Bedsores – Symptoms and Causes
Overview
Bedsores, also known as pressure ulcers, pressure injuries, or decubitus ulcers, are skin damages that occur when constant pressure is applied to skin areas for extended periods.
These injuries typically develop on skin covering bony parts of the body such as:
- Heels
- Ankles
- Hips
- Tailbone
People with limited mobility who spend most of their time in beds or chairs face the highest risk of developing these wounds.
Bedsores can form rapidly, sometimes within hours or days. While many heal with proper treatment, some may never completely recover.
Signs and Symptoms
Pressure ulcers show several warning signs. You might notice changes in skin color or texture. The affected area may swell.
Sometimes, a wound might drain pus-like fluid. The skin might feel either warmer or cooler than surrounding areas. Many people also experience pain or tenderness at the site.
Pressure sores develop in stages. They range from mild with just skin redness to severe wounds that reach deep into muscle and bone.
Pressure Ulcer Common Locations
Wheelchair users typically develop pressure sores in specific areas:
- Buttocks or Tailbone
- Spine and Shoulder Blades
- Arms and Legs (where they touch the chair)
For bedridden individuals, common pressure sore sites include:
- Head (back and sides)
- Shoulder Blades
- Hips, Tailbone, and Lower Back
- Heels, Ankles, and Behind the Knees
When Medical Help Is Needed
If you spot early signs of a pressure sore, change positions to reduce pressure on that area. If you don’t see improvement within 24-48 hours, contact your healthcare provider.
Seek immediate medical attention if you notice:
- Fever
- Drainage from the wound
- Bad smell from the sore
- Warmth around the affected area
- Swelling of the sore or surrounding skin
These signs may indicate an infection that requires prompt treatment.
Causes
Bedsores develop due to limited blood flow to the skin caused by constant pressure. When people can’t move easily, their skin becomes more likely to suffer damage.
Three main factors contribute to bedsores:
Pressure
When any body part experiences continuous pressure, blood cannot flow properly to tissues. Without enough oxygen and nutrients from blood, skin and tissue become damaged and may eventually die.
People who can’t move much typically develop pressure sores in areas with less fat or muscle padding over bones, such as:
- Spine
- Tailbone
- Shoulder blades
- Hips
- Heels
- Elbows
Friction
This happens when skin rubs against clothing or bedding materials. The rubbing motion can damage delicate skin, especially if the skin is already moist.
Shear
Shear forces occur when surfaces move in opposite directions. For example, when someone slides down in a bed that has its head raised, the skin over the tailbone might stay in place while the bone moves downward.
This pulling in different directions damages tissue.
These three factors often work together, making skin more vulnerable to breaking down, particularly in people with limited mobility or those confined to beds or wheelchairs for long periods.
Risk Factors
Several factors can increase your chances of developing bedsores. These include:
Limited Mobility: People who cannot move easily or change positions while in bed or seated face a higher risk.
Incontinence Issues: Extended contact with urine or stool weakens skin and makes it more prone to damage.
Reduced Sensation: Individuals with neurological conditions or spinal injuries may not feel discomfort, preventing them from noticing early warning signs.
Poor Diet and Hydration: Inadequate intake of fluids, protein, calories, vitamins, and minerals can weaken skin integrity.
Circulatory Problems: Conditions that affect blood flow, such as diabetes or vascular disease, increase the risk of tissue damage.
Advanced Age: People over 70 have a higher likelihood of developing bedsores due to thinner skin and slower healing.
The risk increases significantly when multiple factors are present. For example, an elderly person with diabetes who has limited mobility faces greater danger than someone with just one risk factor.
Complications
Pressure ulcers can lead to several serious complications if not properly treated:
Cellulitis is a soft tissue and skin infection that causes redness, warmth, and swelling in the affected area. People with nerve damage may not feel pain in the infected area, making early detection difficult.
Bone and joint infections can develop when infection from pressure ulcers penetrates deeper tissues. These include:
- Septic arthritis (joint infection) that damages cartilage and tissues
- Osteomyelitis (bone infection) that reduces limb and joint function
Cancer development can occur in chronic, non-healing wounds. These are known as Marjolin ulcers, which can develop into squamous cell carcinoma.
Sepsis is a rare but dangerous complication that occurs when infection enters the bloodstream. This systemic infection response can be life-threatening.
Preventing Pressure Sores
Position Change Strategies
Changing position often is key to prevent pressure sores. Try to shift your body every two hours, and ask for help if needed.
For those with enough arm strength, performing wheelchair pushups can help – simply push up on the armrests to lift your body briefly.
Consider specialized equipment for better support:
- Adjustable wheelchairs that tilt to redistribute pressure.
- Pressure-relieving cushions and mattresses that better support your body.
- Properly position beds (keep head elevation below 30 degrees when possible).
Avoid using donut-shaped cushions as they can actually increase pressure on surrounding skin areas.
Skin Protection Techniques
Proper skin care plays a vital role in preventing pressure sores:
| Skin Care Action | How to Do It |
|---|---|
| Clean Regularly | Use gentle cleansers. Pat (don’t rub) skin dry. |
| Reduce Moisture Exposure | Change wet clothing or bedding promptly. |
| Apply Protective Products | Use barrier creams where skin contacts urine or stool. |
| Check Daily | Inspect skin for redness, warmth, or breaks. |
Watch for irritants like clothing buttons or wrinkled sheets that can damage skin. Daily skin checks help catch potential problems early before they become serious sores.
Other important prevention steps include staying well-nourished, drinking enough water, stopping smoking, managing stress levels, and maintaining physical activity when possible.
