Pressure Ulcers / Bedsores
Pressure ulcers, also called pressure injuries or bedsores, are wounds that can develop when prolonged pressure reduces blood flow to the skin and underlying tissues.
They most often occur over bony areas such as the heels, ankles, hips, tailbone and elbows, particularly in patients who have difficulty changing position independently.
Early recognition, pressure relief and appropriate wound care are important because pressure injuries can progress into deeper tissue damage when the underlying pressure continues.
Schedule a Wound Evaluation
Pressure Can Damage More Than the Skin
Tissues need a continuous supply of oxygen and nutrients from the bloodstream. When prolonged pressure compresses blood vessels between a bony area and an external surface, circulation can be reduced.
Friction, shear, moisture and reduced mobility can further increase the risk of skin breakdown and deeper tissue injury.
Prolonged Pressure
Staying in one position for an extended period can reduce circulation to tissues over bony areas.
Shear
Sliding in a bed or chair can cause skin and deeper tissues to move in different directions, potentially damaging small blood vessels.
Friction
Repeated rubbing against bedding, clothing or another surface can injure fragile skin and increase breakdown risk.
Moisture
Excess moisture from perspiration, drainage or incontinence can weaken the skin and make it more vulnerable to injury.
Where Do Bedsores Usually Develop?
Pressure injuries commonly form where bones are close to the surface of the skin. The exact location often depends on whether a patient spends most of the day lying down, sitting or using a wheelchair.
Stages of Pressure Injuries
Pressure injuries are commonly classified according to how deeply the skin and underlying tissues have been damaged.
Stage 1
The skin remains intact but shows persistent discoloration or redness that does not resolve normally after pressure is relieved.
Stage 2
Partial-thickness skin loss may appear as a shallow open wound or blister involving the outer layers of skin.
Stage 3
Full-thickness skin loss extends into the fatty tissue beneath the skin, creating a deeper wound.
Stage 4
Full-thickness tissue loss may expose or directly involve deeper structures such as muscle, tendon or bone.
Some pressure injuries cannot initially be staged because slough or eschar obscures the depth of tissue damage. Deep tissue pressure injuries may also present with persistent deep discoloration before an open wound develops.
Who Is at Greater Risk?
Pressure injuries can affect anyone, but risk increases when a person cannot reposition independently or has medical conditions that affect skin health, sensation or circulation.
Limited Mobility
Patients who spend prolonged periods in bed, a chair or a wheelchair may be unable to relieve pressure frequently enough.
Reduced Sensation
Neuropathy, spinal cord injury or other neurologic conditions may make it difficult to feel discomfort from sustained pressure.
Poor Circulation
Reduced arterial blood flow can make tissues more vulnerable to injury and can interfere with wound healing.
Nutrition
Inadequate calories, protein, vitamins or hydration can affect the body's ability to maintain and repair healthy tissue.
Diabetes
Diabetes can affect circulation, sensation and wound healing, increasing the risk of skin complications.
Incontinence
Repeated exposure to moisture may damage the skin barrier and increase susceptibility to breakdown.
Advanced Age
Older skin may be thinner and more fragile, particularly when combined with limited mobility or chronic illness.
Serious Illness
Hospitalization, surgery or chronic disease may limit movement and reduce the body's ability to recover from tissue injury.
Understanding the Full Extent of the Injury
Effective pressure-ulcer treatment begins by assessing more than the visible wound. The care team may also evaluate circulation, infection risk, nutrition, mobility and the amount of ongoing pressure on the area.
Wound Assessment
The size, depth, drainage, tissue type and surrounding skin are evaluated to understand wound severity.
Circulation
Blood flow may be assessed when poor arterial circulation or vascular disease could be limiting healing.
Infection Evaluation
The wound is examined for signs of local or spreading infection and additional testing may be ordered when appropriate.
Pressure Source
Identifying and correcting the pressure, positioning or equipment contributing to the injury is critical to healing.
A Comprehensive Approach to Healing
Pressure injury treatment is tailored to the depth of the wound, underlying health conditions and the factors preventing normal healing.
One of the most important elements is offloading, which reduces or removes pressure from the injured area while the wound heals.
A wound cannot heal effectively if repeated pressure continues to injure the same tissue. Pressure relief is a central part of treatment and prevention.
When a Pressure Injury Is Not Healing
Some wounds require more advanced treatment because of their depth, duration, infection risk or underlying medical problems.
Debridement
Dead or unhealthy tissue may need to be removed so the wound bed can support healthier tissue growth.
Advanced Dressings
Specialized wound products may help manage drainage, maintain an appropriate healing environment and protect surrounding skin.
Negative Pressure Therapy
Selected deeper wounds may benefit from negative pressure wound therapy to manage drainage and support wound-bed development.
Bioengineered Products
Advanced skin substitutes or other biologic treatments may be considered for selected wounds that do not progress with standard care.
Reducing Pressure Before a Wound Develops
Many pressure injuries can be prevented by identifying high-risk patients early and creating a consistent pressure-relief and skin-care plan.
Reposition Regularly
Changing position helps prevent prolonged pressure from remaining concentrated on the same tissues.
Use Support Surfaces
Pressure-redistributing mattresses, cushions and other equipment may help protect vulnerable areas.
Inspect the Skin
Regular skin checks can identify early redness, discoloration or breakdown before deeper injury develops.
Keep Skin Protected
Managing moisture, friction and dryness can help maintain a healthier skin barrier.
Signs a Wound Needs Prompt Attention
Pressure injuries can deepen or become infected. Changes in the wound or the patient's overall condition should not be ignored.
Increasing Drainage
New or increasing drainage, particularly when cloudy or foul-smelling, may indicate a wound complication.
Redness & Warmth
Spreading redness, warmth, swelling or increasing tenderness around the wound may indicate infection.
Worsening Tissue
Darkening tissue, increasing wound depth or rapidly expanding skin damage should be evaluated promptly.
Fever or Illness
Fever, chills, confusion or other systemic symptoms can occur with more serious infection.
Seek prompt medical attention for spreading redness, fever, rapidly worsening wounds, significant drainage, foul odor or other signs of infection.
Pressure Ulcer FAQs
What is a pressure ulcer?
A pressure ulcer, pressure injury or bedsore is an area of skin and tissue damage caused primarily by prolonged pressure. Friction, shear and moisture can also contribute to the injury.
Where do bedsores usually occur?
Pressure injuries frequently develop over bony areas such as the heels, ankles, hips, tailbone, elbows, shoulder blades and back of the head.
What are the stages of a pressure ulcer?
Pressure injuries are commonly classified from Stage 1 through Stage 4 based on the depth of tissue damage. Some wounds may also be described as unstageable or as deep tissue pressure injuries.
Can a pressure ulcer heal?
Yes. Many pressure injuries can heal with appropriate pressure relief, wound care and management of underlying medical factors. Healing time depends on wound depth, circulation, nutrition, infection and overall health.
How are pressure ulcers treated?
Treatment may include repositioning and offloading, wound dressings, debridement, moisture control, infection management, nutritional support and advanced wound therapies when appropriate.
How can bedsores be prevented?
Prevention focuses on frequent repositioning, pressure-redistributing surfaces, regular skin inspection, moisture management, adequate nutrition and identifying patients who are unable to change position independently.