Bedsores are the result of inflammation and damage caused by irritation to the skin and inhibited blood flow. The condition occurs when skin is rubbed against a bed, chair, cast, or other hard object for an extended period of time. Bedsores can range from mild inflammation to deep wounds that involve muscle and bone. Infections can be a serious complication to the condition.
Bedsores are also called decubitus ulcers, pressure ulcers, or pressure sores. They often start out with shiny red skin that becomes itchy or painful, then quickly blisters and deteriorates into open sores. Once there is a break in the skin, there is a strong possibility of the sore becoming infected, causing further medical problems. Bedsores are most apt to develop over the bony prominences of the ankles, the hip bones, the lower back, the shoulders, the spinal column, the buttocks, and the heels of the feet. Bedsores are most likely to occur in people who must use wheelchairs or who are confined to bed.
Bedsores are medically categorized by stages:
- Stage I: The skin reddens, but it remains unbroken.
- Stage II: Redness, swelling, and blisters develop. There is possibly peeling of the outer layer of the skin.
- Stage III: A shallow open wound develops on the skin.
- Stage IV: The sore deepens, spreading through layers of skin and fat down to muscle tissue.
- Stage V: Muscle tissue is broken down.
- Stage VI: The underlying bone is exposed, and there is danger of severe damage and infection.
Causes & symptoms
Bedsores most often happen when the most superficial blood vessels are pressed against the skin and squeezed shut, closing off the flow of blood. If the supply of blood to an area of skin is cut off for more than an hour, the tissue will began to die due to lack of oxygen and nutrients. Ordinarily, the layer of fat under the bony areas of the skin helps keep the blood vessels from being compressed in this way. Also, people have a normal impulse to change positions frequently when they are sitting or lying down, so the blood supply is usually not kept from any area of the skin for very long. Bedsores are most likely to occur in people who have lost the protective fat layer or whose movement impulse is hindered.
Friction or rubbing from poorly fitted shoes or clothing and wrinkled bedding often cause a sore to develop. Constant exposure to the moisture of urine, feces, and perspiration may also cause the skin to deteriorate. In such cases there is an increased the risk of skin infection as well as sores.
Risk factors for bedsores:
- older than 60 years of age
- heart disease
- diminished tactile sensation
- paralysis or immobility
- poor circulation
- prolonged bed rest
- spinal cord injury
- disuse atrophy
Physical examination of the skin, medical history, and patient and caregiver observations are the basis of diagnosis. Any sign of reddening of the skin will be closely monitored.
Contrasting hot and cold local applications can increase circulation to problem areas and help flush out waste products, speeding the healing process. Hot compresses should be applied for three minutes, followed by 30 seconds of cold compress application, repeating the cycle three times. The cycle should always end with the cold compress. In addition, zinc and vitamins A, C, E, and B-complex should be taken to help maintain healthy skin and repair injuries.
A poultice can be made of equal parts of powdered slippery elm, Ulmus fulva; marsh mallow root, Althaea officinalis; and Echinacea spp. The herbs should be blended together with a small amount of hot water and applied to the skin three or four times per day to relieve inflammation. Poultices used on broken skin or infected areas should never be reused.
An herbal tea made from Calendula officinalis can be used as an antiseptic wash and a wound healing agent. Calendula cream can also be applied to the affected area.
A healthcare provider should be consulted whenever a person develops bedsores. An emergency situation may be indicated if sores become tender, swollen, or warm to the touch, if the patient develops a fever, or if the sore has pus or a foul-smelling discharge.
For mild bedsores, treatment basically involves relieving pressure on the area and keeping the skin clean and dry. When the skin is broken, a non-stick covering may be used. A saline solution is often used to clean the wound site whenever a fresh bandage is applied. Disinfectants are applied if the site is infected. The doctor may also prescribe antibiotics, special dressings or drying agents, and ointments to be applied to the wound. Heat
lamps are used quite successfully to dry out and heal the sores. Warm whirlpool treatments are sometimes also recommended for sores on the arm, hand, foot, or leg.
In a procedure called debridement, a scalpel may be used to remove dead tissue or other debris from the wound. Deep sores that don't respond to other therapy may require skin grafts or plastic surgery. If there is a major infection, oral antibiotics may be given. If a bone infection, called osteomyelitis, develops or infection spreads through the bloodstream, aggressive treatment with antibiotics over the course of several weeks may be required.
With proper treatment, bedsores should begin to heal two to four weeks after treatment begins. Left untreated, however, gangrene, osteomyelitis, or a systemic infection may develop. In the United States, about 60,000 deaths a year are attributable to complications caused by bedsores.
Prompt medical attention can prevent pressure sores from deepening into more serious infections. People whose movement or sense of touch is limited by disability and disease should be monitored to insure that the skin remains clean, dry, healthy. A bedridden patient should be repositioned at least once every two hours while awake. A person who uses a wheelchair should remember to shift the body's position often or they should be helped to reposition the body at least once an hour. To avoid injury, it is important to lift, rather than drag, a person being repositioned. Wheelchair users should sit up as straight as possible, with pillows behind the head and between the legs if needed. Donut-shaped seat cushions should not be used because they may restrict blood flow.
Even slight friction can remove the top layer of skin and damage the blood vessels beneath it. Pillows or foam wedges can be used to keep the ankles from rubbing together and irritating each other; pillows placed under the lower legs can raise the heels off the bed. To minimize pressure sores, there should be adequate padding in beds, chairs, and wheelchairs. Those who are bed-ridden can be protected by using sheepskin pads, specialized cushions, and mattresses filled with air or water. In addition, a 1997 study indicates that topical use of essential fatty acids can help the skin stay healthy.
Berkow, MD, Robert, editor-in-chief, et al The Merck Manual of Medical Information, Home Edition. New York: Pocket Books, 1997.
The Editors of Time-Life Books The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments Virginia: Time-Life, Inc., 1996.
Declair, V. Ostomy Wound Management 43, no. 5 (1997): 48-52.
International Association of Enterstomal Therapy, 27241 La Paz Road, Suite 121, Laguna Niguel, CA 92656
National Pressure Ulcer Advisory Panel, SUNY at Buffalo, Beck Hall, 3435 Main Street, Buffalo, NY 14214 <http://www.npuap.org.>