Bedsores: Causes, Symptoms, Stages, Treatment, and Prevention
Learn about bedsores (pressure ulcers): their causes, symptoms, stages, treatment, risk factors, and effective prevention methods.
Bedsores, also known as pressure ulcers or decubitus ulcers, are injuries to the skin and underlying tissue caused by prolonged pressure on the skin. Most often affecting individuals with limited mobility, bedsores can lead to serious complications if not addressed promptly. This comprehensive guide covers all essential aspects of bedsores, including their causes, symptoms, stages, treatment options, and preventive strategies.
What Are Bedsores?
Bedsores are localized injuries to skin and underlying tissue, primarily resulting from sustained pressure, friction, or shear forces that block blood flow. This lack of blood flow deprives skin and tissues of oxygen and nutrients, eventually causing tissue breakdown or death. Bedsores most commonly develop in patients who are bedridden, use wheelchairs, or have medical conditions restricting movement.
- Also known as: pressure ulcers, pressure injuries, decubitus ulcers
- Typical sites: bony prominences such as the heels, ankles, hips, tailbone, elbows, and shoulders
- At-risk populations: immobile, elderly, or individuals with neurological disorders, poor nutrition, or incontinence
Causes of Bedsores
The primary cause of bedsores is prolonged pressure on a specific body area, which reduces or cuts off blood supply, leading to tissue damage. Several contributing factors increase the risk or accelerate the development of these ulcers:
- Pressure: Continuous pressure from lying or sitting, particularly over bony areas, impedes blood flow to the tissues.
- Friction: Rubbing or pulling of the skin against bedding or clothing can exacerbate skin damage, especially in patients with frail skin.
- Shear: Sliding movements (e.g., when a patient slides down in bed) can stretch and tear blood vessels, further impairing circulation.
- Moisture: Skin exposed to sweat, urine, or feces is more susceptible to breakdown and infection.
Risk Factors
Anyone can develop bedsores under certain conditions, but some factors significantly increase the risk:
- Limited mobility: Inability to change position independently (e.g., after surgery, spinal cord injuries, advanced illness)
- Age: Older adults, especially those over 65, have thinner, less elastic skin and slower healing
- Chronic medical conditions: Diabetes, vascular disease, or conditions that affect blood flow or sensation
- Poor nutrition and hydration: Deficiencies weaken the skin and reduce its ability to recover from damage
- Incontinence: Prolonged exposure to urine or feces causes skin damage and increases infection risk
- Sensory impairment: Conditions like spinal cord injuries, neuropathy, or coma make it difficult to notice or react to discomfort
Common Sites of Bedsores
Bedsores typically develop on parts of the body where bone is close to the skin and there is less cushioning from muscle or fat. The most susceptible areas include:
| Bed-bound Individuals | Wheelchair Users |
|---|---|
|
|
Symptoms and Signs of Bedsores
The symptoms of bedsores vary according to their stage and severity. Early detection is essential for effective treatment. Key symptoms include:
- Changes in skin color or texture: Redness in lighter skin tones, or blue/purple in darker skin. The affected area may feel firmer or softer than surrounding tissue.
- Swelling: Inflammation and puffiness in the affected area
- Pain and tenderness: Discomfort, burning, or itching (though those with nerve damage may not feel pain)
- Pus-like drainage: Fluid discharge may indicate infection
- An area feeling cooler or warmer to touch: Temperature changes due to inflammation or infection
- Open wounds or blisters: Advanced stages can involve broken skin or exposed tissue
What others are reading
Stages of Bedsores
Healthcare providers often classify bedsores based on the extent of tissue damage. The National Pressure Injury Advisory Panel (NPIAP) recognizes four main stages of pressure ulcers, plus special categories:
- Stage 1: Intact skin with non-blanchable redness in a localized area. Skin may be painful, firm, soft, warmer, or cooler than surrounding tissue. No open wounds are present.
- Stage 2: Partial-thickness skin loss presenting as a shallow, open ulcer with a red or pink wound bed. May also present as a blister, either intact or ruptured.
- Stage 3: Full-thickness tissue loss. Fat may be visible, but bone, tendon, or muscle are not exposed. The ulcer may have slough (yellowish dead tissue) and may include undermining or tunneling.
- Stage 4: Full-thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar (dead tissue) may be present. These wounds often include undermining and tunneling. Risk of infection is very high.
- Unstageable: Full-thickness tissue loss where the base of the ulcer is covered by slough or eschar. The true depth cannot be determined until the dead tissue is removed.
- Deep tissue pressure injury: Persistent, non-blanchable deep red, maroon, or purple discoloration. Skin may be intact or blood-filled blister, indicating underlying soft tissue damage.
