(Pressure Ulcers; Bed Sores; Decubitus Ulcers)
A pressure sore is a lesion that develops on the skin and underlying tissues, usually over bony areas, due to unrelieved pressure.
Pressure Sore (Skin Ulceration)
Pressure sores result from lying or sitting in one position for too long a time. The skin and tissues need enough blood supply for oxygen and nutrients. Prolonged pressure cuts off the blood supply to tissues that are compressed between a bony area and a mattress, chair, or other object. Without oxygen and nutrients, the tissue starts to become damaged and dies.
Several factors contribute to the development of pressure sores including:
- Pressure—Pressure sores can result from the inability to change position or to feel discomfort caused by pressure. People with normal mobility and sensation change position automatically, without thinking.
- Friction—Even friction from pulling someone across bed sheets can damage small blood vessels that supply the skin tissue.
- Poor nutrition
- Moisture—This can come from sweating due to fever or leakage of urine or stool.
- Obesity —Extra weight increases pressure on the skin over the bones and joints.
This condition is more common in older adults and people of African American or Hispanic descent. Other factors that may increase the chance of pressure sores include:
- Immobility, such as being bed- or chair-bound
- Sensory loss
- Poor nutrition
- Low body weight
- Chronic or complex medical problems, such as:
- Bone fracture
- Swelling or water retention
- Dry skin
Symptoms of a pressure sore may include:
- Skin tissue that feels firm or boggy
- Local redness, warmth, tenderness, or swelling
- Reddish or purplish skin discoloration, often over a bony area
- Pain or itching of the skin
- Blistering, sores, skin breakdown, or drainage
You will be asked about your symptoms and medical history. A physical exam will be done. Pressure sores are staged according to the depth and tissues that are involved.
Your bodily fluids may be tested. This can be done with:
- Wound culture
- Blood tests
Images may be taken of your bodily structures. This can be done with:
Treatment aims to relieve pressure on the area, heal the wound, avoid complications, and prevent future pressure sores. In many cases, a caregiver will provide care for your pressure sores.
- Avoid placing any weight or pressure on the wound.
- Change position at least every 2 hours, around the clock.
- Maintain good body alignment.
- Make sure bedclothes are clean and without wrinkles.
- If needed, use a special mattress.
Clean soiled skin after each bowel movement and urination. Wash with mild soap and warm water. Rinse well. Pat dry. Do not rub. Apply lotion as advised.
You or your caregiver will be taught how to tend to the wound. Some basic instructions include:
- Clean the sore, remove dead tissue, and apply a dressing.
- Do not put anything else on the sore.
- Wash hands before and after performing wound care. Wear disposable gloves.
- Clean the wound every time the bandage is changed.
- You may need to take pain medication a half hour or hour before dressing changes.
Surgery and Other Procedures
The doctor may surgically remove dead tissue. Skin grafts may be needed. In some situations, electrotherapy may be used to stimulate blood flow and promote healing.
Most pressure sores can be prevented. Suggestions include:
Follow these tips when repositioning:
- Change position in bed at least every 2 hours or, in a wheelchair, at least hourly. If you are able to move yourself, shift position every 15 minutes.
- Maintain good body alignment.
- Talk to your doctor about whether you should elevate the head of your bed.
- Find a sitting or lying position that is 30° toward one side or the other, but not squarely on the hip.
- Place a pillow under your calves to keep the heels off the mattress.
- Place a pillow between the knees.
- Do not use donut-ring cushions, which can cut off circulation.
Talk to the doctor about using:
- A special foam mattress designed to reduce the risk of pressure sores
- A mechanical mattress or overlay that inflates and deflates to change the pressure on the body
- Sheepskin overlay
- Use a special cushion for a wheelchair.
- Wear special pads to protect skin that is resting against braces and other devices.
- Keep the skin clean and dry.
- Do not massage bony areas.
- If incontinent, use a protective cream on skin that may come in contact with urine or stool. Do not let stool or urine remain for extended periods of time.
- Check the skin at least daily for signs of pressure problems.
- Keep sheets clean and free of wrinkles.
- Maintain good nutrition.
Family Doctor—American Academy of Family Physicians
National Pressure Ulcer Advisory Panel
The College of Family Physicians of Canada
Pressure ulcer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 9, 2015. Accessed January 12, 2015.
Pressure ulcer category/staging illustrations. National Pressure Ulcer Advisory Panel website. Available at: http://www.npuap.org/resources/educational-and-clinical-resources/pressure-ulcer-categorystaging-illustrations/. Accessed January 12, 2015.
5/27/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: McInnes E, Jammali-Blasi A, Bell-Syer S, Dumville J, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2011;(4):CD001735.
11/25/2013 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Moore ZE, Webster J. Dressings and topical agents for preventing pressure ulcers. Cochrane Database Syst Rev. 2013 Aug 18;8.
8/11/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Chen C, Hou WH, et al. Phototherapy for treating pressure ulcers. Cochrane Database Syst Rev. 2014;7:CD009224.
6/22/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Qaseem A, Mir TP, et al. Clinical Guidelines of the American College of Physicians. Risk assessment and prevention of pressure ulcers; a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69.
Last reviewed January 2015 by Peter Lucas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.