Bed Sores

Pressure sores, also known as bedsores, are injuries to the skin and underlying tissue. They happen when pressure is put on the skin for a long time. These sores often develop on bony parts of the body like the heels, ankles, hips, and the area at the base of the spine (tailbone). Other names for bedsores include pressure ulcers and decubitus ulcers.

People at higher risk for bedsores are those with medical conditions that make it hard for them to change their position or move around. This includes people who spend most of their time in a bed or a chair. Bedsores can form over a period of hours or days.

While most bedsores heal with treatment, some may not completely heal. There are steps you can take to prevent bedsores and to help them heal if they do develop.

Bedsores, also called pressure ulcers, are sores that develop on the skin due to prolonged pressure. They happen when blood flow to an area of skin is cut off for too long. This can happen to anyone who spends a lot of time sitting or lying down in one position.

Recognizing bedsores early is important. Here are some common signs:

• Changes in skin color: The skin might look red, purple, or even black in the affected area. Sometimes the skin might look darker or lighter than the surrounding skin.
• Changes in skin texture: The skin might feel different – perhaps rough, hard, or even blister-like.
• Swelling: The affected area might swell up.
• Pus or drainage: A yellowish or greenish liquid might come from the sore.
• Temperature difference: The affected area might feel unusually hot or cold compared to other parts of the body.
• Pain or soreness: The skin will feel painful or sore.

Bedsores are categorized into different stages, based on how deep they are and how much skin and tissue damage they cause. They can range from minor inflammation to serious injuries that involve muscle and bone.

Where do bedsores commonly occur?

• For people who use wheelchairs: Common spots include the tailbone (coccyx), buttocks, shoulder blades, and the backs of the arms and legs where they rest against the chair.
• For people who are bedridden: Bedsores often appear on the back or sides of the head, shoulder blades, hips, lower back, tailbone, heels, ankles, and the skin behind the knees.

What to do if you suspect a bedsore:

If you notice any of these warning signs, try changing your position to relieve pressure on the area. This helps improve blood flow to the affected skin.

If the sore doesn't improve within 24 to 48 hours, it's crucial to contact your doctor or other healthcare provider. This is especially important if you notice any signs of infection.

Signs of infection:

Seek immediate medical attention if you notice any of these signs of infection:

• Fever: A higher than normal body temperature.
• Increased drainage or pus: More liquid or a change in the color or smell of the drainage.
• Bad odor: A foul smell coming from the sore.
• Warmth or swelling around the sore: The area surrounding the sore feels hot or swollen.

Early detection and treatment are key to preventing bedsores from getting worse. Don't hesitate to seek help if you have concerns.

If you notice a spot on your skin that's getting sore or irritated from being in one position for too long, try changing your body position to take the pressure off. If the sore doesn't get better in a day or two, talk to your doctor or other healthcare provider.

Get immediate medical attention if you see any signs of infection. These include a fever, any pus or liquid coming from the sore, a bad smell from the sore, or if the area around the sore feels warm or swollen.

Bedsores, also called pressure ulcers, happen when pressure on the skin reduces blood flow. This lack of blood flow starves the skin and tissues of the oxygen and nutrients they need to stay healthy. Over time, this can cause the skin and underlying tissue to break down and die.

Several factors contribute to bedsores:

1. Pressure: Constant pressure on any part of the body can cut off blood supply to that area. Imagine squeezing a garden hose – the water flow slows down. The same happens in your body. Blood delivers oxygen and important nutrients to your tissues. Without these, the skin and tissues can get damaged and even die. People who can't move easily are more likely to get bedsores because pressure builds up in areas where there's less padding, like the bony parts of the spine, tailbone, heels, elbows, hips, and shoulder blades.

2. Friction: When skin rubs against clothing or bedding, it creates friction. This can irritate and damage delicate skin, especially if the skin is also damp or moist. Think about dragging a cloth across a surface—it can cause wear and tear. Similar rubbing can happen to skin that is already vulnerable.

3. Shear: Shear happens when two surfaces move in opposite directions. For example, when you raise the head of a bed, your body might slide down. The skin over your tailbone may stay in place while the rest of your body moves. This creates a shearing force that can damage the skin. The skin is stretched and pulled in different directions, making it more likely to tear. This is similar to how a sheet of paper might tear when you pull one end while holding the other.

