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Pressure Sores – Treatment, Stages, and Symptoms

What Are Pressure Sores?

You may know pressure sores by their more common name: bedsores. Also sometimes called pressure ulcers, they occur when you lie or sit in one position for too long, and the weight of your body against the surface of the bed or chair cuts off blood supply to the skin. This often happens if you're on bed rest or in a wheelchair.


Image of a healthcare professional treating a pressure sore on a patient's leg.

Your doctor may refer to the "stage" of your pressure sores. The stages indicate how deep the sores are, which affects the treatment approach. If caught early, these sores can heal in a few days with minimal fuss or pain. However, without treatment, they can worsen significantly.


Pressure Sores Causes

Pressure sores develop when your skin is pressed against a surface (like a mattress or a cushion) for an extended period. This pressure restricts blood flow to that area of the skin, causing skin cells to die and making the area sensitive. Pressure sores can form in a few days or even just a few hours.


Several factors contribute to pressure sores:


  • Pressure: Even minimal weight on a certain body part, over time, can cause significant pressure. This pressure restricts blood flow, depriving the skin of oxygen and nutrients, weakening it and causing cells to die.


  • Rubbing: Rubbing, even from blankets or clothing, can damage sensitive skin, especially if the skin is moist from sweat.


  • Stretched skin: When two surfaces slide against each other, it can cause your skin to pull or stretch, such as sliding down a raised bed, which can aggravate the skin on your tailbone.



Common Areas of Pressure Ulcers

Pressure sores often form on bony parts of the body, such as the spine and tailbone, which lack substantial fat or muscle padding. The specific areas where they develop depend on your position.

 healthcare professional treating a pressure sore on a patient's breast.
If you spend most of your time in bed:
  • Head (where it rests against the pillow)

  • Shoulder blades

  • Hips

  • Tailbone and buttocks

  • Back of the knees

  • Ankles

  • Heels


If you stay in a wheelchair:

  • Shoulder blades

  • Spine

  • Arms or legs (where they touch the chair)


From devices pressing against your skin:

  • Nose, ears, or back of the head from an oxygen mask

  • Mouth from poorly fitting dentures


Pressure Sores Risk Factors

Some individuals are more susceptible to pressure sores due to various factors:


  • Immobility: Difficulty moving and spending prolonged periods in one position.

  • Incontinence: Inability to control bladder or bowels, leading to skin irritation from moisture.

  • Poor nutrition and hydration: Lack of essential nutrients and water weakens the skin.

  • Loss of physical feeling: Conditions like spinal cord injuries reduce sensation, making it harder to detect the need to change positions.

  • Blood flow problems: Conditions like diabetes and vascular disease impede blood circulation.

  • Thin or weakened skin: Casts or prosthetic devices can weaken the skin, making it more vulnerable.


Pressure Sores Stages and Symptoms

There are four stages of pressure sores, ranging from mild to severe:


Stage I: The mildest stage, affecting only the upper layer of skin.

  • Symptoms: Pain, burning, itching, and a red area on the skin that doesn't lighten when pressed. The affected area may feel firmer or softer, or warmer or cooler than surrounding skin.


Stage II: Sores that penetrate deeper into the skin.

  • Symptoms: Broken skin, open wounds, pus-filled blisters, swelling, redness, clear fluid or pus, and pain.


Stage III: Sores that extend through the second layer of skin into fat tissue.

  • Symptoms: Crater-like appearance, bad odor, signs of infection (red edges, pus, heat, drainage), and black tissue if it has died.


Stage IV: The most severe stage, affecting muscles, ligaments, and bones.

  • Symptoms: Deep, large sores with black skin, visible tendons, muscles, and bones, and signs of infection.


Other stages:

  • Unstageable: The bottom of the sore is covered by dead skin, preventing staging.

  • Suspected deep tissue injury: The surface appears as Stage I or II, but deeper tissue is at Stage III or IV.




Pressure Sores Diagnosis

To diagnose a pressure sore, your doctor will examine your skin and ask questions such as:


  • When did the sore appear?

  • Does it hurt?

  • How often do you change positions?

  • Have you ever had a pressure sore before?


Your doctor will consider your symptoms and determine the stage of the sore. They might take a picture to track healing progress. If an infection is suspected, tests like blood tests, biopsies, or imaging (X-ray, MRI) may be done.


Pressure Sores Complications

Untreated pressure sores can lead to serious complications, such as:

  • Skin infections: Bacteria entering open wounds, leading to infections like cellulitis or septicemia.

  • Sepsis: Severe infection causing the body to attack its tissues.

  • Amputation: Severe sepsis might require limb removal.

