Bedsores: Causes and Treatments

Bedsores are areas of damaged skin and tissue that develop when sustained pressure cuts off circulation to parts of your body. People on bed rest or who use wheelchairs regularly are especially at risk. See more pictures of skin problems.
Bedsores are areas of damaged skin and tissue that develop when sustained pressure cuts off circulation to parts of your body. People on bed rest or who use wheelchairs regularly are especially at risk. See more pictures of skin problems.
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For many people, bed rest is a welcome respite when recovering from a cold, the flu or a minor injury or illness. For people who are bedridden because of major illnesses, disability or old age, however, extended hours in bed can be a source of real pain. Prolonged bed rest can cause injury to skin and tissue on various parts of the body, a condition commonly known as bedsores.

A bedsore, also known as a pressure ulcer or decubitus ulcer, is an area of skin that's become damaged from constant pressure and prolonged lack of movement. Constant pressure decreases blood flow to the area, which causes skin cells to die and the skin itself to break down. The damaged area eventually becomes an open wound, causing further damage and possible infection to muscle and bone tissue below [source: Zeller].


Bedsores most often develop among people who use wheelchairs regularly or who cannot leave their beds. Their inability to move or turn over makes them especially susceptible [source: Mayo Clinic]. Bedsores are a common problem in hospitals. In 2003, nearly half a million U.S. hospital patients suffered from bedsores during their stay. That number represented a 63 percent increase from 1993 statistics [source: Russo].

But bedsores don't just happen in hospitals. Many people who are on bed rest at home or who use wheelchairs in their daily lives are vulnerable to the damaging effects of reduced mobility. These people often deal with bedsores on a regular basis, so it's important for them and their caregivers to understand the causes and symptoms of bedsores as well as the treatments and preventive measures.

Read on to learn how to prevent and treat this common skin condition.


Bedsore Symptoms

It's important to recognize the early signs of bedsores to alleviate pain and reduce damage. Understanding the symptoms and signs of bedsores can also help prevent them.

The name "bedsores" can deceive people about the severity of the condition. Bedsores aren't simply skin irritations that affect only the skin's surface. They may begin that way, but bedsores quickly develop into major wounds that infect not only the skin, but also the muscle, bone and blood below [source: AETNA InteliHealth]. Bedsores can also be extremely painful.


Early signs of a bedsore include long-lasting redness in a particular area of skin that's itchy or painful. The area may also feel warm or spongy. In people with darker skin, the area may appear blue or purple rather than red and may become flaky. These are considered stage I symptoms [source: Mayo Clinic].

If caught in the early stages, more serious damage can be prevented. Alleviating the pressure to the area should enable the developing bedsore to clear up on its own. However, if a bedsore goes unnoticed and the pressure continues, then it quickly advances to the next stage. Stage II symptoms include skin loss and the growth of a blister or an open sore [source: Collison]. Red or purple coloring may infuse the area and swelling may occur [source: AETNA InteliHealth]. If the bedsore continues untreated, then stage III symptoms will develop.

At stage III, the damage has moved beyond the skin's outermost layers, and infection has spread to the tissue below. The bedsore now looks more like a deep crater [source: Mayo Clinic]. At this point, the bedsores are causing more serious pain, and they must be treated to avoid stage IV complications.

A stage IV bedsore is a serious medical emergency. At this point the wound has deepened and reached a person's muscles, bones and joints, and the person is at risk of developing an infection that can spread to the blood [source: Mayo Clinic]. If the infection reaches the blood, a condition known as sepsis, then it can be carried to other parts of the body, including the heart [source: Zeller]. Signs of sepsis include fever and chills. Stage IV bedsores require more invasive and prolonged medical treatment.

Read on to learn how to treat bedsores at various stages.


Treating Bedsores

Treating bedsores early is important because bedsores can advance from one stage to the next rapidly. If stage I symptoms occur, then steps to relieve pressure on the area should be taken immediately. It's also important to keep the affected skin clean by washing it with mild soap and water and drying the area gently [source: University of Washington School of Medicine].

Once the bedsore has moved beyond stage I, seek medical advice from a doctor. If the skin is already broken, the wound requires a dressing to protect the damaged area. See-through dressings are best, and specially treated dressings, such as hydrocolloid patches, provide added healing and protection for deeper sores [source: Collison]. Dressings should be changed often, and the wound should be cleaned to avoid infection.


