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Pressure sores: Treatment, symptoms, advice and help

About pressure sores

Pressure sores or bed sores are ulcers on the body parts exposed to prolonged pressure and occur in immobilized and bedridden patients. Bed sores cause considerable morbidity and often require very prolonged care. They can be prevented with good nursing care and simple precautions in bedridden patients.

Pressure sores: Incidence, age and sex

Bedsores occur commonly and the incidence is relatively high in developed countries. They generally occur in elderly patients who are bedridden and hospitalized for a longer periods of time.

Signs and symptoms of pressure sores: Diagnosis

Bedsores are easily diagnosed on physical examination and start as areas of redness on pressure points. This is followed by formation of a blister. Subsequently the skin gets broken and an ulcer is formed. Ulcers can advance into the deeper layers of skin and can even involve ligaments and bones. The secondary infection can cause fever and other signs of sepsis.

Causes and prevention of pressure sores

Bedsores occur at the sites of pressure over bony prominences. The common sites are lower back (sacrum), hips, elbows, shoulders, knees and ankles. The pressure of bone against the surface causes tissue injury and can damage the local blood vessels. Local moisture because of incontinence or sweating, and raised skin temperature also accelerate the ulcer formation. The risk factors associated with the formation of bedsores include immobility, long-term hospitalization, malnutrition, low blood pressure, diabetes, smoking and advanced age.

Most bedsores can be prevented with good nursing care. Preventive measures include changing the position of patient frequently, use of air and water mattresses, pressure distributive mattresses, ensuring proper nutrition, treatment of fever and infection and avoiding soiling of body with secretions.

Pressure sores: Complications

Pressure sores can cause significant morbidity and may lead to sepsis, multi-organ dysfunction, reduced protein levels in the blood, anaemia and gangrene. The infection can spread to the bone and can cause what is called osteomyelitis. These complications are responsible for prolonged hospital stay and can be fatal.

Pressure sores: Treatment

The most important first step in treatment of pressure sores is relief of pressure from the affected area which may be achieved by repositioning the patient or using pressure distributive mattresses. The dead tissue needs to be removed by surgery or other means in order to accelerate healing. Treatment of infection by using antiseptic dressings is also important. In addition, treatment of associated conditions like diabetes and sepsis, and ensuring proper nutrition, either orally or by intravenous supplementation helps in timely healing of ulcers. The patient and the caregivers need proper education for control of ulcers and prevention of recurrence.

The pressure sores (syn. bed sores, decubitus ulcer) information advice that you find here is written for the benefit of non-medical laypersons by a pressure sores specialist who is part of a team of 100 practising UK consultants and GPs. The content is in keeping with UK guidelines and based on current best practice for the management and treatment of pressure sores (syn. bed sores, decubitus uncer).

Pressure Sores - (syn. Bed sores, Decubitus ulcer): Definition

Pressure sores are wounds that occur from tissue breakdown as a result of unrelieved pressure over a particular body site. Pressure sores typically occur over underlying bony prominences when an individual lies or sits for long periods of time. The important factor in the development of these sores is unrelieved pressure. Pressure sores typically occur over the base of the spine, the hip, the heel, the back of the head and back. Pressure sores may also occur over the bony promiences of the buttocks (ischial tuberosities).

Pressure Sores - (syn. Bed sores, Decubitus ulcer): The severity of a pressure sore is graded into four stages:

Stage 1: With these pressure sores, the skin is intact but remains red for more than one hour after release of pressure.

Stage 2: These sores have blistering or ulceration of the skin with or without infection.

Stage 3: These pressure sores have destruction of the skin and underlying fat with tissue loss into the muscle. Infection may be present.

Stage 4: These pressure sores are the most serious and such sores involve the underlying bone or joint; infection may be present.

Pressure Sores - (syn. Bed sores, Decubitus ulcer): Incidence/Age

The incidence of pressure sores is highly variable depending upon the population evaluated. Typical studies suggest that approximately 10% of the general hospital population will have a pressure at any one time. Pressure sores may affect individuals of any age but they are more common in older patients.

The major factor underlying the development of pressure sores is unrelieved pressure. In addition shearing forces loss of feeling, incontinence, exposure to moisture, loss of mobility and friction may all contribute to the development of pressure sores. Individually any one of these factors does not produce a pressure sore but does so in combination with unrelieved pressure.

These patient groups are commonly at risk of developing pressure sores: 1, patients with neurological illnesses; 2, the elderly and 3, the hospitalised. Pressure sores are associated with medical problems such as heart disease, neurological disease and bone and joint injuries. Increasing age is an associated factor for pressure sores and in one study over 60% of patients with pressure sores were more than 70 years of age. Other factors associated with the developments of pressure sores are strokes, being bed or chair bound and impaired nutritional intake. In addition, patients who are chronically ill and debilitated frequently have nutritional deficiencies.

The early sign of a pressure sore is redness of the skin that persists following the release of pressure. Should the pressure continue, say beyond 2-6 hours, blistering and ulceration of the skin may appear. Should the pressure continue further death of the underlying fat will occur, typically after about 6 hours of relieved pressure. At this stage the skin may appear blue and firm to touch. Full thickness tissue loss with extensive destruction, exposing bone and joints is the next stage and this will develop should pressure relief not be instituted.

Forces such as shear and friction rather than direct pressure may produce the early signs of pressure sore formation. Prolonged, unrelieved direct pressure typically results in tissue loss with ulcer formation. These ulcers often demonstrate an iceberg phenomenon. That means the skin wound is only the "tip of the iceberg" and there may be a large associated underlying wound. The size of the underlying wound is often not appreciated by the patient or their carers. Pressure sores may smell offensive and may develop serious wound infections.

Pressure Sores - (syn. Bed sores, Decubitus ulcer): Complications of disorder

Chronic wounds such as pressure sores may get infected.

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