What are bed sores or pressure ulcers?
In simple terms a bed sore or pressure ulcer is used to describe any skin lesion or wound caused by unrelieved pressure that damages the underlying tissue.
The real problem with them is that, if left untreated, they can become infected and quickly eat into the underlying layers of the skin causing wounds that can be extremely painful.
In our view the terms bed sore or pressure ulcer do not do justice to the level of suffering which can be involved. The term pressure ulcer is probably the more precise- as they frequently occur where there is pressure in a bony area of the body and another surface such as a bed or chair.
Where do bed sores occur on the body?
When people are confined to bed bedsores are most common over the hip, spine, lower back, tailbone, shoulder blades, elbows and heels.
Where wheelchairs are being used the ulceration tend to occur on the buttocks and bottoms of the feet.
What are the Causes of Bed or Pressure Sores?
Bed or Pressure Sores are commonly caused by the friction of the bed sheets, prolonged exposure to cold, a lack of nutrition, poor hygiene and dehydration.
In most circumstances they develop where there is prolonged immobility- hence the term bed sore.
Bed sores are common (though avoidable) in places where people who are bed bound are being cared for. Normally this would be in nursing and care homes hospitals and also where care is provided at home with carer or nursing support visiting daily.
How Serious are Pressure or Bed Sores?
Pressure sores in residential care and nursing homes can vary widely. Some can be mild which are shown as a pink colouration on the skin. More severe pressure sores are very serious, and the pressure sore can extend through to the bone of the person affected.
If they are left untreated and the wound develops to a depth so that the bone becomes infected then the situation can be very serious as antibiotics may not work. In such cases amputation can be the only option. More serious still is the situation where not only amputation but blood poisoning may occur and in such situations the patient is at risk of decline and death.
How do I recognise if a Bed Sore or Pressure Ulcer is developing?
The first sign is a patch of redness, it is vital that this is protected from additional pressure as if not the redness can turn into open sores and ulcers.
This redness is normally made worse by friction (this is especially where a person in bed slides across the bed sheets).
Another factor that can make the redness worse is where there is moisture (normally from urine or sweat) that is not dealt with promptly
A good early test is when patients with a pale skin develop a lasting patch of red skin that does not change colour to white when pressed with a finger. It may be more difficult to detect this with patients with darker skin.
A next critical phase is if the redness develops into an open sore causing swelling and oozing of the sore. This is indicative of the sore becoming established below the skin surface.
If untreated the affected skin becomes a crater which goes below the skin surface.
Finally, if untreated the infection goes into (and eats into) muscle bone and joint.
What Are the Grades of Pressure Sores or Bed Ulcers
A Grade 1 pressure sore is relatively mild. Though it is uncomfortable it rarely causes more than a discolouration of the skin or mild discomfort
A Grade 2 ulcer looks like a blister or a graze. The skin takes on an ulcerous appearance and this means that the nerve endings are exposed leading to intense pain and discomfort.
A Grade 3 pressure sore goes beneath the skin surface and the ulceration is in the fatty tissue below. Because there are less nerve endings exposed these are not as painful but the problem that arises from the breaking of the skin surface is that there is a very high risk of subsequent infection.
Grade 4 Pressure or Bed Sores are very serious because the ulceration has gone through the fatty tissue and started to reach the bone or muscle. This is very problematic as not only is the risk of infection high but the capacity of the skin to heal naturally is radically reduced which means the process of recovery once the problem has been identified is slow and painful.
What Complaints will the Person suffering bedsores make?
A person suffering from the stages of bedsores as they develop is likely to complain of decreased sensation in the affected area and also itchiness and discomfort.
How can Bed or Pressure Sores be Prevented?
Common ways to ensure that bed or pressure sores do not develop are ensuring that the patient changes position in a chair or bed at least every two hours and using items that reduce pressure when the patient or resident is being moved in bed- for instance by using special bed sheets to move the patient up and down the bed.
Other simple measures are to ensure that the patient or resident is eating well balanced and nutritious meals and also is well cared for when washing or being washed.
For more information please see our page on pressure sore treatment