Bedsores are more likely to develop if you have trouble moving around. This is because staying in one position for too long puts pressure on your skin, damaging it. Several factors increase your risk:

Immobility: If you have difficulty moving or changing positions in bed or a chair, you're at higher risk. This could be due to health problems like poor health, a spinal cord injury, or other conditions that limit your movement.

Incontinence: Frequent exposure to urine or stool can irritate and damage the skin, making it more vulnerable to bedsores.

Lack of Sensation: If you have a spinal cord injury, neurological disorder, or another condition that affects your ability to feel pain or discomfort, you might not notice early warning signs of pressure sores. Without the feeling of pressure, you won't know when to shift your position.

Poor Nutrition and Hydration: Your body needs enough water, calories, protein, vitamins, and minerals to keep skin healthy and tissues strong. If you're not getting enough of these, your skin becomes more fragile and prone to damage.

Blood Flow Problems: Certain medical conditions, like diabetes and vascular disease, can affect blood flow to the skin. Reduced blood flow means tissues don't get enough oxygen and nutrients, making them more susceptible to damage and bedsores.

Age: People over 70 are at a greater risk of developing bedsores. This is often due to a combination of factors, including decreased mobility, possible health conditions, and changes in the skin's ability to heal.

Pressure sores (bedsores) can lead to several serious problems.

One common complication is cellulitis, an infection of the skin and surrounding tissues. This infection can cause the affected area to feel warm and swollen. The skin might also change color and look red and inflamed. A crucial point is that people with nerve damage in the affected area might not feel any pain, even with a serious infection, making it harder to detect.

Bone and joint infections are another risk. A pressure sore can become infected, and that infection can spread to the bones and joints. Joint infections, known as septic arthritis, can damage the cartilage and tissues in the joints, potentially causing permanent damage. Bone infections (osteomyelitis) can also damage the function of joints and limbs.

In some cases, a long-lasting, non-healing pressure sore can develop into a type of skin cancer called a Marjolin ulcer. This is a squamous cell carcinoma, a type of cancer that starts in the flat, scaly cells of the skin.

Finally, though rare, a pressure sore infection can sometimes lead to sepsis. Sepsis is a very serious, life-threatening complication of an infection that spreads throughout the body. It's a medical emergency requiring immediate treatment.

It's important to remember that some of these complications can be quite serious and may even be life-threatening. Prompt and appropriate treatment of pressure sores is crucial to prevent these more severe problems.

Preventing Bedsores: A Practical Guide

Bedsores, also known as pressure ulcers, happen when pressure on the skin is too high for too long. This can damage the skin and tissues underneath. Fortunately, you can take steps to prevent them.

Positioning is Key:

Regularly changing your position is crucial to avoid putting too much stress on any one area of your skin. This means shifting your weight frequently in bed or a chair. If you can't move yourself easily, ask for help to change your position every couple of hours. If you have enough strength, you can lift yourself up or do simple exercises like wheelchair pushups (pushing up on the chair arms) to help redistribute pressure. Consider a specialty wheelchair that tilts to relieve pressure.

Supporting Your Body:

Using cushions or special mattresses designed to distribute pressure can also be very helpful. Avoid doughnut-shaped cushions, as these can actually concentrate pressure on the surrounding skin. If you're in a bed, try to keep the head of the bed at a low angle (no more than 30 degrees). This helps prevent "shearing," where the skin is pulled in different directions, causing damage.

Skin Care is Essential:

Keeping your skin clean and dry is important. Gently wash your skin with a mild soap and pat it dry. Regular cleaning helps reduce the skin's exposure to moisture, urine, and stool. Use moisture barrier creams to protect your skin from these substances. Change your bedding and clothing as needed to avoid irritation from wrinkles or buttons.

Daily Checks:

It's vital to examine your skin every day for any signs of a bedsore. Look closely for redness, blisters, or other changes. Early detection allows for prompt treatment and prevents the problem from worsening. If you notice any unusual changes, talk to your doctor or nurse.

