Bed Sores – Symptoms, Causes, Stages, And Treatment

Bed sores, also referred to as decubitus ulcers or pressure ulcers are the injuries you develop on the skin as well as underlying tissue. It usually occurs due to the prolonged pressure on your skin. Pressure ulcers are common on the skin covering the boy regions of the body. So, you can see them on your ankles, heels, tailbone, and hip. It is prominent among people who suffer from other medical conditions limiting their ability to move or change their positions. So, it results in such people spending most of their time in a wheelchair or a bed. You can develop decubitus ulcers within hours or days. With proper medical intervention, some of the ulcers heal without any complications. But, some of the ulcers never heal completely. Read ahead to know how to prevent and take steps to heal them.

Symptoms Of Bed Sores

If you or your loved ones are at risk of developing pressure ulcers, then you need to check the skin for its signs. The warning signs associated with pressure ulcers are:

• Unusual changes in the skin color
• Change of texture in the affected area
• Swelling
• Tenderness
• The specific area feels warm or cooler to touch compared to other areas
• Pus-like draining

Pressure ulcers are classified into different stages based on their depth, severity, and other features. You can suffer from different degrees of skin and tissue damage. So, it can vary from unbroken and red skin to deep injury involving muscle as well as bone.

Common Sites Of Bed Sores

People who are immobile and use wheelchairs all the time suffer from pressure ulcers. It develops on the following sites:

• Spine
• Shoulder blades
• Buttocks or tailbone
• Places resting against the chair like legs and back of the arms
• The pressure ulcers can develop in people bedbound in the following areas:
• Side or back of the head
• Shoulder blades
• Affected person’s lower back, the hip, or tailbone
• Ankles
• Heels
• The skin behind the knees

See A Doctor For Bed Sores

When should you consult a doctor for bed sores? People who show warning signs of the condition need to try repositioning. Changing position relieves pressure from the sensitive parts. But, if you see no change in the condition after 24 to 48 hours, then you need to contact the doctor immediately. Immediate medical attention is required when you see signs of infection like:

• Fever
• Pus (drainage from the ulcer)
• Bad smelling pressure ulcers
• Swelling around the sore
• Increased warmth or redness

Causes Of Bed Sores

Bed sores are caused due to the interruption of blow flow to a specific part of the skin. It usually occurs due to the pressure against the skin. When you are unable to move, it can make your skin vulnerable to damage. So, it results in the development of pressure ulcers. Three primary factors contributing to the condition are:

Pressure

It is the most common cause of pressure ulcers. Due to constant pressure on any part of the body, the blood flow to the tissues reduces. Proper blood flow is essential for delivering the necessary nutrients and oxygen to the tissues. When your tissues and the skin surrounding it are deprived of essential nutrients, it results in damage. Severe damage can result in the death of the tissue and skin. This kind of pressure is common among people suffering from immobility. It usually happens in areas that are not well padded with fat or muscle. It can also develop on the skin covering a bone like the elbows, hips, tailbone, spine, shoulder blades, and heels.

Friction

You develop pressure ulcers due to friction which occurs when skin rubs against the bedding or clothing. It makes your skin, sensitive skin more susceptible to injuries. The risk increases with moist skin.

 Shear

You develop pressure ulcers due to shear. It occurs when two surfaces move in the opposite direction. For example, if you are lying down on a bed slightly elevated at the head area and you slide down, then you develop a shear. It is because as your tailbone moves down, the skin covering the bone stays intact. So, the pulling in the opposite direction leads to pressure ulcers.

Risk Factors Associated With Bed Sores

Not all people face the risk of developing Bed sores. Some people are more vulnerable to developing the condition compared to others. The risk becomes higher when you have trouble moving or cannot change your position easily when you sitting or lying in a bed. The risk factors associated with the condition include:

Immobility

When a person is immobile (cannot move their legs, hands, or body), then you can develop pressure ulcers. It occurs due to the following conditions:

• Poor health
• Spinal cord injury
• Stroke
• Parkinson’s disease
• Osteoarthritis

Several other health conditions can also result in immobility which makes affected people vulnerable to pressure sores.

Incontinence

The loss of bladder control or incontinence makes your skin vulnerable to ulcers. It is because the extended exposure to urine and stool makes the skin moist and prone to developing pressure ulcers.

Lack Of Sensory Perception

Due to the loss of sensory perception, you can face impaired levels of consciousness. So, it results in a person’s inability to feel pain or discomfort. So, you never become aware of the warning signs to relieve pressure or the need to change your position. It is common among people suffering from spinal cord injuries or neurological conditions like motor weakness or paralysis.

Poor Nutrition And Hydration

You need to consume enough calories to maintain the health of your skin. So, you need a diet with the right amount of calories, vitamins, protein, and minerals. Taking fluid is essential to maintain healthy skin and prevent the breakdown of tissues. Lack of proper nutrition can result in pressure ulcers.

Conditions Affecting Blood Flow

Certain medical conditions affect proper blood flow. So, people suffering from vascular diseases and diabetes can face an increased risk of tissue damage. So, it puts them at risk of pressure ulcers.

