Bedsores (Pressure Injuries)

What are bedsores?

Bedsores are wounds that occur from prolonged pressure on your skin. People who are immobile for long periods, such as those who are bedridden or use a wheelchair, are most at risk for bedsores. These painful wounds, or pressure ulcers, can grow large and lead to infections. In some instances, bedsores can be life-threatening.

What are other names for bedsores?

You may also hear these terms for bedsores:

• Decubitus ulcers.
• Pressure injuries.
• Pressure sores.
• Pressure ulcers.
• Pressure wounds.

How common are bedsores?

Experts estimate that 2.5 million Americans develop bedsores every year. Anyone can get bedsores.

What parts of your body do bedsores affect?

Bedsores can begin anywhere. For example, people who use oxygen therapy can develop pressure sores on the bridges of their noses, ears or the backs of their heads. Pressure ulcers can also form inside your mouth from ill-fitting dentures, intubations or mechanical ventilation.

But bedsores are most likely to develop on the parts of your body where your bones sit closest to your skin, such as your:

• Ankles.
• Back.
• Buttocks.
• Elbows.
• Heels.
• Hips.
• Tailbone.

What causes bedsores?

Bedsores occur when pressure reduces or cuts off blood flow to your skin. This lack of blood flow can cause a pressure wound injury to develop in as little as two hours. Skin cells on your epidermis (your skin’s outer layer) start to die. As the dead cells break down, a pressure ulcer injury forms.

Bedsores are more likely to develop when there’s pressure along with:

• Moisture from sweat, urine (pee) or stool (poop).
• Traction (pulling or stretching of skin) from sliding down in an inclined bed or wheelchair.

Who is at risk for bedsores?

People who have thinner skin and people who have limited (or no) ability to move are more likely to develop bedsores. These include people who:

• Are in a coma or a vegetative state.
• Experience paralysis.
• Use wheelchairs.
• Wear casts and splints or prosthetic devices.

What health conditions increase your risk of bedsores?

Children and adults with certain health conditions are more likely to develop bedsores. These conditions include:

• Cancer.
• Cerebral palsy.
• Chronic venous insufficiency.
• Dementia.
• Diabetes.
• Heart failure.
• Kidney failure.
• Malnutrition.
• Peripheral artery disease.
• Spinal cord injury or spina bifida.

What are the signs of bedsores?

Bedsores can be painful and itchy. But some people who have dulled sensations aren’t able to feel them. What a bedsore looks like and what symptoms it causes varies depending on the stage of the wound.

What are the stages of bedsores?

Healthcare providers use a staging system to determine the severity of a pressure ulcer.

Stages of bedsores or pressure ulcers include:

• Stage 1: Your skin looks red or pink, but there isn’t an open wound. It may be hard for people with darker skin to see a color change. Your provider may refer to this stage as a pressure injury. Your skin may feel tender to the touch. Or your skin might feel warmer, cooler, softer or firmer.
• Stage 2: A shallow wound with a pink or red base develops. You may see skin loss, abrasions and blisters.
• Stage 3: A noticeable wound may go into your skin’s fatty layer (the hypodermis).
• Stage 4: The wound penetrates all three layers of skin, exposing muscles, tendons and bones in your musculoskeletal system.

What are the complications of bedsores?

Bedsores increase your risk of potentially life-threatening bacterial infections like cellulitis and septicemia. You may develop sepsis or require an amputation. Worldwide, bedsores lead to the deaths of more than 24,000 people each year.

Some people develop sinus tracts, which are passages that connect the pressure sore injury to structures deeper in your body. Depending on the sinus tract connection, you may develop:

• Bacteria in your bloodstream (bacteremia), which can lead to bacterial meningitis or endocarditis.
• Bone infections (osteomyelitis) or joint infections (septic arthritis).
• Group A streptococcus infections, ranging from cellulitis to necrotizing fasciitis (flesh-eating disease).

What are the signs of an infected bedsore?

Fever and chills are often the first signs of an infection. The pressure ulcer may be:

• Extremely painful.
• Foul smelling.
• Red and very warm to the touch.
• Swollen.
• Oozing pus.

