What are bedsores?

Causes and Symptoms

Bedsores are caused by sustained pressure on the skin, blocking blood flow. Impaired circulation causes the skin tissue to die and tear.

Persons at risk for bedsores include the bedridden, wheelchair-bound, immobile, or unconscious. Paraplegics and others with spinal cord disease or neuromuscular injuries are at risk because of their inability to sense pain in affected limbs or because of sitting in a wheelchair. Bed-bound persons who lie in one position for extended lengths of time may develop bedsores. The malnourished may experience bedsores as a result of little padding over bony areas. The elderly prove more vulnerable to bedsores because of thin skin, decreased circulation, and restricted mobility. Chronic diseases such as diabetes, urinary incontinence, or vascular disease can increase the risk of bedsores.

Bedsores typically occur in the skin over bony areas such as the elbows, heels, ankles, back, lower spine or tailbone, hips, shoulders, and back of the head. In the early stage, the skin becomes red, soft, and warm to the touch. If pressure is relieved by changing body position, then the skin will heal. If the pressure continues, however, then the skin may blister and then break down, leaving an open wound. Without intervention, the bedsore can progress to skin cell death, with damage to deeper levels of skin or muscle. An advanced bedsore smells odorous and becomes infected without proper treatment. Unattended, the bedsore can result in infection leading to fever, confusion, and death.

Treatment and Therapy

Certain measures can prevent or minimize the development of bedsores in persons at risk. Relief from pressure on the skin by frequently changing body position is critical. Other approaches include keeping the skin clean and dry, minimizing friction against the skin, and maintaining healthy nutrition.

Treatment for bedsores includes monitoring the skin for redness and taking immediate measures to minimize further breakdown. The bedsore should be cleansed and covered with a dressing as prescribed by the health-care provider. Dead tissue can be removed to prevent infection and encourage healing through surgical debridement or mechanical debridement by gentle scrubbing or wound irrigation. Enzyme preparations are available to dissolve dead tissue. Antibiotic solutions can be applied to the bedsore and oral antibiotics can be taken to decrease the risk of secondary infections.

Bibliography

Brown, Pamela. Quick Reference to Wound Care. Sudbury, Mass.: Jones and Bartlett, 2009.

MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2005 Aug 12]. Pressure Sores; updated 2013 Aug. 26; reviewed 2013 June 5; cited 2013 Aug. 29; about 2 p.

Ousey, Karen. Pressure Area Care. Malden, Mass.: Blackwell, 2005.

Pieper, Barbara. Pressure Ulcers: Prevalence, Incidence, and Implications for the Future. Washington, D.C.: National Pressure Ulcer Advisory Panel, 2012.

Webster, J. G. Prevention of Pressure Sores: Engineering and Clinical Aspects. New York: Taylor & Francis, 1991.