Complications of Bedsores
If untreated, bedsores can result in severe complications such as:
- Cellulitis: Bacterial skin infection that can spread to deeper tissues
- Bone and joint infections: Osteomyelitis and septic arthritis can develop if infection spreads to bone or joints
- Sepsis: Life-threatening response to severe infection that can lead to organ failure
- Cancer: Rarely, chronic, nonhealing wounds can develop into squamous cell carcinoma
When to See a Doctor
It’s important to consult a healthcare provider immediately if you notice:
- Signs of infection (fever, foul odor, pus, worsening redness)
- Increasing pain, swelling, or warmth around the sore
- Lack of improvement within 24–48 hours after reducing pressure
Treatment of Bedsores
The main goals of bedsore treatment are to promote healing, relieve pain, prevent additional pressure, and manage infection. Treatment depends on the stage and severity but may include:
- Pressure relief: Regularly changing position, using specialized mattresses, overlays, or cushions
- Cleaning and dressing wounds: Keeping the wound clean and applying dressings to promote healing and prevent infection
- Removal of damaged tissue: Debridement (removing dead or infected tissue) via surgical, enzymatic, or mechanical methods
- Medication: Antibiotics (for infection), pain medication, topical treatments to promote healing
- Nutrition and hydration: Adequate calories, protein, vitamins, and fluids are crucial for skin renewal and repair
- Surgery: Severe, deep ulcers may require surgical repair, such as skin grafts or flap surgery
Preventing Bedsores
Prevention is far easier and more effective than treatment. Caregivers and at-risk individuals should follow these key strategies:
- Reposition frequently: Change positions at least every 2 hours in bed and hourly if in a wheelchair
- Use pressure-relieving devices: Special mattresses, cushions, heel protectors, and overlays reduce pressure at vulnerable points
- Keep skin clean and dry: Gently cleanse skin daily and after any incontinence or sweating episodes
- Inspect skin regularly: Perform daily checks for redness, discoloration, or early signs of breakdown, especially on bony areas
- Optimize nutrition and hydration: Ensure a balanced diet rich in calories, protein, vitamins, and minerals, and adequate fluid intake
- Manage incontinence: Use barrier creams and absorbent products to protect sensitive areas
- Support mobility: Encourage as much movement and activity as possible within physical limitations
Living With and Caring for Bedsores
Managing bedsores requires ongoing attention:
- Adhere to prescribed treatments and wound care regimens
- Maintain good hygiene and proper skin care
- Encourage gentle exercise and mobility, if medically appropriate
- Monitor wounds for signs of healing or detection of new sores
- Coordinate with healthcare professionals for routine assessments, nutritional guidance, and advanced therapies
Frequently Asked Questions (FAQs)
Q: What does a bedsore look like when it first develops?
A: Early bedsores may appear as reddish, purplish, or blue areas of skin that do not turn white (blanch) when pressed. The area may feel warm, firm, or tender, and may cause pain or itching. In darker skin, discoloration may be harder to spot.
Q: Who is most at risk for bedsores?
A: People with limited mobility, such as those who are bedbound, use a wheelchair, or have neurological, vascular, or chronic medical conditions. Elderly adults and patients with poor nutrition, dehydration, or incontinence are also at higher risk.
Q: How long does it take a bedsore to develop?
A: Bedsores can develop in just a few hours when skin is subjected to sustained pressure, especially in those most at risk.
Q: Can bedsores be prevented?
A: Yes. Regular repositioning, good skin care, pressure-relieving devices, proper nutrition, and prompt management of incontinence are highly effective preventive measures.
Q: Are bedsores serious?
A: Bedsores can range from mild irritation to life-threatening wounds if not treated correctly. Severe cases may lead to deep tissue damage, infection, sepsis, or even death.
Resources and Support
- Consult wound care specialists and healthcare professionals for up-to-date and personalized care plans
- Local support groups and online resources may offer further guidance, emotional support, and practical caregiving advice
If you or someone you care for is at risk of bedsores, early intervention and vigilant care are key to preventing serious complications and ensuring the best possible outcomes.
References
- https://my.clevelandclinic.org/health/diseases/17823-bedsores-pressure-injuries
- https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893
- https://www.nursinghomeabusecenter.com/nursing-home-injuries/bedsores/symptoms/
- https://www.uofmhealthsparrow.org/departments-conditions/conditions/bedsores-pressure-ulcers
- https://www.ncbi.nlm.nih.gov/books/NBK553107/
- https://www.nhs.uk/conditions/pressure-sores/
- https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/bedsores.html
- https://www.cancer.gov/publications/dictionaries/cancer-terms/def/decubitus-ulcer
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