  • Bacteria in the bloodstream: Leading to serious conditions like bacterial meningitis or endocarditis.

  • Bone and joint infections: Infections entering nearby bones or joints.

  • Cancer: Rarely, chronic wounds can turn into skin cancer (squamous cell carcinoma).



Pressure Sores Treatment

Treatment varies based on the stage of the sore:


Stage I:

  • Relieve pressure by changing positions frequently.

  • Use foam pads, pillows, or mattresses.

  • Clean the sore with mild soap and water.

  • Maintain a diet high in protein, vitamins A and C, iron, and zinc, and drink plenty of water.


Stage II:

  • Clean the wound with saline solution and dry it gently.

  • Cover the sore with an appropriate bandage.

  • Consult your doctor if there are signs of infection.


Stage III:

  • Requires more intensive care from a doctor.

  • Dead tissue may need to be removed (debridement).

  • Antibiotics may be prescribed to fight infection.


Stage IV:

  • Immediate medical attention is necessary.

  • Surgery may be required.


Medications:

  • Pain relief with nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen).

  • Prescription pain relievers in cream or ointment form.

  • Antibiotics for infected sores.


Surgical treatments:

  • Skin grafts to cover large, non-healing sores.


Pressure Sores Prevention

Preventing pressure sores involves proactive measures:

  • Reposition frequently:** Move every 15 minutes in a wheelchair and every 2 hours in bed.

  • Use specialized cushions and mattresses:** Avoid doughnut cushions.

  • Keep skin clean and dry:** Use moisture barrier ointments if needed.

  • Inspect skin daily:** Check for early signs of bedsores.

  • Eat a healthy diet and stay hydrated:** Support skin health.

  • Quit smoking and manage stress:** Promote overall well-being.


Pressure Sores Prognosis


The healing time for bedsores depends on their severity. Mild sores may heal in weeks, while severe sores may take months and might require surgery. Untreated sores can cause long-term problems, but with proper care, they generally improve. Early detection and treatment are crucial for a better prognosis, and ongoing care and prevention strategies are vital to avoid recurrence.


Pressure Sores FAQs

How do you get rid of pressure sores?

  • Treatment depends on severity, but generally involves relieving pressure, keeping the area clean, and using prescribed medications or treatments. Severe sores may require antibiotics or surgery.


What does a Stage I pressure sore look like?

  • A Stage I pressure sore appears as a red area that does not blanch (turn white) when pressed. The skin may feel firmer or softer, or cooler or warmer than surrounding skin.


What does a Stage II pressure sore look like?

  • A Stage II pressure sore may present as broken skin, an open wound, or a pus-filled blister. The surrounding area may be swollen and red.


What causes pressure sores?

  • Pressure sores are caused by prolonged pressure on the skin, which restricts blood flow. This can be exacerbated by rubbing, moisture, and stretched skin from sliding.


Common sites of pressure ulcers:

  • Tailbone, buttocks, shoulder blades, spine, arms, legs, head, hips, lower back, heels, and ankles.



When to See a Doctor

If you notice signs of a bedsore, such as redness, pain, or a change in skin texture, it’s essential to change your position to alleviate pressure. If the area does not improve within 24 to 48 hours, or if there are signs of infection such as fever, drainage, or an unpleasant smell, seek


Pressure sores, also referred to as bedsores or pressure ulcers, are a major concern for individuals who are confined to bed or use wheelchairs for extended periods. These sores can vary from mild to severe, impacting not only the skin but also deeper tissues, including muscles and bones. Understanding the causes, risk factors, and stages of pressure sores is essential for effective prevention and treatment.


The key to managing pressure sores is early detection and proactive care. Regularly changing positions, using specialized cushions and mattresses, maintaining good hygiene, and ensuring proper nutrition and hydration are crucial steps in preventing the development of pressure sores. When pressure sores do occur, timely and appropriate treatment is critical to prevent complications such as infections, sepsis, and even the need for amputation.


At AmoryCare Home Care of New Jersey, we are dedicated to providing comprehensive care and support to individuals at risk of pressure sores. Our team of skilled healthcare professionals is committed to helping you or your loved ones maintain skin integrity and overall health through personalized care plans and preventive measures. By staying vigilant and proactive, you can significantly reduce the risk of pressure sores and ensure a better quality of life for those in your care.


In conclusion, pressure sores are a serious but preventable condition. With the right knowledge, tools, and support, you can effectively manage and prevent pressure sores, ensuring the well-being and comfort of your loved ones. Trust AmoryCare Home Care of New Jersey to guide you through every step of the process, providing expert advice and compassionate care to help you navigate the challenges of pressure sores.


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