Illness & Conditions - Health Conditions
What are pressure sores?
A pressure sore (bed sore) is an injury to the skin and/or the tissues under the skin. Constant pressure on an area of skin reduces blood supply to the area. Over time, it can cause the skin to break down and form an open sore ( ulcer ). Pressure sores are more likely to form if you or a person you are caring for is in the hospital or is confined to a chair or bed.
Pressure sores most often form on the skin over bony areas where there is little cushion between the bone and the skin. Most pressure sores form on the lower part of the body, including over the tailbone and on the back along the spine, on the buttocks, on the hips, and on the heels. Other common spots are the back of the head; the backs of the ears; the shoulders, elbows, and ankles; and between the knees where the legs rub together.
Pressure sores can range from red areas on the surface of the skin to severe tissue damage that goes deep into muscle and bone. These sores are hard to treat and slow to heal. Other problems, such as bone , blood, and skin infections, can develop when pressure sores do not heal properly.
What causes pressure sores?
Things that cause pressure sores include:
As we get older, our skin gets more thin and dry and less elastic, so it is easier to damage. Poor nutrition—common among older people and people who cannot move easily—makes these natural changes in the skin worse. Skin in this condition may easily develop a pressure sore.
How are they treated?
Treatment focuses on preventing a sore from getting worse and on making the skin healthy again. Treatment includes:
If infection develops, the person will need antibiotics . Severe pressure sores may need surgery.
How can you prevent pressure sores?
These steps can help keep skin healthy:
What increases the risk of getting pressure sores?
People at greatest risk for getting pressure sores are those who:
Frequently Asked Questions
Pressure sores usually develop on the skin over a bony area where there is less cushion between the skin and bones. Most pressure sores develop on the lower part of the body, on the skin over the sacrum and tailbone (the lowest part of the back), the hips, buttocks, or heels. Pressure sores also occur on the back of the head, the backs of ears, around the shoulders and elbows, between the knees, and over the ankles.
In stages 3 and 4 there may be little or no pain due to significant tissue damage. Serious complications, such as infection of the bone ( osteomyelitis ) or blood (sepsis), can occur if pressure sores progress.
Sometimes a pressure sore does not fit into one of these stages.
Exams and Tests
Pressure sores are usually diagnosed with a physical examination.
Tests to confirm a diagnosis may include a:
Treatment focuses on preventing pressure sores from getting worse and on restoring healthy skin.
Steps to treat pressure sores include:
Most stage 1 and stage 2 pressure sores will heal within several weeks with proper treatment. Stage 3 and 4 pressure sores can take months or even years to heal. Even though progress is slow, continued care and treatment can prevent complications such as further tissue damage, infection, and pain.
Pressure sores occur most frequently in people who are confined to beds or chairs. In many cases, a person with a pressure sore also has one or more medical conditions that may affect treatment and healing. These conditions include diabetes , kidney disease, and heart disease.
Manage tissue load
Relieving and spreading out pressure is the most important part of preventing and treating pressure sores. When pressure is in one spot for long periods of time, the blood flow to that area is decreased. This damages or kills the cells, and creates a sore. Pressure can be relieved and spread in several ways. Often a combination of these is best. To relieve and spread pressure:
Protect and treat the sore area
The basics of wound care are cleaning, covering, and keeping slightly moist to provide the best chance for wound healing.
Protect healthy skin
In addition to avoiding pressure, take steps to protect healthy skin.
Eat a healthy diet
Good nutrition is important to both preventing and treating pressure sores. Focus on getting enough liquids, calories, protein, and vitamins, and on controlling your weight. Both increases and decreases in body weight can help cause pressure sores. 3 Talk to your doctor or a registered dietitian about a healthy diet for you.
Treat infection as needed
Open sores, such as pressure sores, are easy places for infections to start. Your doctor will be watching for signs of infection, and you can help watch for these signs. Tell your doctor if you notice:
To treat an infection, you may use medicine such as antibiotics , along with special care of the wound. You and the people around you will also be taught to take steps to keep germs from spreading to other parts of your body or to other people. These steps include keeping the sore covered at all times except during treatment, good hand-washing before and after caring for the pressure sore, and properly wrapping and throwing away used bandages.
Treat pain as needed
Pain may or may not be a problem with pressure sores. If you do have pain, talk to your doctor. Some people with pressure sores do not need any pain medicine, some need pain medicine just when the sore is being treated, and some need pain control medicine on a regular schedule.
Most pressure sores develop when you or a person you are caring for is hospitalized or confined to a chair or bed. You can take steps to prevent pressure sores. After a pressure sore has developed, you can help prevent the sore from getting worse. To prevent or help heal pressure sores:
Other Places To Get Help
Last Revised: February 15, 2011
National Pressure Ulcer Advisory Panel (2007). Pressure ulcer stages. Available online: http://www.npuap.org/pr2.htm.
Thomas DR (2003). Management of chronic wounds. In CK Cassel et al., eds. Geriatric Medicine, 4th ed., pp. 967–977. New York: Springer-Verlag.
Ho CH, Bogie K (2010). Pressure ulcers. In WR Frontera et al., eds., DeLisa's Physical Medicine and Rehabilitation: Principles and Practice, 5th ed., vol. 2, pp. 1393–1409. Philadelphia: Lippincott Williams and Wilkins.
Reddy M (2011). Pressure ulcers, search date June 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
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