17823 Bedsores Pressure Injuries

Overview

Pressure injuries, commonly known as bedsores or pressure ulcers, are wounds that develop when constant pressure on the skin reduces blood flow to a specific area. This damage usually happens over bony parts of the body, such as the tailbone, hips, heels, or elbows, especially when a person stays in one position for too long without moving. The damage can be as mild as a red, sore patch or as severe as a deep wound reaching the muscle or bone.

Yes, pressure injuries are relatively common among people in hospitals and long-term care settings. According to the UK’s NHS, about 1 in 10 people admitted to hospital will develop one. They are also seen in people cared for at home who have limited mobility.

Pressure injuries mainly affect people who find it difficult to move themselves, such as those who are bed-bound, in a wheelchair, or have a condition that reduces sensation. Older adults are particularly at risk because their skin is thinner and they may have underlying health issues. However, anyone with limited mobility or loss of feeling in the skin can be affected, including younger people with spinal injuries.

Symptoms

Common symptoms

• Discoloured skin that doesn’t turn white when pressed (on darker skin, it may look purple, blue, or darker than surrounding skin)
• Warm or cool areas of skin that feel different from the surrounding area
• Swelling, tenderness, or a firm or boggy texture
• An open sore or blister that may ooze fluid or pus
• Pain, itching, or a burning sensation in the affected area

Symptoms in children

• Babies and children may show signs of pressure damage more subtly, such as fussiness, feeding difficulties, or trouble sleeping
• Look for red or darker patches on the back of the head, heels, or sides of the ears — common in infants from car seats, high chairs, or casts
• When a child cannot tell you something hurts, they may move less or avoid touching the affected spot

Symptoms in older adults

• Older adults often have thinner skin, so pressure injuries may appear as purple, bruised-looking areas or shiny, dry patches
• Because of reduced nerve sensation, they may not feel pain even when a sore is developing
• It is important to check bony areas daily, such as the tailbone, shoulder blades, heels, and the back of the head

Causes

Main causes

• Unrelieved pressure on skin and the tissue beneath it, which blocks small blood vessels — reduce blood flow to the area
• Friction, when the skin rubs against a bed sheet or clothing, removes the top protective layer
• Shear, when the skin stays in place but deeper tissue moves, stretching and tearing blood vessels
• Moisture from sweat, urine, or faeces, which weakens the skin and makes it easier to damage

Risk factors

• Being confined to a bed or wheelchair
• Limited movement or paralysis
• Loss of sensation (for example, after a spinal injury or in neuropathy)
• Poor diet or not drinking enough fluids
• Very low or very high body weight
• Older age (over 70)
• Certain chronic conditions, such as diabetes, vascular disease, or anaemia
• Urinary or faecal incontinence
• Medication use that affects mobility, sensation, or tissue health

When to see a doctor

See a doctor urgently if:

• Fever, chills, confusion, or feeling generally unwell
• Red streaks spreading away from the sore, or a sore that suddenly enlarges
• Foul-smelling discharge or fluid that looks like thick pus
• Exposed muscle, bone, or tendon at the base of the wound

Book a routine appointment if:

• Any area of skin discoloration that lasts more than a day or two
• A sore that does not start healing after a week of regular pressure relief
• Pain or tenderness that increases when the skin is touched
• Recurrent pressure injuries or concerns about prevention

Diagnosis

A doctor, nurse, or specialist will do a physical exam and look at the skin. They will ask about how the injury started, your mobility, and any other health conditions. They may also describe the sore using a staging system — commonly stage 1 to stage 4 — which tells them how deep the damage is. In some cases, they may need to gently remove any crusting or dead tissue to see the true depth.

Tests that may be done

• Physical inspection and staging of the pressure injury
• Blood tests if there are signs of infection or to assess nutrition
• A wound swab is taken to identify bacteria if the sore looks infected
• An imaging test, such as an ultrasound or X-ray, if the provider suspects damage to deeper tissue or bone

What to expect at your appointment

Your provider will explain how severe the pressure injury is and what you (or your caregiver) can do at home. They may refer you to a tissue viability nurse, wound care clinic, or community nursing team. You will be given a plan for repositioning, dressings, and monitoring. Expect the provider to reassess the sore regularly — in person or through home visits — until it heals.

Treatment

Treatment for pressure injuries focuses on relieving pressure, keeping the wound clean and moist, preventing infection, and helping the body repair the damaged tissue. Simple stage 1 injuries sometimes improve with regular repositioning and skincare alone. More advanced injuries require professional wound care and sometimes more intensive interventions.

