pressure areas and use of special equipment like mattresses and cushions to protect the common areas affected with the sores.

Early sores are usually easier to control and protect from becoming deeper sores. With more advanced and deeper sores treatment becomes difficult - especially if the patient is diabetic and there is poor wound healing.

Pressure sores often get infected and may lead to complications like sepsis, gas gangrene infections etc.

Treatment of pressure sores includes dressings, creams and gels to heal the wound and surgery is sometimes recommended deeper ulcers and sores.

Reviewed by April Cashin-Garbutt, BA Hons (Cantab)

Further Reading

Sources

  • http://www.nhs.uk/conditions/Pressure-ulcers/Pages/Introduction.aspx
  • http://www.nice.org.uk/nicemedia/pdf/CG029publicinfo.pdf
  • http://www.royalfree.nhs.uk/pip_admin/docs/Pressure_sores_143.pdf
  • http://www.patient.co.uk/doctor/Pressure-Sores.htm
  • http://www.stoppain.org/pressureulcers/common/pdf/BIMC_patient.pdf
  • http://osp.mans.edu.eg/tmahdy/papers_of_month/0708_Pressure_Sores.pdf
  • http://www.ucop.edu/agrp/docs/la_ulcers.pdf

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