Pressure sores (also called pressure ulcers or bedsores) develop when skin and the tissue beneath it are squeezed for too long, usually over a bony area. They can appear surprisingly quickly in a person who cannot move easily, but careful daily care prevents many of them.
When a person lies or sits in one position, their body weight presses the skin against the bone beneath it. This reduces blood flow to that area. If the pressure is not relieved, the skin and deeper tissues can be damaged. Friction (rubbing) and shear (skin being pulled as the body slides down a bed or chair) add to the damage.
Damage can begin within hours in a person who is very frail or unwell. Deeper tissue can sometimes be damaged before the skin surface shows much change, which is why prevention and early reporting are so important.
Pressure sores most often develop over bony areas. For a person lying in bed, check the lower back and tailbone (sacrum), heels, hips, shoulder blades, elbows and the back of the head. For a person sitting for long periods, check the buttocks, the base of the spine and the backs of the heels. Also check under medical devices such as oxygen tubing, splints or catheter tubing.
Look at and gently feel the skin. Early warning signs include redness that does not fade after pressure is removed, areas that look purple, bluish or darker than the surrounding skin, and skin that feels warmer, cooler, firmer or softer than nearby areas. On darker skin, redness may be difficult to see, so changes in colour, temperature and texture are especially important.
Regular repositioning is the most important step. How often this is needed depends on the person's risk, the mattress being used and their overall condition. A nurse or doctor should advise a schedule, and higher-risk patients need more frequent changes. Keeping a simple turning chart helps family members share this task reliably, including at night.
When lying on the side, a slight tilt supported by pillows rather than lying directly on the hip bone reduces pressure. Keep the head of the bed as low as is comfortable and safe for the person, because a raised bed encourages sliding and shear. People sitting in a chair should be encouraged to shift their weight regularly if they can.
Heels are especially vulnerable. A pillow placed lengthways under the lower legs, so that the heels float just clear of the mattress, can help. Avoid placing the pillow directly under the knees.
Lift rather than slide the person when repositioning. A draw sheet, used by two people, reduces friction and shear. Ask a nurse or physiotherapist to show you safe handling techniques that protect both the patient and the caregiver's back.
A pressure-relieving mattress or cushion may be recommended for people at higher risk. These help, but they do not replace repositioning. Ask for advice before buying equipment, because different products suit different needs.
If you notice an area of skin that remains red or discoloured after pressure is relieved, a blister, or any broken skin over a pressure area, arrange for a nurse or doctor to assess it promptly. Early treatment can prevent a small area of damage from becoming a deep wound.
An existing pressure sore needs professional assessment and a treatment plan. Sineth Hospitals' pressure sore care at home page describes the nursing support available for patients who already have a wound. Seek prompt medical advice if a wound becomes larger, deeper, more painful, has an unpleasant smell or discharge, or if the surrounding skin becomes red, hot and swollen.
Fever, rigors (shaking chills), new confusion or drowsiness in a person with a pressure sore may indicate a serious infection and need urgent medical assessment. See when home care is not enough for emergency warning signs.
Published by: Sineth Hospitals
Medically reviewed by: Dr. Seneth Gajasinghe, MBBS (Colombo), MD (Colombo), Medical Director, Sineth Hospitals
Last reviewed:
If a patient already has broken skin, a blister or a wound over a pressure area, ask a doctor or nurse to assess it rather than treating it with home remedies.
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