Pressure ulcers (also known as pressure sores or bedsores) are injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin.
They can happen to anyone, but usually affect people confined to bed or who sit in a chair or wheelchair for long periods of time.
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Symptoms of pressure ulcers
Pressure ulcers can affect any part of the body that's put under pressure. They're most common on bony parts of the body, such as the heels, elbows, hips and base of the spine.
They often develop gradually, but can sometimes form in a few hours.
Early symptoms of a pressure ulcer include:
- part of the skin becoming discoloured - people with pale skin tend to get red patches, while people with dark skin tend to get purple or blue patches
- discoloured patches not turning white when pressed
- a patch of skin that feels warm, spongy or hard
- pain or itchiness in the affected area
A doctor or nurse may call a pressure ulcer at this stage a category one pressure ulcer.
The skin may not be broken at first, but if the pressure ulcer gets worse, it can form:
- an open wound or blister - a category two pressure ulcer
- a deep wound that reaches the deeper layers of the skin - a category three pressure ulcer
- a very deep wound that may reach the muscle and bone - a category four pressure ulcer
When to get medical advice
If you're in hospital or a care home, tell your healthcare team as soon as possible if you develop symptoms of a pressure ulcer. It'll probably continue to get worse if nothing is done about it.
You should be regularly monitored and offered advice and treatment to reduce the risk of pressure ulcers, but sometimes they can develop even with the highest standards of care.
If you're recovering from illness or surgery at home, or are caring for someone confined to bed or a wheelchair, contact your GP surgery if you think you or the person you're caring for might have a pressure ulcer.
Get medical advice immediately if there is:
- red, swollen skin
- pus coming from the pressure ulcer or wound
- cold skin and a fast heartbeat
- severe or worsening pain
- a high temperature (fever) of 38C (100.4F) or above
These symptoms could be a sign of a serious infection that needs to be treated as soon as possible.
Treatments for pressure ulcers
Treatments for pressure ulcers depend on how severe they are.
For some people, they're an inconvenience that requires minor nursing care. For others, they can be serious and lead to life-threatening complications, such as blood poisoning.
Ways to stop pressure ulcers getting worse and help them heal include:
- applying special dressings that speed up the healing process and may help to relieve pressure
- moving and regularly changing your position
- using specially designed static foam mattresses or cushions, or dynamic mattresses and cushions that have a pump to provide a constant flow of air
- eating a healthy, balanced diet
- a procedure to clean the wound and remove damaged tissue (debridement)
Surgery to remove damaged tissue and close the wound is sometimes used in the most serious cases.
Read more about the treatments for pressure ulcers.
Who's most at risk of getting pressure ulcers
Anyone can get a pressure ulcer, but the following things can make them more likely to form:
- being over 70 - older people are more likely to have mobility problems and have skin that's more easily damaged through dehydration and other factors
- being confined to bed with illness or after surgery
- inability to move some or all of the body (paralysis)
- urinary incontinence and bowel incontinence
- a poor diet
- medical conditions that affect blood supply, make skin more fragile or cause movement problems - such as diabetes, peripheral arterial disease, kidney failure, heart failure, multiple sclerosis (MS) and Parkinson's disease
Preventing pressure ulcers
It can be difficult to completely prevent pressure ulcers, but there are some things you or your care team can do to reduce the risk.
- regularly changing your position - if you're unable to change position yourself, a relative or carer will need to help you
- checking your skin every day for early signs and symptoms of pressure ulcers - this will be done by your care team if you're in a hospital or care home
- having a healthy, balanced diet that contains enough protein and a good variety of vitamins and minerals, particularly vitamin C and zinc - if you're concerned about your diet or caring for someone whose diet may be poor, ask your GP or healthcare team for a referral to a dietitian
- stopping smoking - smoking makes you more likely to get pressure ulcers because of the damage caused to blood circulation
If you're in a hospital or care home, your healthcare team should be aware of the risk of developing pressure ulcers. They should carry out a risk assessment, monitor your skin and use preventative measures, such as regular repositioning.