How are bedsores diagnosed?

You may see a wound specialist for diagnosis and treatment. Healthcare providers diagnose and stage bedsores based on their appearance. Your provider will photograph the sore to monitor wound healing.

You may get certain tests to check for infections, such as:

• Biopsies.
• Blood cultures and tests.
• X-rays or MRIs.

What are nonsurgical treatments for bedsores?

You or a caregiver may be able to treat stages 1 or 2 bedsores. For stages 3 or 4 bedsores, you might see a wound specialist. Depending on the severity of the pressure ulcer, it may take weeks or months for the sore to heal.

To treat a pressure injury, you or your healthcare provider may:

• Irrigate or clean the wound with soap and water or saline (sterile saltwater solution).
• Dress (cover) the wound with special medical bandages designed to promote healing. These include water-based gel (hydrogel), hydrocolloid, alginates (seaweed) and foam dressings.

For deep, severe pressure ulcers, your healthcare provider will remove dead tissue during a procedure called debridement. Your provider removes the dead tissue using a scalpel. Or they may apply ointments that help your body dissolve the dead tissue. Your provider may first numb the area with a local anesthetic because even though the tissue is dead, the area around it isn’t.

What medications treat bedsores?

Depending on your symptoms, you may take:

• Antibiotics.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Pain relievers.

What are surgical treatments for bedsores?

Stages 3 or 4 pressure sores that are deep or affect a large area of skin may require surgery. You may need a skin graft to close the wound and promote healing.

How can you prevent bedsores?

These steps can lower your risk of bedsores:

• Change positions every 15 minutes if you’re seated or every one to two hours if you’re in a bed. A caregiver can help you do this if you’re unable to reposition yourself.
• Check your skin regularly (or have a caregiver do it) to look for changes in skin color and sensations (tenderness or pain, warmth or coolness).
• Eat a nutritious diet and stay well hydrated.
• Keep your skin clean and dry. Apply moisture barrier creams to protect your skin from sweat, urine and stool.
• Participate in physical therapy exercises.
• Seek help to quit smoking. Nicotine slows wound healing.
• Use specially designed mattresses or foam cushions to ease pressure on your skin. Don’t sit on a donut. This will spread the pressure outward.
• Wash and change your bedsheets, undergarments and clothes often.

What is the outlook for someone with bedsores?

Your skin isn’t as strong as it was once your pressure sore has healed. It’s important to take preventive measures like repositioning your body often. Advanced bedsores (stages 3 or 4) are more difficult to treat. These pressure sores increase your risk of infection and life-threatening issues.

When should I call the doctor?

Alert your healthcare provider if you’re at risk for bedsores and you notice:

• Changes in skin color.
• Signs of infection.
• Skin tenderness, pain or warmth.

What should I ask my provider?

You may want to ask your healthcare provider:

• What caused the bedsore?
• What’s the best treatment for me?
• Do I need surgery?
• What steps can I take to prevent bedsores?
• Should I look for signs of complications?

What’s the role of a nutritious diet when you have bedsores?

Many people who develop bedsores are malnourished. Malnutrition can occur due to advanced age or health conditions. A nutritious, high-protein diet can prevent bedsores or help them heal. You may also need to take vitamins and supplements. In rare instances, people who are extremely malnourished may need tube feeding (enteral nutrition) or IV nutrition.

A note from Cleveland Clinic

Having the limited ability to move and reposition your body puts you at risk for bedsores. If you’re in a wheelchair, bedridden or have other risk factors, it’s important to check your skin for signs of bedsores regularly. (Have a caregiver, loved one or healthcare professional check for sores if you’re unable to do so.) It’s best to catch bedsores early (stages 1 and 2) before your skin breaks open or the opening gets too large. These pressure ulcers respond well to treatment. Pressure injuries that go deeper into the skin (stages 3 or 4) increase your risk of infections and other issues. Proper medical care is critical. Talk to your healthcare provider about ways to lower your risk of developing bedsores.