Bedsores, also known as pressure ulcers or decubitus ulcers, are one of the most common yet preventable wounds, especially among people with limited mobility. These painful wounds not only affect the skin but can also lead to serious complications if left untreated.

Understanding bedsores, their causes, stages, treatment, and proper care is essential for patients, caregivers, and healthcare professionals. In this blog, we provide a comprehensive wound guide to help manage and prevent bedsores effectively.

What Are Bedsores?

Bedsores are injuries to the skin and underlying tissue caused by prolonged pressure on the skin. They commonly develop on bony areas like the heels, ankles, hips, and tailbone.

When pressure restricts blood flow to the skin, tissue damage occurs, leading to painful wounds. Bedsores are particularly common in people who are bedridden, use wheelchairs, or are unable to change positions frequently.

Unlike simple skin irritations, bedsores can progress to deep wounds, exposing muscle or bone if not treated promptly.

Causes of Bedsores

Bedsores are primarily caused by prolonged pressure, but several factors contribute to their development:

1. Immobility

Patients who are bedridden, paralyzed, or use a wheelchair for long periods are at high risk.

2. Poor Nutrition and Hydration

Skin health depends on adequate nutrients and hydration. Malnutrition or dehydration increases the risk of bedsores.

3. Friction and Shear

Sliding in bed or a chair can cause friction, damaging the skin layers.

4. Medical Conditions

Conditions like diabetes, vascular diseases, or neuropathy can reduce blood flow and sensation, increasing the risk of pressure ulcers.

5. Age

Older adults have thinner skin, which is more prone to injury from pressure.

6. Moisture

Excess moisture from sweating, incontinence, or wound drainage can weaken the skin.

Stages of Bedsores

Bedsores are classified into four stages, based on severity:

Stage 1: Reddened Skin

• Skin is intact but red or discolored
• Area may feel warm, firm, or painful
• No open wound yet

Stage 2: Partial Thickness

• Partial loss of skin: appears as a blister or shallow open sore
• Surrounding skin may be red or irritated
• Pain is noticeable

Stage 3: Full Thickness

• Damage extends into the fat layer beneath the skin
• Wound appears deep, crater-like, sometimes with yellowish tissue (slough)
• Increased risk of infection

Stage 4: Severe Full Thickness

• Extensive tissue damage, exposing muscle, tendon, or bone
• Often accompanied by necrosis or infection
• Healing is difficult and may require surgical intervention

Symptoms of Bedsores

Common symptoms include:

• Red, inflamed, or discolored skin
• Pain or tenderness in the affected area
• Open sores with drainage in advanced stages
• Swelling or warmth around the wound
• Foul odor (indicating infection)

Early recognition is key Stage 1 bedsores are often reversible with proper care.

Diagnosing Bedsores

Healthcare providers use a combination of physical examination and patient history to diagnose bedsores:

• Visual Inspection: Stage, depth, and location of the ulcer
• Palpation: Checking skin temperature, texture, and firmness
• Imaging Tests: X rays or MRI may be used to assess underlying tissue or bone infection in advanced cases
• Lab Tests: Blood tests can help detect infection or nutritional deficiencies

Treatment of Bedsores

Treatment depends on stage and severity. The goal is to promote healing, prevent infection, and relieve pressure.

1. Relieve Pressure

• Regularly change positions (every 2 hours for bedridden patients)
• Use special mattresses, cushions, or foam pads to reduce pressure

2. Wound Care

Proper wound care is crucial. This wound guide can help manage bedsores:

Step 1: Clean the Wound

• Use sterile saline to gently clean the ulcer
• Avoid harsh chemicals that damage tissue

Step 2: Debridement

• Remove dead tissue to encourage healing
• Can be done surgically, mechanically, chemically, or with enzymes under medical supervision

Step 3: Apply Dressings

• Hydrocolloid dressings: maintain moisture and protect from infection
• Foam or alginate dressings: absorb exudate and cushion the wound
• Transparent film dressings: allow observation while protecting skin

Step 4: Monitor for Infection

• Signs include redness, warmth, pus, swelling, or foul odor
• Antibiotics may be prescribed if infection occurs

Step 5: Support Healing

• Maintain clean, dry skin around the ulcer
• Keep patient well-nourished and hydrated
• Encourage movement and repositioning as tolerated

3. Pain Management

• Over-the-counter medications (acetaminophen, ibuprofen)
• Prescription medications for severe pain
• Positioning and cushioning can reduce discomfort

4. Advanced Treatments

For Stage 3 or 4 bedsores:

• Negative pressure wound therapy (vacuum-assisted closure)
• Skin grafts or surgical repair
• Hyperbaric oxygen therapy in some cases to enhance healing

The Healing Process of Bedsores

Bedsores heal slowly due to reduced blood flow and tissue damage. The process includes:

1. Inflammatory Phase: Body responds with redness, swelling, and pain; white blood cells fight infection.
2. Proliferative Phase: New tissue forms, including collagen and small blood vessels.
3. Maturation Phase: Wound contracts and strengthens; skin remodeling occurs.

Healing time varies from weeks to months, depending on the stage and overall health of the patient.

Preventing Bedsores

Prevention is always better than treatment. Key steps include:

• Reposition immobile patients every 1–2 hours
• Use pressure-relieving mattresses or cushions
• Keep skin clean, dry, and moisturized
• Ensure proper nutrition and hydration
• Inspect skin daily for early signs of pressure injuries
• Avoid friction by using lifting devices or proper techniques

Complications of Bedsores

If left untreated, bedsores can lead to:

• Infections: Cellulitis, bone infection (osteomyelitis), or sepsis
• Chronic wounds: Long-lasting ulcers that are difficult to heal
• Tissue necrosis: Dead tissue that may require surgery
• Severe pain and reduced mobility

Early recognition and proper care are critical to avoid these complications.

When to Seek Medical Help

Seek immediate attention if you notice:

• Worsening wounds or spreading redness
• Pus, foul odor, or signs of infection
• Fever or feeling unwell
• Black, deep, or exposed tissue

Prompt medical intervention can save tissue and prevent life-threatening infections.

Conclusion

Bedsores are serious wounds that affect skin and tissue health, particularly among people with limited mobility. With the right knowledge, preventive measures, and proper wound care, most bedsores are treatable and preventable.

This blog serves as a complete wound guide for bedsores, covering causes, stages, treatment, healing, and prevention. Early recognition, regular monitoring, and proper care can make a huge difference in recovery and quality of life.