Pressure Sores

What are pressure sores?

Pressure sores are sores on your skin. They are caused by being confined to a bed or wheelchair nearly all the time. Sometimes they are called bedsores or pressure ulcers. The sores change appearance over 4 stages. The sores look red in stage 1. By stage 4 (the most serious), they are deep and open. At this stage, you can see your muscle, bone, tendons, and joints.

The sores usually develop over the bony parts of your body. Those are places with little padding from fat. Sores are common on heels and hips. Other areas include the base of the spine (tailbone), shoulder blades, the backs and sides of the knees, and the back of the head. You are more likely to get pressure sores if you are paralyzed, or use a wheelchair. This is common among people who spend most of their time in bed. An assisted care facility is an example of this.

Pressure sores can develop even when you’re in confined for a short period. This includes people who must stay in bed or wheelchair because of an illness or an injury. Chronic diseases make it difficult for pressure sores to heal. These include diabetes and hardening of the arteries.

Symptoms of pressure sores

Symptoms look different at each of the 4 stages:

Stage 1.

The area looks red. It may feel warm to the touch. It may burn, hurt, or itch. The pressure sore may look blue or purple in people who have dark skin.

Stage 2.

The area is more damaged. The sore may be open. It may look like a cut or blister. The skin around the sore may be discolored. The sore is painful.

Stage 3.

The sore will have a crater-like look. This is due to increased damage below the surface. This makes the wound deeper.

Stage 4.

This is the most serious. Skin and tissue are severely damaged. It becomes a large wound. Infection is possible. You are likely able to see muscle, bones, tendons, and joints.

Infected pressure sores take longer to heal. The infection can spread to the rest of your body. Signs of infection at the site include:

  • Thick, yellow, or green pus
  • A bad smell coming from the sore
  • Redness or skin that is warm to the touch
  • Swelling around the sore
  • Tender to the touch around the sore

Signs that the infection has spread include:

  • Fever
  • Chills
  • Confusion or difficulty concentrating
  • Rapid heartbeat
  • Weakness

What causes pressure sores?

Pressure sores are caused by sitting or lying in one position for too long. Stage 1 pressure sores can occur in as little as 2 hours in the same position. This puts pressure on certain areas of your body. It reduces blood supply to the skin and the tissue under the skin. If you don’t change position frequently, the blood supply will drop. A sore will develop.

How are pressure sores diagnosed?

Your doctor will do a physical exam. He or she will look at the sores. Your doctor also will look at the sore’s size, depth, and appearance. He or she will look for blood or fluid oozing from the sore. Your doctor will check to see if your sore has a bad smell. He or she also will check for additional sores.  Your doctor will ask you questions about your recent medical history. Certain tests also can help. These tests might include a blood test. Your doctor or nurse will insert a small needle into your vein and collect a small sample of blood to send to a lab. Another test would be to take a sample of the tissue from the sore. This is done by scraping or cutting it from the sore. That sample is sent to the lab.

Can pressure sores be prevented or avoided?

The best way to prevent pressure sores is to avoid spending long periods of time in a chair or bed. If you are unable to turn and move, ask your caretaker to help. Plan ahead for an upcoming surgery. Arrange for help you when you get home, That person should be able to help you move.

Keep your skin healthy. This includes keeping your skin clean and dry. Mild soap and warm water can help. Don’t use hot water. Apply lotion to your skin often. If you must spend a lot of time in bed or in a wheelchair, check your entire body daily. Look for spots, color changes, or other signs of sores. Pay attention to the pressure points where sores are most likely to occur.

If you smoke, quit. Smoking increases your risk of  pressure sores. Exercise improves blood flow. Strengthen your muscles and improve your overall health. Talk to your doctor if physical activity is difficult. He or she can suggest certain exercises. Your doctor can refer you to a physical therapist for help.

Pressure sores treatment

Treatment depends on the seriousness of the infection. If the sore is infected, you can apply an antibiotic cream to the area. If bone or deeper tissue are infected, you may require antibiotics orally or by injection (shot or IV).

Other things that can help include:

  • Use foam pads or pillows to take pressure off the sore.Special mattresses, mattress covers, foam wedges, or seat cushions provide support in bed or in a chair. This reduces pressure. Avoid resting directly on your hip bone when you’re lying on your side. Use pillows under one side so that your weight rests on the fatty part of your buttocks instead of on your hip bone. Use pillows to keep your knees and ankles apart. When lying on your back, place a pillow under your lower calves to lift your ankles slightly off the bed. When lying in bed, change your position at least every 2 hours.
  • When sitting in a chair or wheelchair, sit upright and straight.This allows you to move more easily and help prevent new sores. Change positions every 15 minutes when sitting. If you cannot move by yourself, have your caregiver help you shift your position.
  • Improve your nutrition. This helps heal the sore.
  • Maintain good hygiene. Stage 1 sores can be cleaned with mild soap and water. Clean stage 2 sores with a salt and water solution. The saltwater removes extra fluid and loose material. Your doctor or nurse can show you how to clean stage 1 and 2 pressure sores. Your doctor or nurse will likely need to clean stage 3 and 4 pressure sores because of their seriousness.

Living with pressure sores

Living with pressure sores requires a plan to move and turn frequently. Good hygiene will always be required. Pressure sores should be kept covered with a bandage or dressing. Sometimes gauze is used. The gauze must be changed once a day. Newer materials include a see-through film and a hydrocolloid dressing. A hydrocolloid dressing is a bandage made of a gel. It molds to the pressure sore and promotes healing and skin growth. These dressings can stay on for several days at a time.

Dead tissue in the sore can interfere with healing and lead to infection. Dead tissue looks like a scab. To remove dead tissue, rinse the sore every time you change the bandage. Special dressings can help your body dissolve the dead tissue on its own. The dressing must be left in place for several days. Another way to remove dead tissue is to put wet gauze bandages on the sore. Allow them to dry. The dead tissue sticks to the gauze until it is removed. For severe pressure sores, dead tissue must be removed surgically by your doctor.

Removing dead tissue and cleaning the sore can hurt. Your doctor can suggest a pain medicine. Take it 30 to 60 minutes before changing the dressing.

Good nutrition helps the sore heal. Too few calories and protein prevents healing. Nutrients are important too. This includes vitamin C and zinc. Your doctor, nurse, or a dietitian can give you advice about a healthy diet. Be sure to tell your doctor if you have lost or gained weight recently.

As a pressure sore heals, it gets smaller. Less fluid drains from it. New, healthy tissue starts growing at the bottom of the sore. This new tissue is light red or pink. It looks lumpy and shiny. Treatment may take 2 to 4 weeks before you see signs of healing.

Questions to ask your doctor

  • What should I do if I or a loved one has pressure sores and is too heavy to move?
  • Does an adjustable bed help reduce the risk of pressure sores?
  • Can you die from an infected pressure sore?
  • Is diabetic foot ulcer the same as a pressure sore?
  • Can you get pressure sores from sitting in the same position in your job for longer than 2 hours at a time?