Bedsores; Causes, Symptoms, and Treatment

Bedsores are also known as pressure ulcers or decubitus ulcers. They are open wounds on the skin resulting from a long period of continuous pressure on a certain area of the body, which leads to reduced blood flow in these areas and consequently tissue damage.

What are bedsores?

Bedsores form due to constant pressure on certain areas of the body, and they often arise if a person spends a long time lying in the same position. They are a common condition among the elderly and people with limited mobility.

Decubitus ulcers often occur on the skin covering bony areas, and the most common places for bedsores are:

• The thighs
• The knees
• The ankles
• The buttocks
• The heels
• The spine
• The shoulder blades
• The tailbone
• The elbows
• The back of the head

Bedsores can be treated depending on several factors, including the underlying medical conditions and the stage of the ulcer. However, if left untreated, the infection can spread to the blood, the heart, and the bones and become life-threatening.

Causes of Pressure Sores

Prolonged pressure is the main cause of bedsores. Lying or sitting on a certain part of the body for long periods leads to the breakdown of the skin. Wearing a cast or surgical device may also cause skin ulcers.

The sores may also result from significant pressure over a short period or low pressure over a longer period.

The reason these sores form is the compression of tissues and blood vessels, then their deformation, which leads to poor blood circulation, tissue death, and infection.

Risk Factors

The following can increase the chances of sores occurring:

• Inability to move without assistance.
• Advancing age, as the skin becomes thinner and more fragile.
• Urinary incontinence, which increases the risk of skin damage and infection.
• Low body weight, which leads to reduced padding around the bones.
• Certain medical conditions, such as diabetes, which reduces the sensation of pain and prolongs wound healing.
• Poor blood circulation.
• Reduced mental awareness.

Stages of Bedsores

Bedsores occur in stages. Stage one and two sores usually do not require surgery, but stage three and four sores may require it.

Stage One

In this stage, the skin color changes, and the area may appear red if the skin is fair, while the color may vary from blue to purple if the skin is darker. You may also notice:

• A feeling of warmth to the touch.
• The sore appears swollen.
• Pain and burning at the site of the sore.
• Itching.

Stage Two

The injury is in the first layer (the epidermis) and perhaps the second (the dermis) of the skin, so the sore becomes painful and the surrounding skin may change color.

In this stage, the skin begins to crack and the sore appears as a superficial wound that may leak pus, and it may also look like a fluid-filled blister.

Stage Three

In this stage, the injury affects the fat layer, meaning the sore is much deeper inside the skin, so it looks like a crater and may have a foul odor.

Stage Four

In this stage, the sore is very deep and affects many tissue layers, including the bones. Because the sore in this case contains a lot of dead tissue and pus, infection is likely.

What characterizes this stage is the depth of the sore to the point where you can see:

• The muscles
• The bones
• The tendons
• The joints

In addition to the visual features in diagnosing and determining the stages of the sore, further imaging or surgical evaluation of the affected area may be needed.

Treatment of Bedsores

When the sores are in their early stages, they may be treated at home. But in the more severe stages of the sores, a doctor must be consulted.

The measures taken in treatment depend on the stage of the sore. However, the following are generally useful strategies:

• Relieving pressure: This may involve using foam cushions to support the affected areas and changing the body's position.
• Cleaning the wounds: Gently wash minor sores with water and mild soap, and clean open sores with saline solution with each dressing change.
• Applying dressings: These dressings protect the wound and speed up healing. There are antimicrobial dressings and others containing alginic acid, so consult your doctor to prescribe the best one for the condition.
• Using topical creams: Antibacterial creams can help fight infection, while barrier creams can protect damaged or fragile skin.
• Removing dead tissue: This can help the sore heal. The healthcare provider may use a high-pressure water jet or surgical tools to remove that tissue.
• Antibiotics: Take any antibiotics the doctor may prescribe to treat skin, bone, or blood infections.
• Adjusting the diet: While there is limited evidence that any specific diet can help treat pressure ulcers, protein supplements may promote healing and reduce wound size.
• Surgical options: In advanced cases, dead tissue may be removed, the wound cleaned, and the edges closed as much as possible. The surgeon may cover the damaged part with tissue from healthy skin.

How to Prevent Bedsores

Tips for reducing the risk of developing pressure ulcers include the following:

• Change positions in bed at least every two hours.
• Regularly examine the skin for signs of bedsores.
• If you use a wheelchair to sit upright, change your sitting position every 15 minutes, and use a cushion underneath you to relieve the pressure of your weight.
• Use certain mattresses, such as the dynamic types or those made of static foam, as they help relieve pressure. Also, some beds have a pump that ensures a constant flow of air to the mattress.
• Wear special padding on pressure points, including the elbows and heels.
• Make dietary adjustments for adequate and proper nutrition.
• Drink plenty of water.
• Do exercises, even while in bed, to encourage blood circulation.
• Quit smoking and avoid secondhand smoke.

Complications

Without treatment, pressure sores can lead to complications such as:

• Cellulitis, a life-threatening bacterial infection from the surface of the skin to its deeper layers.
• Sepsis or blood poisoning, a serious life-threatening infection that may lead to organ failure.
• Bone and joint infections, if the sore extends to these areas. This type of infection can lead to tissue and cartilage damage, affecting the function of the limbs and joints.

It is often possible to reduce the risk of developing bedsores. When the sore is in an early stage, anyone can treat it at home, but more advanced pressure sores require specialized medical care.