Pressure ulcers prevention awareness

Overview

Pressure ulcers, also called bedsores or pressure sores, are injuries to the skin and the tissue underneath. They happen when constant pressure on one part of the body cuts off blood flow to that area. They most often develop on bony parts of the body like the heels, elbows, hips, and tailbone.

Yes, pressure ulcers are common, especially among people who are in hospital or living in a care home. However, they can happen to anyone who has limited movement for a long time.

Pressure ulcers mainly affect people who cannot move easily on their own, such as those who are bedridden, use a wheelchair, have a spinal cord injury, or are recovering from surgery. Older adults, people with poor nutrition, and those with chronic conditions like diabetes or poor circulation are at higher risk.

Symptoms

Common symptoms

• Red or purple spot on the skin that does not turn white when you press it.
• Warmth or swelling in one area of skin.
• Pain or tenderness in the affected area.
• Blister or open sore on the skin.
• Hard or spongy feeling under the skin.

Symptoms in children

• In children, pressure ulcers can appear on the back of the head, especially in babies who lie on their backs for long periods.
• They may also develop on the ears, heels, or elbows in children who are in casts or have limited movement.

Symptoms in older adults

• In older adults, the skin is thinner and more fragile, so pressure ulcers can develop faster.
• Symptoms may be less obvious because the person may not feel pain due to reduced sensation from conditions like diabetes or nerve damage.
• Look for areas of skin that are red, purple, or darker than the surrounding skin, or skin that feels cooler or warmer than normal.

Causes

Main causes

• Prolonged pressure on one area of the body, especially over a bony part, which stops blood flow to the skin.
• Friction or rubbing of the skin against sheets, clothing, or a wheelchair.
• Shear – when the skin stays in place but the deeper tissues shift, such as when sliding down in a bed or chair.
• Moisture from sweat, urine, or stool that breaks down the skin's protective barrier.

Risk factors

• Being unable to move without help (bedridden or wheelchair use).
• Poor nutrition or dehydration.
• Reduced sensation (from conditions like diabetes, stroke, or spinal cord injury).
• Incontinence of urine or stool, which keeps the skin wet.
• Chronic illnesses such as diabetes, peripheral artery disease, or heart failure.
• Older age because skin becomes thinner and less elastic.
• Smoking, which reduces blood flow to the skin.

When to see a doctor

See a doctor urgently if:

• If you notice any signs of infection: pus, foul smell, spreading redness, fever, or chills.
• If the ulcer exposes deeper layers, shows black or hard tissue, or the wound is getting worse rapidly.
• If you or the person with the ulcer has a sudden change in mental state, such as confusion.

Book a routine appointment if:

• If you see a persistent red or purple spot on the skin that does not fade when pressed, even if the skin is not broken.
• If a blister or open sore appears on an area that is under pressure.
• If you are caring for someone at high risk for pressure ulcers and need guidance on prevention.
• If the ulcer is not getting better after a few days of home care such as repositioning and cleaning.

Diagnosis

A healthcare professional will examine the skin, looking for areas of redness, swelling, blisters, or sores. They will ask about the person's mobility, general health, and any recent changes. They may use a risk assessment tool like the Braden scale to estimate the risk of developing pressure ulcers.

Tests that may be done

• Visual inspection – the main way to diagnose a pressure ulcer.
• Wound culture – a swab of the sore to check for bacteria if an infection is suspected.
• Blood tests – to look for signs of infection or nutritional problems.
• Imaging tests (like X-ray or MRI) – rarely, if the doctor suspects the infection has spread to the bone (osteomyelitis).

What to expect at your appointment

The doctor or nurse will carefully look at all areas of the skin, especially over bony parts. They may press gently on red areas to see if the color changes (blanching). They will also check for signs of infection and may take a photo to track healing. The exam is not painful, but if there is an open sore, it may be tender.

Treatment

Treatment focuses on relieving pressure on the affected area, cleaning the wound, and promoting healing. The sooner treatment starts, the better the outcome. For early-stage ulcers, simple steps like repositioning and special cushions may be enough. For deeper ulcers, more advanced wound care is needed.

Self-care at home

• Reposition frequently – change position at least every 2 hours if in bed, or every 15 to 30 minutes if sitting in a chair.
• Use pressure-relieving equipment such as special mattresses, foam cushions, or heel protectors as recommended by your healthcare team.
• Keep the skin clean and dry, especially after using the toilet or if there is sweating.
• Protect the skin with barrier creams (ask your nurse or pharmacist for advice).
• Eat a healthy diet rich in protein, vitamins C and D, and zinc – good sources include lean meat, eggs, dairy, beans, and leafy greens. Drink plenty of fluids unless your doctor advises otherwise.

Medical treatments

Medical treatment may include special wound dressings that keep the wound moist and clean, such as hydrocolloid or foam dressings. If the wound has dead tissue, a doctor or nurse may need to remove it (debridement). Antibiotics may be prescribed if there is an infection. For deeper ulcers, negative pressure wound therapy (a vacuum device) may be used to draw out fluid and help the wound heal. The exact treatment depends on the stage and condition of the ulcer.

When is surgery considered?

For severe pressure ulcers that do not heal with standard care, surgery may be an option. This usually involves removing dead tissue and closing the wound with a skin graft or flap. Surgery is considered when the ulcer is very deep or involves underlying bone.

Living with this condition

Living with a pressure ulcer means paying extra attention to your skin and movement. Set reminders to change position, check your skin daily for new red spots, and use any prescribed cushions or mattresses. Keep the wound clean and change dressings as instructed. Ask for help if you cannot reposition on your own. Let your healthcare team know about any changes in the wound.

Lifestyle tips

• Stay as active as your condition allows – even small movements help improve blood flow.
• If you use a wheelchair, shift your weight every 15 to 30 minutes by leaning forward or side to side.
• Protect your skin from friction by using soft fabrics and avoiding harsh soaps.
• Avoid sitting or lying directly on the sore – use pillows or foam wedges to offload pressure.

Diet and exercise

Good nutrition is key for healing. Eat enough calories, protein (from meat, fish, eggs, beans, tofu), and vitamins C and zinc (from fruits, vegetables, nuts). Drink water to stay hydrated. If you are able, gentle exercises like stretching or walking (with support) can improve blood flow and muscle strength. Check with your doctor before starting a new exercise routine.

Mental health and emotional wellbeing

Having a pressure ulcer can be frustrating, painful, and stressful. It may limit your activities or make you feel isolated. You might feel worried about healing or dependent on others. It is normal to have these feelings. Talk to your healthcare team, family, or a counselor. Remember that with proper care, most pressure ulcers heal, and prevention can keep new ones from forming.

Prevention

Yes, in most cases pressure ulcers can be prevented. The key is to relieve pressure regularly, keep the skin healthy, eat well, and stay hydrated. Caregivers should help people who cannot move themselves to change position often. Using special mattresses and cushions also helps. Checking the skin daily for early warning signs allows you to act before a sore develops.

Complications

If left untreated

• Infection of the skin and soft tissues (cellulitis).
• Infection of the bone (osteomyelitis).
• Sepsis – a life-threatening infection that spreads through the blood.
• Delayed healing leading to chronic, non-healing wounds.
• Pain, scarring, and loss of function in the affected area.

Long-term outlook

With prompt and proper care, most pressure ulcers heal well. The earlier they are caught, the easier they are to treat. Even deeper ulcers can improve with dedication to repositioning, wound care, and good nutrition. Prevention remains the best approach, and many people successfully avoid pressure ulcers by following simple routines. You and your healthcare team can work together to manage and overcome this condition.

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