Understanding Bedsores: Causes and Treatment Tips from the Experts

By Ashley Little

Medically Reviewed by Susan Bard, MD, is NYC based Board Certified Dermatologist.

Bedsores (otherwise known as pressure ulcers) are a common reality for many bedridden populations across the country. But what exactly are they? Let’s take a look as we explore the causes, symptoms, and complications of bedsores and share some tips from the experts on how to prevent and treat them.

What are Bedsores? 

Also known as pressure ulcers, bedsores are wounds that affect the skin and underlying tissue. 

Causes:

  1. Sustained pressure on one area of the body
  2. Friction between the skin and different fabrics, like clothes or sheets
  3. Shearing occurs when the skin is pulled in one direction while the weight of the body is pulled in the other

Bedsores form due to restricted mobility and tend to affect those who are confined to a bed or those who use a wheelchair full-time.

In both situations, pressure is exerted on various parts of the body day in and day out, such as the tailbone for wheelchair-users or the back of the head for those lying down in bed. This sustained pressure restricts blood flow and can lead to tissue breakdown, leading to the formation of bedsores.

Although pressure is typically the leading cause of bedsores, friction and shearing can also add to the problem. Friction becomes a problem when rough fabrics rub against fragile skin, causing it to break down more easily. This breakdown, when combined with sustained pressure, can definitely create a bedsore.

Shearing, which occurs when the skin is pulled one way, and the body’s weight is pulled another, can also lead to skin breakdown and cause additional pressure. Shearing happens most often when a person is in a bed with the head elevated more than 30 degrees. Shearing can cause the person to slide down slightly while their skin stays in place, creating tension, which could break down the skin and lead to bedsores.

Stages of Bedsores

  • Stage 1: When bedsores first form, they might burn, itch, or feel abnormally warm or cool to the touch. In their early stages, bedsores might make the skin feel unusually spongy or hard, or you may notice the skin breaking down through peeling or flaking.
  • Stage 2: As bedsores progress, they start to fill with fibrin, making them yellow-ish in appearance. They might ooze pus or clear liquid, and they are almost always painful at this stage.
  • Stage 3: If bedsores continue to go untreated, the tissue may start to die and turn black, and the wound will begin to look like a crater as the damage descends below the skin into the fatty tissue.
  • Stage 4: At their worst, bedsores can even eat into muscle tissue, exposing the bone underneath as all of the protective skin and fat dies. These are incredibly extreme cases that may require surgery to repair.

 

Common Areas 

Bedsores typically form on areas of the body that experience consistent pressure (which is why they are also called pressure ulcers).

Some of the most common areas where bedsores might form include:

graphic of bedsores pressure point
back image bedsores pressure points

Risk Factors

If you live a relatively active, able-bodied lifestyle, you might be tempted to believe that bedsores are rare or only happen to elderly populations, but the truth is, bedsores can happen to all kinds of people for all sorts of reasons.

Seniors

This group may have a variety of conditions that restrict their movement; this restricted movement, combined with the fragility of aging skin, can lead to bedsores. According to research published in Wounds Research Clinical Journal, 71% of bedsores occur in patients over 70 years in age.

Full-time wheelchair-users

This subgroup is also at heightened risk for bed sores. According to one study, wheelchair-users spend more than 3 years in hospitals dealing with bedsores, on average. This increased risk is due to the consistent pressure being exerted through constant sitting.

Post-op patients

Bedsores can form during the recovery period after surgery when a patient has severely limited mobility. However, some research shows that bedsores could start forming even as the surgery is being performed. 

According to a study published in the Association of periOperative Registered Nurses Journal, bedsores are a problem for 8.5% of patients who undergo surgery lasting more than three hours.

Pregnant women on bed rest

Pregnant women on strict bed rest can also develop bed sores for the same reasons as post-op patients: restricted movement for extended periods of time leads to consistent pressure and friction, which interferes with blood flow and creates small wounds in the skin which turn into bedsores.

People with blood flow issues

Any kind of condition that impacts blood flow, like diabetes or vascular disease, can increase the likelihood of bedsores. One study found that patients with diabetes were 115% more likely to develop bedsores post-op than patients without diabetes.

Complications & Dangers 

If bedsores are treated as soon as they form, they are typically painful, but not dangerous. However, there are a few scenarios where bedsores can become a serious health risk.

Infection 

Because bedsores are open wounds, it is very easy for them to get infected. If bedsores go untreated or if the infection is treatment-resistant, the infection can spread to the muscles and bones.

This is rare, but it is a possibility, especially with deep bedsores that extend beyond the skin.

Sepsis

In very rare cases, bedsores can lead to sepsis, which is when the infection spreads to the bloodstream. Sepsis is dangerous because our blood is circulated throughout our entire body, so if the blood is infected, it can lead to multiple organ system failures.

Marjolin’s Ulcers

Marjolin’s ulcers are long-term, non-healing wounds. These types of ulcers can, in rare cases, turn into squamous cell carcinoma, or cancer.

Prevention

Clearly, bedsores are not something you want to mess around with. Even though treatment is possible, it’s safer to focus on prevention.

Let’s take a look at some of the best ways to take care of your skin and prevent bedsores from forming in the first place.

1. Reposition Your Body

The best way to combat bedsores is to reposition your body regularly. This isn’t possible for everyone to do on their own, which means you will need a caretaker to help in some cases. 

Experts recommend repositioning every 15 to 20 minutes; this can shift the majority of your weight from one spot to another so that pressure doesn’t build up in one area all day. 

