Pressure ulcer prevention positioning

Overview

Pressure ulcers, also called bedsores, are injuries to the skin and the tissue underneath caused by constant pressure on one area of the body. They happen most often on bony parts like the heels, hips, tailbone, and elbows. With careful positioning and regular movement, most pressure ulcers can be prevented.

Yes, pressure ulcers are common in hospitals, nursing homes, and for people cared for at home. Anyone who cannot move easily is at risk.

Pressure ulcers affect people who have trouble moving on their own, such as those who are bedridden, use a wheelchair, or have limited mobility due to illness, injury, or aging. Older adults and people with poor nutrition or medical conditions like diabetes are also more likely to get them.

Symptoms

Common symptoms

• A patch of skin that feels warm, firm, or spongy when touched.
• Redness that does not go away or turn white when pressed.
• A blister, open sore, or a shallow crater in the skin.
• Pain or tenderness in the affected area.

Symptoms in children

• Irritability or crying when touched or moved.
• Redness on the back of the head, heels, or hips (common areas in young children).
• Restlessness or refusing to stay in one position.

Symptoms in older adults

• Skin thins with age, so pressure ulcers may form faster and look deeper sooner.
• Older adults may not feel pain as strongly, so check skin daily.
• Discoloration that is purple or dark (on darker skin tones, look for changes in skin texture or temperature).

Causes

Main causes

• Prolonged pressure on one part of the body from lying or sitting in the same position.
• Friction or rubbing of the skin against bed sheets or clothing.
• Shear — when the skin stays in place but the deeper tissues shift, for example when sliding down in bed.
• Moisture from sweat, urine, or stool that softens and damages the skin.

Risk factors

• Being unable to move yourself (for example, after a stroke, spinal cord injury, or during illness).
• Poor nutrition and dehydration, which weaken the skin and tissue.
• Medical conditions such as diabetes, vascular disease, or incontinence.
• Age — older adults have thinner, more fragile skin.
• Being very underweight or overweight.

When to see a doctor

See a doctor urgently if:

• Any sore that shows signs of infection (fever, chills, red streaks, increased pain, pus).
• A deep wound where you can see fat, muscle, or bone.

Book a routine appointment if:

• Skin that stays red after you reposition and does not fade within 30 minutes.
• A blister or small open sore that does not improve with skincare and repositioning over a few days.
• You notice a change in skin color or texture on a bony area, especially if you or your caregiver cannot prevent pressure.

Diagnosis

A doctor or nurse will examine your skin and look at the sore. They will ask about how long you have been in one position, any medical conditions, and your nutrition. The sore is then ‘staged’ to describe how deep it is.

Tests that may be done

• Visual inspection — looking at the size, depth, color, and edges of the sore.
• Checking for signs of infection, sometimes with a swab of the wound (culture).
• In rare cases, an X-ray or MRI to see if the infection has spread to the bone (osteomyelitis).

What to expect at your appointment

The healthcare provider will explain the stage of your pressure ulcer (from stage 1 — just red skin, to stage 4 — deep wound). They will talk to you and your caregiver about a care plan that includes repositioning, wound cleaning, special dressings, and nutrition advice.

Treatment

Treatment focuses on taking the pressure off the sore, keeping the wound clean and moist, and helping your body heal. You will need to change positions regularly and use special cushions or mattresses. Good nutrition and hydration are also important.

Self-care at home

• Reposition yourself or ask for help every 2 hours while in bed, and every 15 minutes while sitting in a chair.
• Use pillows, foam wedges, or special cushions to keep pressure off bony areas.
• Keep the skin clean and dry — gently wash and pat dry, do not rub.
• Eat enough protein and drink plenty of fluids to support healing.

Medical treatments

A nurse or doctor may clean the wound with a special solution and apply a dressing that helps keep the area moist. They may use a pressure-relieving mattress or a special bed. For deeper wounds, dead tissue may be removed (debridement) to allow healing. In some cases, a wound vacuum (negative pressure therapy) is used. Your healthcare team will choose the right approach for your specific needs.

When is surgery considered?

Surgery is rarely needed. It may be considered for deep, non-healing pressure ulcers that do not get better with other treatments. A surgeon can clean the wound and close it with a skin flap or graft.

Living with this condition

Living with a pressure ulcer means sticking to a regular turning schedule. Set timers or have a caregiver help you change position. Use pressure-relieving devices like special mattresses or wheelchair cushions. Check your skin every day, and ask for help looking at areas you cannot see.

Lifestyle tips

• Stay as active as possible — even small movements in bed or chair help.
• Use proper equipment: a pressure-relieving mattress, a cushion suited to your chair, and soft bedding.
• Keep the bed free of crumbs and wrinkled sheets that can cause friction.

Diet and exercise

Eat a balanced diet rich in protein (for example, eggs, beans, meat, dairy) and vitamins, especially vitamin C and zinc, which help wound healing. Drink enough water unless your doctor says otherwise. Gentle exercises, like arm or leg lifts if you can, improve blood flow and reduce pressure.

Mental health and emotional wellbeing

Dealing with a pressure ulcer can be frustrating and worrying. It may feel like a setback, especially if you are already unwell. It is normal to feel anxious or down. Talk to your doctor, nurse, or a counselor. You are not alone — pressure ulcers are common and can heal with proper care.

Prevention

Yes, most pressure ulcers can be prevented. The keys are: change position often, protect bony areas with cushions or pillows, keep skin clean and dry, eat well, and check your skin daily. If you are caring for someone who cannot move, learn the proper turning techniques from a nurse.

Vaccines

Not applicable.

Screening programmes

Regular skin checks are recommended for anyone who is at risk. A caregiver or healthcare provider should inspect the skin at least once a day, especially over bony parts of the body.

Complications

If left untreated

• Infection of the sore (cellulitis) that can spread to deeper tissues.
• A serious infection in the bone (osteomyelitis) that is hard to treat.
• Sepsis — a life-threatening infection that spreads through the blood.
• Slow healing and permanent damage to the skin and tissue.

Long-term outlook

With early detection and consistent care, most pressure ulcers heal. Stage 1 and 2 sores often heal completely in a few weeks. Deeper ulcers take longer but many get better with proper treatment, good nutrition, and careful positioning. Your healthcare team will work with you to give you the best chance of healing.

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