A bedsore is an ulcer that develops when skin and the underlying tissue experience prolonged pressure and shear force. Patients who spend a long time in the same position often develop bedsores. They are most commonly seen in bed-bound people, but also in people who spend long periods sitting, including wheelchair users.
A bedsore is the most common name for this injury, but it may also be referred to as a pressure ulcer, pressure sore, or decubitus sore.
In this article, we will explore what bedsores are, the conditions that cause them, and how to recognize when a patient has or is at risk of bedsores. In a follow-up article called How to Prevent Bedsores, we’ll show you how to avoid them and look after a patient who has pressure ulcers.
What Causes Bedsores?
Bedsores have two primary causes:
- Pressure: When a patient lies or sits in the same position for too long, some parts of the body experience constant pressure. The pressure disrupts blood flow and causes skin and tissue to break down.
- Shear forces: Shear forces are rubbing or stretching forces that distort the skin’s tiny blood vessels, disrupting blood flow. Shear occurs whenever there are opposing forces between the skin and material that touches it. For example, when a sitting patient slides down in bed, their skin experiences shear forces from the sheets beneath them.
Blood carries oxygen and other material to the skin. Long-term disruption of the skin’s blood supply damages the affected area, which swells (edema), becomes inflamed, and eventually dies in a process called necrosis.
The body can manage pressure and shear forces when people change positions often. But, if they stay in the same position for a long time, the damage becomes increasingly severe. The worst bedsores are life-threatening, and it is estimated that almost 30,000 people die from bedsores each year around the world.
Pressure and shear forces are the primary causes of bedsores, but other factors play a role, including moisture on skin or sheets and diseases that reduce blood flow, such as arteriosclerosis.
Which Areas of the Body Are Most Often Affected by Bedsores?
Bedsores most commonly occur in the parts of the body that experience pressure when sitting or lying down. They often occur in bony areas such as the back of the head, the elbows, the coccyx (the base of the spine), and the hips, knees, and ankles. Pressure sores also often develop in the buttocks and the thighs.
What Are the Risks Associated With Bedsores?
Many people who suffer bedsores experience them as an inconvenience that must be managed appropriately with the help of a medical professional. With regular care and the right equipment, bedsores can be prevented or successfully treated.
However, bedsores are a serious and potentially life-threatening condition. In the initial stages, a bedsore causes some pain and discomfort, but what starts as a minor injury quickly progresses to the point at which it needs surgery or even amputation to prevent further damage.
How to Recognize Bedsores
The first indication of a bedsore is discolored skin that feels hard or spongy to the touch, often accompanied by itching or pain. This is called a Stage 1 bedsore. The skin may redden, darken, or become unusually shiny, depending on the patient’s skin color. Skin discoloration doesn’t always indicate a bedsore, but if the skin doesn’t return to normal 30 minutes after removing the pressure, then damage is likely.
If you suspect a Stage 1 bedsore, remove pressure from the affected area for several days to allow the skin to heal.
In Stage 2, the skin’s upper layer is broken, causing an ulcer, which is an open sore. The pressure ulcer develops over time. The depth of the injury increases, first damaging the lower layer of skin and the tissue beneath it (Stage 3), ultimately causing deep injury down to the bone (Stage 4). In the worst bedsores, the bone may be exposed.
As the damage progresses, the sore begins to weep fluids and pus. It may smell bad, and the tissue may turn black as it dies. It will probably become infected, and the infection can cause fever and more tissue damage.
Once a bedsore progresses beyond Stage 1, you must seek medical advice. The wound should be cleaned, treated, and dressed by a professional, and the patient may require antibiotics or other medication.
To learn how to prevent and heal bedsores, read How to Prevent Bedsores, or contact a hospital bed expert to find out how adjustable beds and pressure-relief mattresses can help to keep bedsores under control.