If you use a wheelchair full-time, you can reposition by leaning forward for a while, scooting from side to side, or removing your legs from the leg rest for a moment. These simple movements can make all the difference in preventing bedsores.

2. Follow Skin Care Best Practices

Our skin is our largest and one of our most fragile organs, and it has some very specific needs. The best skincare for bedsore prevention is to moisturize with gentle, effective ingredients.

Moisturized skin is healthy skin, and healthy skin is better at dealing with problems like pressure and friction. 

Good moisturizing ingredients to look for include:

  • Water
  • Glycerin
  • Hyaluronic acid
  • Jojoba oil and shea butter
  • Dimethicone
  • Cod liver oil

Additional Skin Care Tips

When you shower or bathe, use gentle, moisturizing soap and lukewarm water to wipe your skin gently without scrubbing.

3. Use Soft Fabrics

One of the most underestimated players when it comes to bedsores is the fabrics that you come into contact with.

Here are some helpful tips when it comes to fabric: 

  • Wear soft, non-irritating fabrics without potentially irritating accessories like buttons, zippers, thick seams, or even tags. All of these things can contribute additional pressure against the skin, further disrupting blood flow and encouraging the formation of bedsores. 
  • Use soft, non-irritating fabrics for your sheets.  If you tend to get warm in bed, you’ll want sheets to be cool and breathable, since sweating can create excess moisture, breaking down the skin and creating bed sores.

4. Choose the Right Mattress

One of the best ways to prevent bedsores is by having the right mattress. Here are some things to consider when it comes to picking a mattress:

  • Your mattress should be very soft to help take excess pressure off your hips, shoulders, and heels. For more information on soft mattresses, check out our best soft mattress recommendations.
  • Choose a plush mattress that hugs your body and dissipates pressure to keep up healthy blood flow even throughout your bed rest.  Most of the best soft mattresses are memory foam, but some hybrid or latex models offer the softness needed to prevent bedsores.
  • If you tend to get hot in bed, you’ll also want a breathable mattress that will keep you cool to prevent sweating. Excess sweat is just extra moisture which can contribute to skin breakdown, which can then lead to bedsores.
  • Although memory foam used to sleep very hot, many memory foam mattresses are now made with cooling gel foam. Hybrid mattresses typically include a layer of coils that can improve breathability. 
  • If you sleep really hot, then a latex mattress is probably the best way to keep cool and gently dissipate excess pressure from your pressure points.

Ask the Experts

Q: How can you improve the healing process of a bedsore?

A: “While proper rotation and care are vital to avoiding pressure ulcers, nutrition plays an important role. Those healing from surgery require adequate energy (calories) and protein to support the healing process. These calories should come from quality carbohydrates and healthy fat sources. Research has shown low blood levels albumin, a protein, is often correlated with pressure ulcer onset. Protein needs also increase with the presence of other disease and illness diagnoses.” Trista Best, MPH, RD, LD

Trista Best is a Registered Dietitian with an extensive dietetic background in Public Health and weight maintenance private practice. She has a B.S. in Health Science, a B.S. Food and Environmental Science, along with a Masters of Public Health Nutrition.

Q: What are some of the most important statistics when it comes to bedsores and pressure injuries?

A: “Approximately 2/3 of pressure injuries occur in adults over 70 years of age, and approximately 60,000 people die each year as a result of pressure injuries (these deaths could have been prevented).

Q: What other information is helpful to know on this topic?

A: “Nutrition plays an important role in wound healing. The body uses more calories as it heals the wound.” Katie Dodd, MS, RDN, CSG, LD, FAND

Katie Dodd is a Registered Dietitian Nutritionist at the Geriatric Dietitian. Dodd has over 11 years of experience working with the elderly and is a Board Certified Specialist in Gerontological Nutrition (CSG). The Geriatric Dietitian provides content and resources on geriatric nutrition for families and caregivers.

Q: Just how serious are bedsores?

A: “Bedsores are very serious depending on the depth of the wound. It can be a nidus of infection and can lead to great morbidity.

Susan Bard, MD, is NYC based Board Certified Dermatologist at Vive Dermatology. Dr. Bard has presented at multiple national conferences and written articles and chapters for peer-reviewed journals like the Journal of the American Academy of Dermatology, Archives of Dermatology, Pediatric Dermatology and the Journal of Investigative Dermatology.

Q:  What do you look for when treating bedsores?

A: “When treating bedsores, it is essential to factor in the person’s age, physical condition, medical condition and severity of the ulcer. This will determine the appropriate next steps for the treatment and healing process. Treating bedsores can range from removing pressure from the wounded area, cleaning the area, wrapping the ulcer with medicated gauze, and antibiotics to treat the infections. If the bedsore is severe, treatment can range from removing the infected skin or dead tissue, skin grafts to pressure wound therapy.

Jocelyn Nadua is a Registered Practical Nurse and Care Coordinator at C-Care Health Services. C-Care is based out of Toronto, providing a wide range of care services at home and health facilities. Services range from daily hygiene assistance, physical activity and condition monitoring.

Summary

Bedsores are not always easy to treat, so it’s better to do everything we can to prevent them through repositioning, proper skincare, soft fabrics, and the right mattress for your needs

If you are a full-time wheelchair user or if you’re on bed rest, make sure you or your caretaker check your skin all over for bed sores every single day. It’s better to treat bed sores earlier rather than later.


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