Pressure Sores

What are pressure sores?

Pressure sores are sores on your skin caused by being in a chair or bed for most of the day and night. Pressure sores also are called bedsores or pressure ulcers. The sores change appearance over 4 stages. In the beginning, the sores look red. By stage 4 (the most serious), the sores are deep and open. You actually can see your muscle, bone, tendons, and joints.

Pressure sores usually develop over the bony parts of your body. Those are places with little padding from fat. Sores are most common on the heels and on the hips. Other areas at risk 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, use a wheelchair, or spend most of your time in bed (such as in an assisted care facility).

Even people who are able to walk can develop pressure sores when they must stay in bed because of an illness or an injury. Some chronic diseases make it difficult for pressure sores to heal. That’s because they affect your blood circulation. Examples of these diseases include diabetes and hardening of the arteries.

Symptoms of pressure sores

There are 4 stages of pressure sores. Symptoms look different at each stage:

Stage 1. The affected skin looks red and may feel warm to the touch. The area also may burn, hurt, or itch. In people who have dark skin, the pressure sore may have a blue or purple tint.

Stage 2. The affected skin is more damaged. It can result in an open sore that looks like a cut or blister. The skin around the wound may be discolored. The sore is very painful.

Stage 3. At this stage, pressure sores usually have a crater-like appearance. This is due to increased damage to the tissue below the skin’s surface. This makes the wound deeper.

Stage 4. This is the most serious type of pressure sore. The skin and tissue is severely damaged. This causes a large wound. Infection can occur at this stage. You are likely able to see muscle, bones, tendons, and joints in stage 4 pressure sores.

If your pressure sore becomes infected, it will 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.
  • Mental 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 (more than 2 hours for a stage 1 pressure sore). This puts pressure on certain areas of your body. This reduces blood supply to the skin and the tissue under the skin. If you don’t change position frequently, the blood supply will get too low. A sore will develop.

How is a pressure sore diagnosed?

Your doctor will examine the sores and ask you questions about your recent medical history. He or she also may consider the size, depth, and appearance of the sore. He or she will look for blood or fluid oozing from the site. Your doctor will check to see if your sore has a bad smell. He or she also will check for additional sores. Certain tests also can help with diagnosis. 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 include taking a sample of the tissue around the sore (your doctor will scrape or cut a small sample) and sending that 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. If you know you will be having surgery and will spend long amounts of time in bed, prepare in advance. Talk to the person who will be assisting with your care to come up with a plan to help you move.

Also, keep your skin healthy. This includes keeping your skin clean and dry. A mild soap and warm (not hot) water can help. Apply moisturizers to your skin so it doesn’t get too dry. 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 special attention to the pressure points where sores are most likely to occur.

If you smoke, quit. People who smoke are more likely to develop pressure sores. Exercise can help improve blood flow. Do what you can to strengthen your muscles and improve your overall health. Talk to your doctor if physical activity is hard for you. He or she can suggest exercises that can work for you. Your doctor also can refer you to a physical therapist for help.

Pressure sore treatment

Treatment of an infected pressure sore depends on the seriousness of the infection. If only the sore is infected, an antibiotic cream can be applied to the sore. When bone or deeper tissue is infected, systemic (not topical) antibiotics are often required. Antibiotics can be given intravenously (through a small needle inserted into a vein) or orally (by mouth).

Other treatments include:

  • Use foam pads or pillows to take pressure off the sore. Special mattresses, mattress covers, foam wedges, or seat cushions can help support you in bed or in a chair to reduce or relieve 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. Also, 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. An upright, straight position allows you to move more easily and help prevent new sores. Change positions every 15 minutes when sitting in a chair or wheelchair. If you cannot move by yourself, have your caregiver help you shift your position.
  • Improve your nutrition to help the sore heal.
  • Maintain good hygiene. Stage 1 sores can be cleaned with mild soap and water. You can clean stage 2 sores by rinsing the area with a salt and water solution. The saltwater removes extra fluid and loose material. Your doctor or nurse can show you how to clean your 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 means making plans to move and turn frequently. Also, it means maintaining good hygiene. Pressure sores should be kept covered with a bandage or dressing. Sometimes gauze is used. The gauze is kept moist and must be changed at least once a day. Newer kinds of dressings include a see-through film and a hydrocolloid dressing. A hydrocolloid dressing is a bandage made of a gel that molds to the pressure sore and helps promote healing and skin growth. These dressings can stay on for several days at a time.

Dead tissue (which may look like a scab) in the sore can interfere with healing and lead to infection. There are many ways to remove dead tissue from the pressure sore. Rinsing the sore every time you change the bandage is helpful. There are special dressings that 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 and allow them to dry. The dead tissue sticks to the gauze and is removed when the gauze is pulled off. For more 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 for you to take 30 to 60 minutes before your dressing is changed.

Good nutrition is important because it helps your body heal the sore. If you don’t get enough calories, protein, and other nutrients (vitamin C and zinc help heal wounds), your body won’t be able to heal. 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 slowly 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 and looks lumpy and shiny. It may take 2 to 4 weeks of treatment before you see these signs of healing.

Questions to ask your doctor

  • What should I do if I or a loved one is at risk for pressure sores and are too heavy to turn and move?
  • Does an adjustable hospital bed help reduce the risk of pressure sores?
  • Can you die from an infected pressure sore?
  • Is a diabetic foot ulcer the same as a pressure sore?