Bedsores (Pressure Sores)

Bedsores, also called pressure sores or decubitus (de-KU-bi-tus) ulcers, are skin sores caused by prolonged pressure on the skin, usually in people who are paralyzed, bedridden, or too weak to move around much.

What Are Bedsores?

Bedsores develop when the skin is compressed between a protruding bone, like a hipbone or elbow, and an external surface, like a wheelchair or mattress, over a long period of time. This compression limits the flow of blood in blood vessels that bring nutrients and oxygen to the skin and remove wastes. Without oxygen or nourishment, the underlying tissue may deteriorate, and a hole may open in the skin. If left untreated, bacteria can infect the skin opening, and lead to septicemia ^* or infection of muscle or bone.

Because protein and fluids help keep skin healthy and supple, elderly people with a poor diet often are at risk for skin-damaging bedsores. Other people at risk include those who cannot move much or shift their positions, perhaps because they have had a paralyzing stroke, or a long illness, or are in a coma ^* . People in wheelchairs or with spinal cord injuries, particularly those who cannot sense pain well, also are vulnerable to skin sores because they may not feel the ulcer forming. Bedsores are not contagious ^* .

What Are the Symptoms of Bedsores?

A typical bedsore starts as a red area on the skin that may feel hard or warm to the touch. In people with darker skin, the sore may show as a shiny spot on the skin. If pressure is removed at this point, complications can be prevented. If the pressure is not removed, a blister, pimple, or scab may form over this area, which is a sign that the tissue beneath is dying. Eventually, a hole, or ulcer, will form in the skin. The dead tissue may appear small on the skin surface, but it may be larger in deeper tissues. The damage may extend all the way to the bones.

To diagnose bedsores, health care providers examine the skin for redness, blisters, openings, rashes, or warm spots, paying particular attention to bony areas. Any spots previously broken or healed over also are checked, as scar tissue can break open.

How Are Bedsores Treated and Prevented?

Bedsores can be prevented and treated in their early stages by relieving pressure on the body. This means changing a person's position in bed at least every two hours and in a wheelchair every 10 to 15 minutes. People at risk for bedsores should check themselves carefully at least twice daily or ask their caregivers to do so. Doctors recommend using long-handled mirrors to help with these exams.

Other helpful methods to prevent bedsores include:

• using soft pillows to cushion the legs, back, and arms from pressure
• using special mattresses or egg-crate foam mattresses to reduce pressure
• keeping bedclothes unwrinkled and free of crumbs
• keeping skin clean and dry, free of sweat, urine, and stool
• eating a balanced diet and drinking lots of fluids to help skin stay healthy.

If a bedsore does develop, treatment may include antibiotics to treat infections and special gels or dressings to promote healing. In more serious cases, doctors may need to remove the dead tissue and use surgery to close the open sore. If the bedsore reaches the bone, then the affected bone tissue may have to be removed as well.