Other Important Factors:

Maintaining a healthy diet and staying hydrated (drinking enough fluids) is important for overall health, which can help prevent bedsores. Quitting smoking and managing stress also contribute to better skin health. Regular exercise, when possible, can help improve circulation and reduce the risk of pressure sores.

Doctors often check your skin for pressure sores (bedsores). If a pressure sore is present, they'll determine its stage. This stage helps them choose the best treatment. They might also order blood tests to get a better understanding of your overall health.

To learn more about your pressure sore, your doctor might ask:

• When did the sore first appear? Knowing the start date helps track the progress of the sore.
• How painful is the sore? Pain levels are important for figuring out the best treatment plan.
• Have you had pressure sores before? Previous experiences can help determine the best approach to prevention and treatment.
• How were previous sores treated, and what was the result? This helps the doctor learn what works well for you.
• What kind of help do you have with daily care? Knowing about your support system helps the doctor understand your situation.
• How often do you change positions? Regular position changes are crucial to preventing pressure sores.
• What medical conditions do you have, and what is your current treatment? Existing health problems can affect treatment for pressure sores.
• What is your usual diet? Proper nutrition is essential for healing.

Understanding these details helps doctors create a personalized treatment plan to effectively manage and heal your pressure sore.

Treating Pressure Ulcers (Bedsores)

Pressure ulcers, also known as bedsores, are sores that develop on the skin due to prolonged pressure. Treating these sores involves a multi-faceted approach focusing on several key areas:

1. Reducing Pressure:

The first step in treating a bedsore is to relieve the pressure and friction that caused it. This is crucial to prevent further damage. Ways to reduce pressure include:

• Changing Position Regularly: Turning and repositioning yourself frequently is essential. The frequency of repositioning depends on your individual condition and the type of surface you're on. For example, someone in a hospital bed will need more frequent repositioning than someone resting in a chair. This helps distribute pressure across the body, preventing concentrated pressure on one area.
• Using Support Surfaces: Using special mattresses, cushions, and support surfaces is vital. These specialized items help you sit or lie in a way that protects vulnerable skin areas. This is especially important for people who are bedridden or have limited mobility.

2. Caring for the Wound:

How you care for a pressure ulcer depends on how deep the wound is. General steps include:

• Cleaning: If the affected skin isn't broken, gently wash it with a mild cleanser and pat it dry. Open sores should be cleaned with water or a saline solution (saltwater) each time a dressing is changed.
• Applying Dressings: Dressings help speed up healing, keep the wound moist, and create a barrier against infection. Different types of dressings are available, including films, gauze, gels, foams, and specialized treated coverings. You might need a combination of dressings depending on the wound's condition.

3. Removing Damaged Tissue:

For a wound to heal properly, it needs to be free of dead, damaged, or infected tissue. A healthcare professional may remove this damaged tissue (a process called debridement) by gently flushing the wound with water, or by cutting away the damaged areas.

4. Managing Pain:

Pain management is an important part of the treatment process. Over-the-counter pain relievers like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help reduce pain. Topical pain medications can also be helpful during wound care.

5. Maintaining a Healthy Diet:

Good nutrition is essential for wound healing. A registered dietitian can help create a meal plan tailored to your needs to ensure you get the nutrients your body requires for recovery.

6. Seeking Specialized Care:

A variety of healthcare professionals may be involved in your care team, depending on the severity of the pressure ulcer. These professionals may include:

• Primary Care Physician: Oversees the overall treatment plan.
• Wound Care Specialist: Expert in wound care management.
• Nurses/Medical Assistants: Provide care, education, and wound management support.
• Social Worker: Helps you and your family access resources and address emotional concerns.
• Physical Therapist: Helps improve movement and mobility.
• Occupational Therapist: Assists with proper seating and positioning to prevent pressure.
• Registered Dietitian: Develops a personalized nutrition plan.
• Dermatologist: Specialist in skin conditions.
• Surgeon (e.g., neurosurgeon, vascular surgeon, orthopedic surgeon, plastic surgeon): May be needed for complex or severe pressure ulcers that don't respond to other treatments. Surgery might involve using tissue flaps to cover the wound and cushion the affected bone.

When to See a Doctor:

If you notice skin irritation or a sore that isn't healing, it's important to schedule an appointment with a healthcare professional to discuss your condition and determine the best course of treatment.