Self-care at home

• Reposition yourself or have a caregiver help you change position every 2 hours while in bed and every hour while sitting (if possible)
• Use supportive cushions, foam pads, or a special pressure-relieving mattress as recommended
• Keep the skin around the sore clean and dry; wash with mild soap and warm water, then pat dry gently
• Apply a barrier cream or protective ointment around the wound if advised by your nurse (do not apply to the open wound itself)
• Eat enough protein and calories, and stay hydrated, to support healing
• Inspect the skin daily for new red or discoloured patches; use a mirror or ask someone for help for hard-to-see areas

Medical treatments

Advanced wound dressings are available to keep the wound at the right moisture level and protect it from infection. If dead tissue is present, a clinician may need to debride the wound (remove non-living tissue) using a sterile procedure. If there is an infection, you may be prescribed antibiotics. Specialised support surfaces, such as low-air-loss beds or alternating-pressure mattresses, may be used in hospitals or at home. Some wounds benefit from negative-pressure wound therapy, which uses gentle suction to help the wound heal from the inside out.

When is surgery considered?

For stage 3 or stage 4 pressure injuries — where the wound reaches deeper fat, muscle, or bone — surgery is sometimes necessary. Options include skin grafts (taking healthy skin from another area) or flap surgery, where nearby healthy tissue is moved over the wound to close it and improve blood supply. Surgery is not usually the first step, but it may be recommended to prevent worsening or to help a long-standing wound heal.

Living with this condition

If you have a pressure injury (or care for someone who does), incorporate skin checks and repositioning into your daily routine. Set a timer to remind you to change positions. Use a mirror or ask a family member to help inspect hard-to-see places. Keep the area clean and dry, and follow the dressing schedule provided by your nurse. Try to keep up with daily activities and hobbies as much as you can — distraction can ease discomfort.

Lifestyle tips

• Maintain a gentle exercise routine as advised by your physiotherapist to improve circulation and maintain movement
• Avoid sitting or lying on the same spot for long periods; shift your weight slightly every so often if you are able
• If you smoke, quitting smoking is one of the most helpful things you can do to improve wound healing.
• Keep your skin well moisturised (but avoid using creams directly inside the wound)
• Consider using a high-energy, nutrient-rich diet if weight loss is an issue

Diet and exercise

Good nutrition helps your body repair damaged tissue. Eat a balanced diet with plenty of protein (from meat, fish, beans, eggs, or dairy) and vitamins — vitamin C and zinc are particularly important for wound healing. Drink enough fluid unless your doctor tells you otherwise. Exercise may be limited, but a physiotherapist can suggest safe movements, even while seated or lying down, to help with circulation and muscle tone.

Mental health and emotional wellbeing

Living with a pressure injury can be frustrating, isolating, and at times distressing. It is completely normal to feel low, anxious, or helpless. Talk to your healthcare team about your emotions — they can offer support or refer you to a counselling service. If you are feeling overwhelmed, remember that bedsores do heal, and you do not have to cope alone. There are professionals who specialise in wound care and rehabilitation who can help you through it.

Prevention

Pressure injuries are largely preventable. The most important measures are regular repositioning, daily skin checks, keeping the skin clean and dry, and ensuring good nutrition. If you are in a care setting, healthcare staff should have a prevention plan in place — don’t hesitate to ask about repositioning schedules and pressure-relieving equipment.

Vaccines

There is no vaccine that prevents pressure injuries. However, keeping up to date with recommended vaccines, such as the flu and pneumonia vaccines, can reduce your risk of systemic infection if a pressure injury does occur.

Screening programmes

People who are bed-bound or in a wheelchair should have a formal skin assessment by a healthcare professional as part of routine care. Your provider may use a risk assessment tool, such as the Waterlow score in the UK, to identify your level of risk and set up a personalised prevention plan. You can also do your own skin checks daily — screens for early signs.

Complications

If left untreated

• The wound can deepen to involve muscle, bone, or joints
• Serious skin and soft tissue infections, such as cellulitis (infection of deeper skin layers)
• Sepsis, a life-threatening reaction to infection that can spread through the body
• Osteomyelitis, an infection in the bone that is difficult to treat
• Chronic non-healing wounds that may eventually require surgery or lead to amputation in severe cases
• Loss of independence and longer hospital stays

Long-term outlook

The outlook for pressure injuries is generally very good when they are found early and managed consistently. Stage 1 and stage 2 injuries often heal within days to weeks with pressure relief and proper care. Stage 3 and stage 4 injuries take longer and may require specialist treatment, but even these can heal with the right medical team, good nutrition, and patience. The key is to be proactive — report any changes to your care team and follow their advice closely.

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