Extremely damaged and infected skin, such as that found in stages III and IV, requires special attention. Dead skin around the wound prevents skin from healing and must be removed through a process called debridement [source American Geriatrics Society Foundation for Health in Aging]. Medical professionals use several methods of debridement and will evaluate each patient to determine the best process.

A doctor may also prescribe a medicated ointment or antibiotics to ward off infection. Antibiotics can be taken orally or by injection [source: University of Washington School of Medicine]. If infection of internal tissues or the blood occurs, then patients may require prolonged antibiotic treatment.

There are products that make bed rest easier for people who have bedsores, including cushions and pillows that relieve pressure on the body where a sore is developing [source: Mayo Clinic]. If symptoms are caught in the early stages, they can heal on their own and medical intervention can be avoided [source: Mayo Clinic].

Read on to learn how to prevent bedsores.


Preventing Bedsores

Prevention is the best medicine, especially with a painful condition like bedsores, because bedsores are easier to prevent than to treat [source: Mayo Clinic].

Bedsores can develop quickly on people who are immobile or bedridden, and even a few hours of lying or sitting in one position can cause the beginnings of a bedsore. Certain areas of the body are more likely to suffer from sustained pressure, including the back of the head, heels, hips, lower back, spine and shoulder blades [source: Haggerty]. Shifting position to relieve pressure on these spots can go a long way toward preventing bedsores.


Daily exercise can also increase blood flow throughout the body. Even bedridden people can perform stretches and simple exercises in bed [source: AETNA InteliHealth]. People who can't leave their beds or who use wheelchairs regularly should consult a doctor or physical therapist to learn what activities they can do to increase blood flow and reduce their immobility.

Treatment methods mentioned previously can also be used as preventive activities. Eating healthy food, drinking adequate fluids, keeping the skin clean and dry, and avoiding chemicals and harsh detergents can all reduce a person's susceptibility to bedsores. People concerned about bedsores should also keep bed sheets clean, dry and free from crumbs and particles to reduce friction. When leaving the bed, a person should be lifted off the mattress instead of being pulled along the sheet [source: AETNA InteliHealth]. And, as mentioned previously, certain pillows, seat cushions and mattresses can reduce pressure on specific body parts. Special beds that circulate air, which lessen pressure on the body, are also available [source: Collison].

Another preventive measure is appropriate body positioning. Lying on one's side generates less pressure than lying directly on one's hipbones. Separating the knees and ankles with small pillows or pads also helps. And limiting skin-to-skin contact means less friction and moisture on the skin, reducing the likelihood that bedsores will develop [source: Mayo Clinic].

Understanding the causes of bedsores, taking appropriate preventive measures and pursuing treatment early will all help reduce the painful effects of this condition. For more information, check out the links on the next page.


Lots More Information

Related HowStuffWorks Articles

  • AETNA InteliHealth. "Bedsores (Decubitus Ulcers)." (Accessed August 4, 2009)
  • American Academy of Family Physicians. "Pressure Sores." September 2000. (Accessed August 4, 2009)
  • American Cancer Society, Inc. "Skin (Pressure) Sores." April 27, 2009. (Accessed August 4, 2009)
  • American Geriatrics Society Foundation for Health in Aging. "Pressure Ulcers (Bedsores)." March 17, 2005. (Accessed August 4, 2009)
  • Collison, Daniel W. "Pressure Sores." The Merck Manuals Online Medical Library. October 2008. (Accessed August 5, 2009)
  • Haggerty, Maureen and L. Lee Culvert. "Bedsores." Encyclopedia of Surgery. (Accessed August 4, 2009)
  • Mayo Clinic. "Bedsores (pressure sores): Prevention." (Accessed August 4, 2009)
  • Mayo Clinic. "Bedsores (pressure sores): Symptoms." (Accessed August 4, 2009)
  • Russo, C. Allison and Elixhauser, Anne. "Hospitalizations Related to Pressure Sores, 2003." Agency for Healthcare Research and Quality. April 2006. (Accessed August 4, 2009)
  • University of Washington School of Medicine. "Taking Care of Pressure Sores." (Accessed August 4, 2009)
  • Zeller, John L., "Pressure Ulcers." Journal of the American Medical Association. August 23, 2006. (Accessed August 4, 2009)