Pressure Sores

Overview

A pressure sore is an area of skin and the tissue underneath that gets damaged when a part of the body is pressed against a surface for too long. This pressure blocks blood flow, and without enough blood, the skin and tissue can break down and die.

Pressure sores are fairly common, especially among people who are in the hospital, living in a care home, or have limited mobility for a long time. Around 1 in 10 hospital patients may develop one, but many cases are avoidable.

Pressure sores mostly affect people who cannot move easily, such as those who are bedridden, use a wheelchair, or are recovering from surgery. Older adults are at higher risk because their skin is thinner and more fragile, but anyone with reduced movement or poor health can get them.

Symptoms

Common symptoms

• Skin that looks red or purple and does not turn white when you press on it
• A patch of skin that feels warm, cool, firm, or spongy
• An area of skin that itches, burns, or hurts
• A blister or an open sore that may ooze clear fluid or pus
• Skin that is broken, peeling, or has a dark center

Symptoms in children

• Children with limited mobility may get pressure sores in the same bony areas as adults
• A child may show signs of discomfort when moved, or cry during position changes
• The skin may look red or darkened, and may feel warmer than the surrounding skin
• Young children might not be able to describe the pain, so watch for restlessness or a sudden change in mood

Symptoms in older adults

• Older adults often have thinner skin, so pressure sores can develop faster and look different — sometimes just a purple or brown patch
• Nerve damage or other health conditions can make pain less noticeable, so a sore may be found later
• The affected skin may be dry, shiny, or fragile, and tears easily with friction
• Older adults may become more confused or withdrawn if the sore is causing an infection

Causes

Main causes

• Pressure: lying or sitting in one position for too long squeezes blood vessels and blocks blood flow
• Friction: skin rubbing against bedding, clothing, or a wheelchair causes damage
• Shear: when the skin stays still but the deeper tissue moves — for example, sliding down in a bed — it can pull and tear the skin from underneath

Risk factors

• Being confined to a bed or wheelchair
• Having trouble moving or changing position on your own
• Older age, because the skin is thinner and less elastic
• Poor nutrition or dehydration that weakens the skin
• Medical conditions like diabetes, blood vessel disease, or spinal cord injury that reduce blood flow or feeling
• Moisture from sweat, urine, or stool that softens the skin
• Being very thin or, less often, having extra body weight that puts pressure on bony points

When to see a doctor

See a doctor urgently if:

• The sore is deep enough that you can see fat, muscle, or bone
• The surrounding skin turns very dark, black, or leathery
• You notice pus, a strong smell, or a fever — signs of an infection
• The sore is growing quickly or not improving after a few weeks of home care

Book a routine appointment if:

• You see a red or purple spot on your skin that lasts for a few days and does not fade when pressed
• You have a small blister or broken skin that seems slow to heal
• You feel pain or a new tenderness over a bony area
• You are at high risk of sores and need a skin care plan from a nurse or doctor

Diagnosis

A doctor or nurse can usually diagnose a pressure sore by looking at it and gently pressing the skin to see if it changes color. They will also ask about how the sore started, how long you have had it, and whether you have any pain or other symptoms.

Tests that may be done

• A simple examination of the size, depth, and color of the sore
• A swab test to check the wound for bacteria if there are signs of infection
• Blood tests to check for infection or poor nutrition
• Sometimes an X-ray or other scan if your doctor suspects the sore has reached the bone

What to expect at your appointment

During a visit, the doctor or nurse will likely ask you to change position so they can look at the sore and the skin around it. They may take a photo to track healing. They will stage the sore from 1 (superficial) to 4 (deep) to help plan treatment. They will also check your overall health, nutrition, and how well you are able to move.

Treatment

The most important part of treating a pressure sore is relieving the pressure that caused it. This means repositioning often, using special cushions or mattresses, and keeping the wound clean and protected. The treatment plan also depends on the stage and whether there is any infection.

Self-care at home

• Change your position at least every 2 hours when in bed, and every 30 minutes when sitting in a wheelchair, if you are able
• Use pillows or foam pads to lift your heels, elbows, and other bony spots off the bed or cushion
• Keep the area clean and dry — wash gently with warm water and pat dry, do not rub
• Eat plenty of protein, vitamins (especially vitamin C and zinc), and drink enough fluids to help your skin heal
• Check your skin every day for any new red areas or changes

Medical treatments

Doctors may use special dressings that help the wound heal, clean the sore with special solutions, or remove dead tissue with a procedure called debridement. If the sore is infected, they may recommend antibiotics. For larger or deeper sores, treatments like vacuum-assisted closure (negative pressure therapy) may be used to draw the edges together and remove extra fluid. Always follow your healthcare team's instructions for changing dressings and cleaning the wound.

When is surgery considered?

Surgery may be needed if a pressure sore is very deep, has not healed after other treatments, or is causing severe damage. A surgeon may clean out the dead tissue and close the wound with a skin graft or a flap of tissue from a nearby area to help it heal. This is usually considered only after trying simpler methods.

Living with this condition

Living with a pressure sore means making position changes and skin care a regular part of your daily routine. You may need to ask family members or caregivers for help if you cannot move easily. Keep a schedule for turning and repositioning, and use a mirror to check areas you cannot see, like your tailbone and heels.

Lifestyle tips

• Try to do gentle movements or exercises within your ability, as movement improves blood flow
• Quit smoking if you smoke, because smoking weakens blood flow and slows healing
• Avoid sitting on a rubber ring or donut cushion, as it can cause more pressure and reduce blood flow
• Wear loose, soft clothing and avoid tight seams or folds that press into the skin

Diet and exercise

A healthy diet is very important for healing pressure sores. Try to eat foods high in protein, such as lean meat, fish, eggs, beans, and dairy. Vitamin C from fruits and vegetables and zinc from nuts or whole grains also help repair skin. Drink enough water to keep your skin hydrated. Gentle exercise, if your doctor says it is safe, can help improve blood flow and general health.

Mental health and emotional wellbeing

Living with a pressure sore can feel frustrating, painful, and isolating. It may limit your freedom and make you feel dependent on others. You might feel sad, anxious, or worried about your recovery. These feelings are common, and it is important to talk about them with your doctor, a counsellor, or a trusted friend.

Prevention

Yes, many pressure sores can be prevented. The key is to regularly change position, keep skin clean and dry, eat a balanced diet, and inspect the skin every day. For people in bed, repositioning every 2 hours is recommended. For those in wheelchairs, shifting weight or a caregiver helping with pressure relief every 15 to 30 minutes can make a big difference. Special support surfaces, like pressure-reducing mattresses and cushions, also help.

Complications

If left untreated

• Infection of the sore that spreads to the skin around it (cellulitis)
• An abscess (a pocket of pus) under the skin
• Infection spreading to the layers of tissue below the skin
• Infection in the bone (osteomyelitis), which is much harder to treat
• A whole-body infection called sepsis, which can be life-threatening

Long-term outlook

With early detection and proper care, most pressure sores heal well, especially when they are only in the early stages. Deeper sores take longer and may need professional treatment, but many people recover completely or at least see significant improvement. Your care team can help you find the right plan to manage pain, prevent infection, and give your skin the best chance to heal. Hopeful progress happens a little at a time, so be patient with yourself.

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