What are Kennedy ulcers?

A Kennedy ulcer, also known as a Kennedy terminal ulcer (KTU), is a dark sore that develops rapidly during the final stages of a person’s life. Kennedy ulcers grow as skin breaks down as part of the dying process. Not everyone experiences these ulcers in their final days and hours, but they’re not uncommon.

While they can look similar, Kennedy ulcers are different from pressure sores or bed sores, which happen to people who’ve spent days or weeks laying down with little movement. No one is sure about the exact cause of Kennedy ulcers.

Keep reading to learn more about Kennedy ulcers, including how to recognize them and whether there’s anything you can do to treat them.

It can be hard to distinguish between a pressure sore or bruise and a Kennedy ulcer at first glance. However, Kennedy ulcers have a few unique characteristics that you can look for:

  • Location. Kennedy ulcers typically develop on the sacrum. The sacrum is a triangle-shaped area of the lower back where the spine and pelvis meet. This area is also sometimes called the tail bone.
  • Shape. Kennedy ulcers often start as a pear- or butterfly-shaped bruise. The initial spot may grow rapidly. You may observe various shapes and sizes as the ulcer spreads.
  • Color. Kennedy ulcers can have a range of colors, similar to a bruise. You may see shades of red, yellow, black, purple, and blue. In its later stages, a Kennedy ulcer starts to become more black and swollen. This is a sign of tissue death.
  • Onset. Unlike pressure sores, which can take weeks to develop,Kennedy ulcers pop up suddenly. It may look like a bruise at the start of the day and an ulcer by the end of the day.
  • Borders. The edges of a Kennedy ulcer are often irregular, and the shape is rarely symmetrical. Bruises, however, may be more uniform in size and shape.

It’s unclear why Kennedy ulcers develop. Doctors believe that the deteriorating skin may be a sign that organs and body functions are shutting down. Much like your heart or lungs, your skin is an organ.

As the vascular system shuts down, it also becomes harder to pump blood throughout the body. This may cause bones to put added pressure and stress on the skin.

In addition, people with an underlying condition causing organ failure or a progressive disease may be more likely to develop a Kennedy ulcer, but they can affect anyone near the end of their life.

In the majority of cases, a person who develops a Kennedy ulcer will already be under the close supervision of a doctor or hospice care provider who knows how to recognize Kennedy ulcers. However, sometimes a caregiver or loved one may be the first to notice the ulcer.

If you think you or a loved one might have a Kennedy ulcer, tell a doctor as soon as possible. Try to note how long the sore has been there and how quickly it’s changed since you first noticed it. This information is very helpful for distinguishing a pressure sore from a Kennedy ulcer.

Kennedy ulcers usually signal the start of the dying process, and there’s no way to get rid of them. Instead, treatment focuses on making the person as comfortable and pain-free as possible. Depending on where the ulcer is, this might involve placing a soft cushion under the affected area.

If a loved one has a Kennedy ulcer, this may be a good time to invite other loved ones in to say goodbye. If you’re not there, their care team of doctors and nurses may call on you to be by your loved one’s side in their final moments.

It’s never easy to watch the signs of death appear, especially in a loved one. If you’re caring for a dying family member or close friend, make sure to take care of yourself, too. Try to allow others to support you by pitching in with everyday tasks, such as cooking and cleaning.

If you’re feeling overwhelmed, consider seeking out resources from the Association for Death Education and Counseling, which provides a list of resources for many scenarios involving death and grief. Doing this early in the process can also help to prepare you for the possible feelings of depression following the death of a loved one.

Suggested reads

  • The Year of Magical Thinking” is Joan Didion’s award-winning account of her own grieving process following the death of her husband while her daughter was seriously ill.
  • The Goodbye Book” is a great, simple tool to help children process the emotions that come along with losing a loved one.
  • The Grief Recovery Handbook” provides actionable advice to help people overcome grief. It’s written by a group of counselors from the Grief Recovery Institute, is now in its 20th edition, and includes new content dealing with other difficult topics, including divorce and PTSD.
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