Susan Bard, MD
Susan Bard, MD, is NYC based Board Certified Dermatologist.
Susan Bard, MD, is NYC based Board Certified Dermatologist.
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.
Also known as pressure ulcers, bedsores are wounds that affect the skin and underlying tissue.
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.
Bedsores typically form on areas of the body that experience consistent pressure (which is why they are also called pressure ulcers).
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.
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.
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.
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 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.
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.
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.
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.
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 are long-term, non-healing wounds. These types of ulcers can, in rare cases, turn into squamous cell carcinoma, or cancer.
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.
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.
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:
Additional Skin Care Tips
When you shower or bathe, use gentle, moisturizing soap and lukewarm water to wipe your skin gently without scrubbing.
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:
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:
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.
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).
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.
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.
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.
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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