Bedsores (pressure ulcers)
As the skin breaks down, an ulcer or sore forms. This can become extremely painful, and may take a long time to heal if you’re constantly lying down.
You’re most likely to get pressure ulcers on parts of the body where there is not much fat, such as:
- base of the spine
- back of the head
- elbows and shoulder blades
There are four categories of pressure ulcers:
- Category one is superficial so the skin is unbroken. The skin looks discoloured – it’s red on people with white skin, and purple or blue on darker skins. An early warning sign of pressure ulcers is when you apply pressure to discoloured skin, it stays discoloured.
- Category two looks more like a blister, with the outer surface of the skin broken.
- Category three looks like a deep wound, with much more loss of skin and underlying tissue.
- Category four is extremely painful and serious. The muscles and bone underneath the pressure ulcer can also become damaged. These sores are susceptible to life-threatening infections such as MRSA (methicillin-resistant staphylococcus aureus).
Pressure ulcers can usually be managed at home by a district nurse. If the area is infected, hospital treatment is essential. Usually, the damaged tissue is removed using a variety of methods. These include with surgical instruments, through cleansing and irrigation, ultrasound, or laser treatment. In most cases a local anaesthetic is given so the procedure is pain-free.
There are several factors that increase the risk of pressure ulcers:
- Lack of mobility – lying or sitting in one position.
- Friction from being moved or dragged on bedding, or from uncomfortable clothing.
- Certain drugs including chemotherapy, steroids and anti-inflammatories.
- Malnutrition or poor nutrition and dehydration.
- Lying in wet bedding or clothes.
- Type 1 and type 2 diabetes.
If you’re an older person (70+) and your skin has thinned, you’re also more at risk of developing pressure ulcers.
In hospital and hospices, nurses turn patients regularly to avoid them getting pressure ulcers. This can be as often as every 15 minutes or up to two hours.
To prevent pressure ulcers, you can do the following things:
- Check your skin regularly, particularly in places where sores are most likely to appear or where your skin is thin.
- Change position often, and if possible you should alternate between sitting in a chair and lying in bed.
- Get up and walk around if you can ̶ this will improve your circulation, and help to keep your muscles strong.
- Avoid lying in damp or wet clothes and bedding, as this can cause or aggravate pressure sores.
- Make sure that bed sheets are smooth and not wrinkled as this can add to friction on the skin. Cotton sheets are more comfortable than synthetic ones.
- Keep your skin clean and dry and don’t use too much skin cream. Avoid using talcum powder.
These preventative measures also apply when you’ve already developed pressure ulcers. You need to move regularly so that the sores aren’t made worse by being in one position for too long.
It’s important to get a good balanced diet, to give your body the strength to heal and prevent pressure ulcers. Good nutrition makes the skin healthier, so if you’re eating normal meals, try to have plenty of protein ̶ like eggs, fish, cheese and meat ̶ as well as fresh fruit and vegetables.
- If eating is difficult, ask your nurse about nutritional supplements. People taking nutritional supplements before and after operations develop fewer pressure ulcers.
- Always ensure you have plenty of fresh water. Dehydration has been shown to increase the risk of pressure ulcers and can delay healing. Fresh chilled water is much more appealing than water that has been sitting in a jug for hours.
It may not be as easy to be turned regularly if you’re being cared for at home. Your carer might not have the energy or strength. Your nurse will carry out a detailed assessment about pressure-relieving equipment and can advise you about pads, special cushions, mattresses, overlays and V-shaped pillows. These can all help to prevent sores or stop them getting worse:
- An air mattress can be placed on top of your normal bed mattress to relieve pressure.
- V-shaped pillows can relieve pressure on your back.
- You may have to consider buying a new bed mattress, but discuss this with a health professional before making this investment. It’s also possible to get a hospital bed for your home.
Your Marie Curie Nurse or district nurse can advise you on all of these aids, and may be able to give or lend them to you. V-shaped pillows and air mattresses are also available at some supermarkets and department stores, or online, but ask your nurse about this first.
If the person you’re looking after has pressure ulcers, tell the nurse or doctor. They will advise you on the best ways to reduce discomfort and speed up healing.
- Pressure ulcers should be protected with specially-designed dressings and bandages – speak to your nurse about these.
- Paracetamol can relieve pain at early stages of pressure ulcers.
- Your doctor can prescribe creams or ointments to speed up healing.
- Nurses can show you how to take care when washing and drying parts of the body where there are pressure ulcers.
- They can also show you how to gently exercise arms and legs, change someone’s position and check that they’re comfortable if they can’t move around.
- Any exercise – even while sitting in a chair – is helpful to keep circulation moving and relieve pressure.
- A certain type of honey is sometimes used to help heal a pressure ulcer that is an open wound – ask your nurse where to get this.
Not everyone who is bedridden for long periods of time gets pressure ulcers, but even if this happens rest assured there is plenty you can do to make yourself more comfortable and speed up healing. Your nurse will be able to support you with this.
This page is for general information only. It's not intended to replace any advice from health or social care professionals. We suggest that you consult with a qualified professional about your individual circumstances. Read more about how our information is created and how it's used.
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