If you're recovering from illness or surgery at home, or are caring for someone confined to bed or a wheelchair, ask your GP for an assessment of the risk of developing pressure ulcers.
Treatment options for pressure ulcers (sores) typically include regularly changing your position, using special mattresses to reduce or relieve pressure, and dressings to help heal the ulcer. In some cases, surgery may be needed.
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Moving and regularly changing your position helps to relieve the pressure on ulcers that have already developed. It also helps prevent pressure ulcers developing.
After your care team has carried out an assessment of your risk of developing pressure ulcers, they will draw up a repositioning timetable. This states how often you need to move, or be moved if you're unable to do so yourself.
For some people, this may be as often as once every 15 minutes. Others may need to be moved only once every two to four hours.
You may also be given training and advice about:
- correct sitting and lying positions
- how you can adjust your sitting and lying positions
- how best to support your feet to relieve pressure on your heels
- any special equipment you need and how to use it
Mattresses and cushions
If you're at risk of getting pressure ulcers or have a minor ulcer, your care team will recommend a specially designed static foam or dynamic mattress.
If you have a more serious ulcer, you will require a more sophisticated mattress or bed system, such as a mattress connected to a pump that delivers a constant flow of air into the mattress itself.
There are also a range of foam or pressure-redistributing cushions available. Ask your carer about the types most suitable for you.
But according to the National Institute for Health and Care Excellence (NICE), there's limited evidence on what kinds of pressure-redistributing devices are best for the relief and prevention of pressure ulcers in different places, such as heels or hips.
Specially designed dressings can be used to protect pressure ulcers and speed up the healing process.
These dressings include:
- alginate dressings - these are made from seaweed and contain sodium and calcium, which are known to speed up the healing process
- hydrocolloid dressings - contain a special gel that encourages the growth of new skin cells in the ulcer, while keeping the surrounding healthy skin dry
- other dressing types - such as foams, films, hydrofibres/gelling fibres, gels and antimicrobial (antibiotic) dressings may also be used
Ask your carer about which type of dressing they're using for the management of your pressure ulcer.
Gauze dressings aren't recommended for either the prevention or treatment of pressure ulcers.
Creams and ointments
Topical antiseptic or antimicrobial (antibiotic) creams and ointments aren't usually recommended for treating pressure ulcers.
But barrier creams may be needed to protect skin that's been damaged or irritated by incontinence.
Antibiotics may be prescribed to treat an infected ulcer or if you have a serious infection, such as:
- blood poisoning (sepsis)
- bacterial infection of tissues under the skin (cellulitis)
- infection of the bone (osteomyelitis)
Diet and nutrition
Eating a healthy, balanced diet that contains enough protein and a good variety of vitamins and minerals can speed up the healing process.
If your diet is poor, you may see a dietitian. They can draw up a suitable dietary plan for you.
It's also important to keep up fluid intake to avoid dehydration, as being dehydrated can slow down the healing process.
Removing damaged tissue (debridement)
In some cases, it may be necessary to remove dead tissue from the pressure ulcer to help it heal. This is known as debridement.
If there's a small amount of dead tissue, it may be removed using specially designed dressings.
Larger amounts of dead tissue may be removed using:
- high-pressure water jets
- surgical instruments, such as scalpels and forceps
A local anaesthetic should be used to numb the area around the ulcer so debridement (if not being treated with a dressing) doesn't cause you any pain.
Severe pressure ulcers might not heal on their own. In such cases, surgery may be required to seal the wound, speed up healing, and minimise the risk of infection.
Surgical treatment involves:
- cleaning the wound and closing it by bringing the edges of the ulcer together
- cleaning the wound and using tissue from healthy skin nearby to close the ulcer
Pressure ulcer surgery can be challenging, especially because most people who have the procedure are already in a poor state of health.
Risks after surgery include:
- implanted skin tissue dying
- blood poisoning
- infection of the bone (osteomyelitis)
- deep vein thrombosis
Ask your surgeon about the benefits and risks of surgery if it's recommended for you.