Decubitus ulcers or bedsores are sores that develop when an individual is unable to change positions for extended periods of time. They may be prevented by moving to a new position at least every 2 hours.
A decubitus ulcer is also known as a pressure ulcer, pressure sore, or bedsore. It’s an open wound on your skin caused by a long period of constant pressure to a specific area of the body. Decreased blood flow to these areas leads to tissue damage and death.
Decubitus ulcers often occur on the skin covering bony areas. The most common places for a decubitus ulcer are your:
This condition is common among people who are older and people who have decreased mobility. Left untreated, infections can spread to the blood, heart, and bones and become life threatening.
But it’s important to know that bedsores can be treated. An individual’s outlook depends on several factors, including underlying medical conditions as well as the stage of the ulcer.
Decubitus ulcers occur in stages. There’s a staging process to help your healthcare professional diagnose and treat you.
Stage 1 and 2 ulcers usually do not require surgery, but stage 3 and 4 ulcers may.
The skin isn’t broken, but it’s discolored. The area may appear red if you have a light complexion. The discoloration may vary from blue to purple if you have a darker complexion.
For example, if you have a lighter complexion, a sore can turn red instead of turning lighter when you press on it. The sore will stay red for at least 30 minutes.
It may also:
- feel warm to the touch
- look swollen
- be painful
A break in the skin reveals a shallow sore or cut that may leak pus. The sore may also look like a blister filled with fluid. It affects the first (epidermis) and possibly the second (dermis) layers of skin.
The ulcer hurts, and the surrounding skin may be discolored.
The ulcer is much deeper within the skin, affecting your fat layer. You should not be able to see bones or tendons.
The sore looks like a crater and may be foul smelling.
This ulcer is very deep and affects many tissue layers, possibly including the bone. There is a lot of dead tissue and pus. Infection is likely in this stage.
You may be able to see:
Sometimes, it’s not possible to measure the depth of a sore or the amount of tissue damage that has occurred. This makes it difficult to fully evaluate and stage an ulcer.
This may be due to the presence of a hard plaque called an eschar inside the sore. The sore may look:
Ulcers can also contain discolored debris known as slough that may appear:
Your doctor may need to remove the eschar or slough to determine the full extent of the ulcer. Further imaging or surgical evaluation of the area may be required.
Each stage of a decubitus ulcer has different symptoms. Depending on the stage, you may have any of the following:
- skin discoloration
- pain, itching, or burning in the affected area
- open skin
- skin that doesn’t lighten to the touch
- skin that’s softer or firmer than the surrounding skin
- necrosis, or dead tissue that appears black
The sore may also be infected. Symptoms of infection include:
- redness or discoloration surrounding the sore
- pus or green-colored drainage
- a foul smell
Prolonged pressure is essentially the main cause of a decubitus ulcer. Lying on a certain part of your body for long periods causes your skin to break down. The areas around the hips, heels, and tailbone are especially vulnerable to these types of sores.
Other factors that increase the odds of experiencing a bedsore include:
- poor circulation
- excessive moisture
- skin irritants like urine and feces
- friction, such as when a person who is confined to bed has sheets dragged from under them
You may be at greater risk of decubitus ulcers if you:
- are confined to bed following surgery or illness
- can’t move or change positions by yourself while lying in bed or sitting in a wheelchair
- are over 70 years old, as older adults are more likely to have fragile skin and mobility difficulties
- have obesity
- don’t get enough nutrients in your diet, which may influence the condition of your skin
- have urinary or bowel incontinence
- have chronic conditions that can restrict your blood circulation or limit your mobility, such as:
Your healthcare professional may refer you to a wound care team of doctors, specialists, and nurses experienced in treating pressure sores. The team may evaluate your ulcer based on several factors, including:
- the size and depth of your ulcer
- the type of tissue directly affected by your ulcer, such as skin, muscle, or bone
- the color of the skin affected by your ulcer
- the amount of tissue death that occurs from your ulcer
- the condition of your ulcer, such as presence of infection, strong odor, or bleeding
Your healthcare professional may take a biopsy, or sample of the fluids and tissue in your decubitus ulcer, and send it to a lab for testing.
Your treatment will depend on the stage and condition of your ulcer. Repositioning frequently and keeping the site clean, dry, and free of irritants is important to promote healing.
Treatment may include:
- treatment of any infection that is present, which may include:
- antibiotic cream
- oral antibiotics
- intravenous (IV) antibiotics
- local wound care, including specific cleaning and dressing recommendations
- using special bandages that help remove dead tissue
- medication to relieve or reduce any discomfort
- debridement, which removes dead or infected tissue
- repositioning frequently
- reducing friction and moisture in the location
- using special off-loading cushions to reduce pressure on the sore
Stage 3 and 4 ulcers are more likely to require surgical debridement and negative pressure wound therapy. Chronic deep ulcers may be difficult to treat.
Your treatment strategy depends on several factors. Your doctor will discuss the best options for your specific ulcer.
Your doctor or a physical therapist can make recommendations to reduce the likelihood of experiencing bedsores. They may recommend:
- changing positions in bed at least every 2 hours
- if you use a wheelchair, aiming to:
- sit upright
- shift your sitting position every 15 minutes
- use a cushion that redistributes your weight
- regularly checking your skin for signs of pressure sores, if you’re hospitalized or otherwise immobilized
- using pillows or a pressure-reducing mattress to prevent new sores from forming in vulnerable areas
- wearing clothing that isn’t too tight or loose or that bunches up under you
- wearing special padding on pressure points including elbows and heels
- quitting smoking, if you currently smoke
- dietary modifications for adequate nutrition and possibly working with a registered dietitian
- staying hydrated
- exercising as much as possible, such as taking short walks a couple of times per day or sitting up and stretching
Your healing process depends on the stage of your ulcer. The sooner it’s diagnosed, the sooner you can begin treatment and recovery.
Early treatment reduces the likelihood of experiencing possibly life threatening complications, including infection. Later stages often require more aggressive treatments and longer recovery times.
Your healthcare professional may suggest that you change your diet and exercise routine to reduce the risk of recurrence. This may involve eating a balanced diet and getting regular exercise as best you can.