What are pressure ulcers (bed sores)?

Pressure ulcers, also referred to as pressure sores or bed sores, are injuries that occur because of prolonged pressure on the skin.

These injuries typically present on areas of the skin over the bony parts of the body, such as the heels, ankles, elbows hips and tailbone.

Symptoms

It is important to be able to detect the early warning signs of a developing pressure ulcer. Depending on the size, depth and severity of a pressure ulcer, it can fall into one of four categories. These stages are used by medical professionals when assessing damage to the skin.

  • Category 1 pressure ulcer - red, purple or blue discolorations to the skin (which do not whiten under light pressure), patches of skin with an abnormal texture (e.g. spongy or hard) pain, heat or itchiness.
  • Category 2 pressure ulcer - skin becomes broken, forming an open wound or blister.
  • Category 3 pressure ulcer - deeper injury damaging deeper skin tissue.
  • Category 4 pressure ulcer – an extremely deep wound extending to layers of muscle and bone.

Pressure ulcers are common in people with limited mobility, such as dementia patients. Individuals using a wheelchair have an increased risk of developing these skin complaints in areas such as the tailbone or buttocks, shoulder blades and spine, and the back of the arms and legs.

Individuals who are restricted to bed may develop pressure ulcers on the back or side of the head, on the shoulder blades, hip or tailbone, heels, ankles and legs.

You can find out how pressure ulcers are diagnosed here.

Causes

Three primary factors contributing to the formation of pressure ulcers are:

  1. Pressure

Sustained pressure on the body reduces the available blood flow to tissues. Without oxygen and other nutrients to tissue, the skin becomes damaged and eventually dies.

This kind of pressure is typical in parts of the skin that cover a bone and are therefore not padded with muscle or fat, such as the spine, tailbone, shoulder blades, hips, heels and elbows.

  1. Friction

Friction happens when skin rubs against things like clothing or bedding. This puts the skin at high risk for damage and injury, and even more so if it is moist.This is why individuals who have restricted mobility are likely to develop pressure ulcers.

  1. Shear

Shear also contributes to pressure ulcers. This force is seen when two surfaces move in opposing directions.For instance, gravity can cause an individual lying on an elevated bed to slide down, pulling the skin on the tailbone in the opposite direction to the rest of the body, and consequently damaging the skin.

More information on the causes of pressure ulcers can be found here.

Treatment

The treatment for a pressure ulcer is dependent on the severity of the condition (or at what stage the ulcer is in). For example, some minor pressure ulcers may heal on their own without treatment, whereas more severe cases could potentially lead to life-threatening conditions, such as sepsis, without medical assistance.

Several methods that assist the healing of pressure ulcers include:

  • Dressings and bandages containing special gels – like hydrocolloid or alginate – can be used to encourage wounds to heal and new tissue to regenerate, while protecting the affected area from further damage.
  • Topical creams and ointments can be applied to pressure ulcers to reduce pain or itching and to aid the healing process.
  • Antibiotics or antiseptic cream can be prescribed if a pressure ulcer becomes infected. Signs of infection include a fever, nausea, severe redness, pain or swelling.
  • Debridement is a term used to describe the process of removing dead skin. This can be helpful in accelerating the healing of pressure ulcers, and can be achieved using water cleansing, special dressings, or by cutting the tissue with a laser or surgical instruments.
  • Surgery may be necessary for extremely severe ulcers that are not able to heal and are highly prone to infection. This procedure will typically involve closing the ulcer by bringing together its edges or by using grafted skin from a different area of the body.

More information on how to treat pressure ulcers can be found here.

Prevention

Certain steps can be taken to minimize the risk of developing pressure ulcers, such as:

  • Frequently changing position, either manually, or with the help of a caregiver
  • Using specially designed pressure redistributing equipment fitted to mattresses, cushions and wheelchairs.
  • Ensuring a healthy and balanced diet with lots of protein, vitamins and minerals
  • Keeping the skin clean and dry
  • Quitting smoking, which can increase the risk of getting pressure ulcers.

Further Reading

Last Updated: Oct 5, 2018

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