Pressure Ulcers

What are pressure ulcers?

A pressure ulcer is a breakdown of skin and underlying tissue caused by constant pressure on the skin for a long time. Pressure ulcers can occur if you lie in bed or sit in a chair for long periods of time without shifting your weight. They may also be caused by rubbing or friction on the skin.

Pressure ulcers used to be called bedsores.

How do they occur?

Pressure ulcers are caused by pressure or rubbing of the skin that covers the parts of the body where the bones are easily felt. The most common areas of the body for pressure ulcers are the tailbone, top of pelvis, side of hip joint, back of the heel, ankle, knee, and elbow. Constant pressure on the skin squeezes the tiny blood vessels that supply the skin with nutrients and oxygen. When skin is starved of nutrients and oxygen for too long, the tissue dies and a pressure ulcer forms.

The following risk factors increase your chance of getting pressure ulcers:

• bed or chair confinement
• inability to move without help
• loss of bowel or bladder control (the moisture from stool or urine may irritate the skin)
• poor nutrition, resulting in unhealthy skin
• decreased alertness, possibly from health problems, medicines, or anesthesia
• a lack of fat tissue over bony areas such as the hips, heels, and ankles.

What are the symptoms?

Pressure ulcers appear over bony parts of the body where there is irritation or pressure. The symptoms develop in stages:

• Stage I: A reddened or darkened area of skin appears and does not go away within 30 minutes after you change your position to put less pressure on the area.
• Stage II: The skin cracks, blisters, peels, or breaks.
• Stage III: The skin opens up and may ooze or drain. The ulcer is completely through the skin and may start to involve underlying tissues. Some yellow tissue may be seen.
• Stage IV: A deep ulcer develops. Muscle is visible. Bone may also become visible.

How are they diagnosed?

Your health care provider will examine your skin.

How are they treated?

Treatment depends on how severe the ulcer is. Pressure ulcers need prompt and ongoing care in the early stages to try to avoid tissue damage and infection.

If you have any of the symptoms listed above, you should:

• Tell your health care provider.
• Keep pressure off the area. For example, if the ulcer is on your back, try to lie on your stomach or side.
• Keep the ulcer clean and protect it from urine and stool. Several products can be used to clean and protect the skin. Your health care provider can help you with this.
• If the skin is broken, your health care provider can recommend a product that will help the ulcer heal. It will also protect the area from infection and protect the skin around the ulcer.
• Do not massage the area. Massage may cause more tissue damage. Also, do not massage any of the bony parts of your body.
• Turn or change your position every 1 to 2 hours.
• Eat a healthy diet. Talk with your health care provider and dietitian about your diet and nutritional supplements.
• Ask your health care provider about special products that can help reduce pressure on the skin. Ask about mattress and chair cushions to reduce pressure. Do not use doughnut cushions to reduce pressure; they may make the condition worse.
• Tell your health care provider right away if you develop a fever, notice an odor or change in the color of drainage from an ulcer, or develop redness around an ulcer.
• If you are unable to move easily, pillows may be placed under your legs from midcalf to ankle to keep your heels off the bed. Never place pillows under your knees. This puts pressure on your heels.
• Exercise your body by tensing and relaxing your muscles, wiggling fingers and toes, and rotating your wrists and ankles to keep them as flexible as possible. If you can't do this, have someone bend and straighten your arms and legs every day to keep you from getting stiff.
• Lightly powder your sheets to reduce friction. Someone helping you to change position can use a sheet to lift you so you don't have to slide on the bed.
• Try not to elevate the head of your bed more than 30 degrees except when you eat or drink.

How long will the effects last?

Pressure ulcers can take a long time to heal if they are completely through the skin. The rate at which the broken skin heals depends on your general health, diet, and home care. It is best to try to prevent pressure ulcers.