Pressure ulcer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 17, 2016
StartDiseasesPressure ulcer

Pressure ulcers, which are commonly known as bed sores, form as a result of skin taking on prolonged periods of pressure. As skin tissue is exposed to too much pressure for too long of a time from a bed or other surface, it starts to lose blood flow, resulting in red, irritating sores.


Definition & Facts

Typically those in danger of developing bedsores are people who are bed-ridden and unable to move around and change positions on the bed. After being confined to the bed for a long period of time, sores start to form on the bonier parts of their bodies, such as the ankles, hips, and tailbone.

While these sores often form as a result of patient neglect, it's still very possible for them to form even when a patient is in the hands of excellent and attentive caretakers. Patients and doctors fear bed sores because they are not always easy to treat.

Symptoms & Complaints

There are four different stages of pressure ulcers with each indicating a different level of severity and having different characteristics.

  • Stage 1 is the least severe form of pressure ulcer, and it contains unbroken skin; redness that doesn't lighten when touched; and pain, coolness, and warmth that is more intense than surrounding skin.
  • Stage 2 includes minor skin loss and a wound that could appear pus-filled, shallow, pink, or red
  • Stage 3 marks a deep, crater-like ulcer wound that typically exposes some fat through the skin. Yellowing dead skin might be present at the edges of the wound and the damage of the ulcer might be present even under healthy layers of skin.
  • Stage 4 represents a very deep ulcer wound that exposes muscle, bone, and tendon. There is typically yellowed or dark and crusty dead skin around the edges of the wound, and it is possible that the impact of the wound exists under healthy skin as well as where the wound is present.

If a pressure ulcer is very severe, it will have yellow, brown, or black dead skin grown over it which will prevent physicians from seeing how deep it is. The area will typically be mushy and either warm or cold. Pressure sores will typically form on parts of the body that are bony such as the tailbone, shoulder blades, spine, back of the head, hips, heels, and ankles.


The primary cause of bed sores is prolonged pressure against a specific section of skin that keeps blood from flowing to that section and its nearby tissues. Being confined to a wheelchair or bed is typically the culprit for this prolonged pressure. When the external pressure against a certain part of skin exceeds the pressure of the blood flow toward that part of skin, that skin does not receive the oxygen and nutrients necessary to replenish skin cells and tissues.

If a person already has fragile skin, that person's skin is susceptible to friction. When changing positions in bed, friction can cause fragile skin to develop ulcers. Another cause of ulcers is when a person's skin is being pulled in the opposite direction of their bone. Slumping down in a hospital bed can cause this to happen, effectively stretching what is already weak skin and making it vulnerable to ulcers.

Diagnosis & Tests

Doctors will diagnose a bedsore with the use of a few criteria; the size and depth of the sore, foul odors coming from the sore, spreading tissue damage around the sore, and fluid present around the sore. Questions will be posed to the patient about his or her daily diet, health history, and current medical diagnoses. In some cases, tests might be done to determine the existence and severity of sores. These tests include blood tests and tissue cultures which are performed on non-healing wounds that might be susceptible to fungal infection or cancer.

Treatment & Therapy

Stage 1 and 2 pressure ulcers will usually heal within a few weeks with proper maintenance and care. Stage 3 and 4 pressure ulcers are a different matter and usually take considerable effort to heal, if they can be healed at all. Typically, stage 3 and 4 ulcers will be dealt with through a team approach. Physicians will be responsible for putting together a recovery plan that extensively plans the steps needed for a full recovery. Nurses help to maintain the plan by assisting and caring for the patient on a daily basis.

A dietitian is usually present to arrange an appropriate diet for the patient that will afford him or her the proper nutrition necessary to heal ulcers. Surgeons of different kinds may be necessary if the wound requires extensive surgery. And a physical therapist could be used if the patient needs help becoming mobile again after the healing of the ulcer. The initial healing measures to be taken for ulcers of all intensities are to re-position the patient's body, clean and dress wounds, and remove damaged tissue and skin. For some people dealing with bed sores, emotional support in the form of psychological therapy might be necessary as well.

Prevention & Prophylaxis

Bed sores are most typically seen among those in wheelchairs and bed-confined patients. The constant pressure against skin caused by being in the same position for long periods of time is what leads to the sores. To fight against the forming of bed sores, patients need to make sure that they're switching positions frequently.

Wheelchair-confined patients can reduce constant pressure by shifting their weight in the chair, or putting a cushion on the chair that reduces pressure points. Bed-ridden patients can reduce constant pressure by shifting their weight and using a cushioned mattress. Other measures to be taken in order to prevent bed sores include staying hydrated; keeping proper nutrition; cleaning, drying, and moisturizing the skin; and staying active to maintain healthy blood flow.