Pressure Sores: What They Are, Causes, Stages, Symptoms & Treatment

Bedsores strike many of those who are largely confined to a bed or wheelchair, and they are tough to treat.

Every year, over 2.5 million Americans suffer from pressure sores, also known as bedsores or pressure ulcers. These cause pain, raise the risk of severe infections and typically result in more medical care.

Pressure sores develop when prolonged pressure on the skin reduces blood flow, leading to sores. In this article, experts explore pressure sores, their causes, stages, symptoms, treatment and ways to prevent them.

What are pressure sores?

The Mayo Clinic says pressure sores are skin and tissue injuries that occur when the skin experiences prolonged pressure. These sores commonly form on bony areas of the body like the hips, ankles, heels and tailbone.

People most vulnerable to bedsores often have medical conditions that can limit their mobility or require them to spend extended periods in a bed or chair. These conditions can hinder their ability to change positions regularly, increasing the risk of pressure sores.

What causes pressure sores?

Pressure sores result from reduced or interrupted blood flow to the skin. This condition can lead to the formation of pressure wounds in as little as two hours, as the skin's outer layer, the epidermis, begins to die and break down, causing a pressure ulcer.

The Cleveland Clinic indicates that pressure sores are more likely to occur when combined with:

1. Moisture: Sweat, urine or stool can exacerbate the risk
2. Traction: Stretching or pulling of the skin, often due to sliding down in a bed or wheelchair

Pressure sores from hospitalization

According to Johns Hopkins Medicine, pressure sores can become a significant concern for frail, older adults, often linked to their quality of care. When immobile or bedridden individuals aren't repositioned correctly, provided with proper nutrition and given adequate skin care, sores can develop.

People with diabetes, circulatory issues and poor nutrition are also at a higher risk for these conditions. Hospitalization can sometimes exacerbate the risk, as patients may have limited mobility and need assistance with repositioning and skin care to prevent pressure sores.

Pressure sore stages

Health care providers utilize a staging system to determine the extent of the injury. These stages help categorize the severity of pressure sores:

• Stage 1: At this stage, the skin appears reddish or pinkish without an open wound. For individuals with darker skin, identifying color changes can be challenging. Health care professionals often refer to this as a pressure wound or injury. Dr. Kari Keys, a professor of plastic surgery, says in a video for UW Medicine that, “If you have non-blanching redness and you poke at it, and it doesn’t turn white, that’s a stage one pressure sore.”
• Stage 2: A shallow wound emerges with a pink or red base. Visible skin loss, abrasions and blisters characterize this stage. “If the skin breaks open, that’s stage 2,” Keys said.
• Stage 3: A more pronounced wound extends into the hypodermis (the skin's fatty layer). “Once we get that full thickness into the fat later, that’s stage 3,” Keys shared.
• Stage 4: In this advanced stage, the wound has penetrated all three layers of the skin, exposing tendons, muscles, and even bones within the musculoskeletal system.

Pressure sore symptoms

Common pressure sore signs and symptoms include:

• Unusual changes in skin color or texture: Keep an eye out for any abnormal alterations in the color or texture of the skin
• Swelling: Swelling in or around the affected area may indicate a pressure sore
• Pus-like draining: The presence of pus-like discharge from the wound is a concerning symptom
• Variation in skin temperature: A specific region of the skin feeling either warmer or cooler to the touch than the surrounding areas is a red flag
• Tender areas: Tenderness in the skin or surrounding tissues can indicate a developing pressure sore early

Pressure sore treatment

The treatment for pressure sores depends on their type and severity, with a key goal being to prevent further pressure on the affected area. A report from InformedHealth.org shares that solutions include specialized mattresses, repositioning and movement to ease pressure.

Various wound dressings are employed, and wounds are cleaned with tap water or saline solution during dressing changes. For stage 3 and 4 sores, the dead tissue may be removed, often using tweezers or a scalpel.

Many pressure sores heal without surgery, but it may take time. Pain during cleaning and dressing changes can be managed with local anesthetics or ibuprofen-containing dressings. Oral medications like acetaminophen or ibuprofen are options for pain relief, with stronger painkillers prescribed if needed.

Pressure sore self-care tips

A video from the Cleveland Clinic shares the following self-care tips if you are suffering from pressure sores:

• Clean your skin right away if you get urine or stool on it
• Use creams or oils to keep skin moistened (do not rub or massage any parts of the skin that are red or purple in color)
• Use moisture-absorbent pads underneath you and have a family member or care provider change them if they get wet
• Order a special bed or mattress that can help relieve pressure
• Have someone turn or reposition your body frequently
• Eat a healthy diet consisting of poultry, eggs, fish, nuts, seeds, shellfish, beans and peas
• Drink plenty of water

How to prevent pressure sores

To prevent pressure sores, the Mayo Clinic recommends several strategies. Regularly repositioning yourself to reduce skin stress is crucial. Additionally, take good care of your skin, ensure proper nutrition and hydration, quit smoking, manage stress and exercise daily.

These steps can significantly reduce the risk of developing pressure sores and promote overall skin health. That said, there are situations where pressure sores are unavoidable, such as for bed-bound or wheelchair-bound patients. In these cases, pressure sores on the buttocks from sitting are common.

Living with pressure sores

Managing pressure sores involves regular repositioning, maintaining hygiene and keeping the sores covered with bandages. Options like gauze, see-through films and hydrocolloid dressings aid healing and can stay on for days, suggests the American Academy of Family Physicians.

Dead tissue, resembling a scab, can hinder the healing process and cause infections. Removing dead tissue by rinsing the sore during bandage changes or using special dressings is crucial. Severe cases may require surgical removal of dead tissue.

Pain management may be needed during dressing changes, and a diet rich in calories, protein and vital nutrients is essential for healing. As pressure sores heal, they shrink, produce less fluid, and develop new, healthy tissue. This transformation can take two to four weeks.

Resources

Agency for Healthcare Research and Quality: Pressure Ulcers

Mayo Clinic: Bedsores (Pressure Ulcers)

Cleveland Clinic: Bedsores (Pressure Injuries)

Johns Hopkins Medicine: Bedsores

InformedHealth.org: Pressure Ulcers (Overview)

Cleveland Clinic: At-Home Care for Your Pressure Injuries

American Academy of Family Physicians (familydoctor.org): What are Pressure Sores?