Bedsores, also called pressure sores or decubitus (de-KU-bi-tus) ulcers, are skin sores caused by prolonged pressure on the skin, usually in people who are paralyzed, bedridden, or too weak to move around much.
Bedsores develop when the skin is compressed for a long time between a protruding bone, such as a hipbone or elbow, and an external surface, such as a wheelchair or mattress. This compression limits the flow of blood in blood vessels that bring nutrients and oxygen to the skin and remove wastes. Without oxygen or nourishment, the underlying tissue may deteriorate, and a hole may open in the skin. If left untreated, bacteria * can infect the skin opening and lead to septicemia * or infection of muscle or bone.
Because protein and fluids help keep skin healthy and supple, elderly people with a poor diet are often at risk for skin-damaging bedsores. Other people at risk include those who cannot move much or shift their positions, perhaps because they are paralyzed or have a long-term illness, or are in a coma * . People who are confined to wheelchairs, particularly those who cannot feel pain clearly, are also vulnerable to skin sores because they may not feel the ulcer forming. Bedsores are not contagious * .
A typical bedsore starts as a red area on the skin that may feel hard or warm to the touch. In people with darker skin, the sore may show as a shiny spot on the skin. If pressure is removed at this point, complications can be prevented. If the pressure is not removed, a blister, pimple, or scab may form over this area, which is a sign that the tissue beneath is dying. Eventually, a hole, or ulcer, will form in the skin. The dead tissue may appear small on the skin surface, but it may be larger in deeper tissues. The damage may extend all the way to the bones.
To diagnose bedsores, healthcare providers examine the skin for redness, blisters, openings, rashes, or warm spots, paying particular attention to bony areas. Any spots previously broken or healed over also are checked, as scar tissue can break open.
Bedsores can be prevented and treated in their early stages by relieving pressure on the body. Doing so requires changing a person's position in bed at least every two hours and in a wheelchair every 10 to 15 minutes. People at risk for bedsores should check themselves carefully at least twice daily or ask their caregivers to do so. Doctors recommend using long-handled mirrors to help with these exams because these tools help caregivers examine hard-to-see areas.
Other helpful methods to prevent bedsores are:
Bedsores can develop quickly. If a bedsore does develop, treatment may include antibiotics to treat infections and special gels or dressings to promote healing. In more serious cases, doctors may need to remove the dead tissue surgically and close the sore. If the bedsore reaches the bone, then the affected bone tissue may have to be removed as well.
See also Paralysis • Skin Conditions: Overview
Merck Manual: Consumer Version. “Pressure Sores.” http://www.merckmanuals.com/home/skin-disorders/pressure-sores/pressure-sores (accessed November 20, 2015).
MedlinePlus “Pressure Sores.” U.S. National Library of Medicine. http://www.nlm.nih.gov/medlineplus/pressuresores.html (accessed November 20, 2015).
National Pressure Ulcer Advisory Panel (NPUAP). 1025 Thomas Jefferson St. NW, Suite 500 East, Washington, DC 20007. Telephone: (202) 521-6789. Website: http://www.npuap.org (accessed November 20, 2015).
* bacteria (bak-TEER-ee-uh) are single-celled microorganisms that typically reproduce by cell division. Some, but not all, types of bacteria can cause disease in humans. Many types can live in the body without causing harm.
* septicemia (sep-tuh-SEE-me-uh) is a bacterial infection in the blood that spreads throughout the body, with potentially fatal results.
* coma (KO-ma) is an unconscious state, like a very deep sleep. A person in a coma cannot be woken up and cannot move, see, speak, or hear.
* contagious (kon-TAY-jus) means transmittable from one person to another, usually referring to an infection.