Stages Of Bed Sores

Bed sores are divided into four stages based on the severity of the condition. From severe stage to the most severe one, you can classify into:

Stage 1

The bed sores look red. When you touch the affected area, it feels warm to touch. In people with darker skin tones, the affected area has a purple or blue tint to it. You feel itching, burning, or pain in the affected area.

Stage 2

The affected area has a damaged look. So, you can see an open scrape, blister, or sore. The person affected by the problem complains of significant pain. You can also see significant discoloration on the skin around the wound.

Stage 3

Due to the damage below the surface of the skin, the skin has a crater-like appearance.

 Stage 4

The affected area has severe damage and you can see the presence of a large wound. The damage extends to muscles, bones, tendons, and joints. It is a severe stage as the wound can become infected.

You cannot assign a stage to tissue loss (full-thickness). Along with tissue loss, you can also see eschar or slough at the covering the base of the ulcer or in the wound bed. Slough you can see has a yellow, brown, green, grey, or tan color. While eschar appears black, brown, or tan.

Complications Associated With Bed Sores

Developing pressure ulcers can cause severe distress. But, it needs medical attention as early as possible. Without proper medical intervention, you can suffer from severe agony and other complications. Some of these complications are life-threatening. The common complications are:

Cellulitis

Cellulitis is the skin infection caused by bacteria. The infection also affects the connected soft tissues. If you develop the condition, then you develop the following signs:

• Redness
• Warmth
• Swelling of the affected area

People suffering from nerve damage may not feel pain in the cellulitis affected area. It is a serious condition requiring medical attention.

Bone And Joint Infections

One of the main complications associated with pressure ulcers is it can spread to joints as well as bones. Due to the infection from pressure ulcers burrowing, you suffer from septic arthritis (joint infections). It can result in damage to the cartilage and tissue. When you suffer from osteomyelitis or bone infections, it reduces the function of your limbs and joints.

Cancer

Marjolin’s ulcers

When you suffer from long-term wounds that take longer to heal (like Marjolin’s ulcers), it develops into a type of cancer. People who fail to get treatment for their pressure ulcers can develop a type of squamous cell carcinoma.

Sepsis

In rare cases, pressure ulcers can result in sepsis.

Diagnosing Bed Sores

When you see symptoms of pressure ulcers, you need to see the team of doctors who is specialized to treat wounds. So, the special team with experience treating pressure ulcers evaluates your condition. The team assesses your condition by checking the following:

• The size and depth of the ulcer
• The exact type of tissue affected by the Bed sores (like skin, bone, or muscle)
• Your skin color in the affected area
• The exact amount of tissue death occurring from the ulcer
• Symptoms accompanying with the sores (like bleeding, infection, and strong odor)

When you are visiting the doctor, the health care team takes samples of the fluids as well as tissue from the decubitus ulcer. During the assessment, the doctor also looks for signs of bacterial growth and malignant cells.

Treating Bed Sores

Unfortunately, treating Bed sores is not easy. But, with early medical intervention, you can get relief. The open wound caused due to decubitus ulcers may not heal rapidly. Even when the healing takes place, it is not consistent. This occurs due to damage caused to your skin as well as other tissues. Less severe pressure ulcers heal within a few weeks with proper care and treatment. In case you develop serious wounds, it requires surgery. So, try to get needed medical assistance as early as possible. Here are the treatment options:

Reducing Pressure To Manage Bed Sores

As the first line of treatment, your doctor suggests strategies to reduce pressure and friction from the body. So, steps are taken to reduce it by:

Repositioning

Staying in the same position for a long time can cause pressure ulcers. Therefore, you need to turn and change your position often. Depending on the quality of the surface you sit or lie and the severity of the condition, you can reposition several times.

Use Support Surfaces

To protect your vulnerable skin, you can use special cushions, beds, or mattress. It helps you sit or lie in a specific manner to protect the susceptible skin.

Cleaning And Dressing The Wounds

If you develop Bed sores, then the next steps suggested by the doctor is to care for the pressure ulcers. Depending on the severity and deepness of the wound, you have to follow care instructions like:

Cleaning

You can use a gentle cleanser to clean the affected skin (if it is not broken). Then, pat dry. While you need to use pure water or saline solution (saltwater) to clean the wounds each time you change the dressing.

Put A Bandage

When you place a bandage over the wound, it speeds up healing. It is because the bandage can trap moisture and keep the wound moist while the skin around it remains dry. You can choose from different types of bandages like

• Gauzes
• Films
• Foams
• Gels
• Treated coverings

In some cases, you need a combination of dressings for covering the pressure ulcers.

Remove Damaged Tissue

When you have developed tissue damage, then to heal properly, the doctor suggests removing such infected, damaged, or dead tissue. You have to get medical assistance to remove debride (damaged tissue) from the wounds. It is achieved by flushing the wound gently with water or removing (cutting out) the damaged tissue.

Other Interventions To Manage Bed Sores

Apart from the above-mentioned techniques, your doctor also suggests other interventions to deal with the pain and other discomfort associated with the condition. The techniques used to address the other issues are:

Drugs For Pain Control

Medications are provided to manage pain caused due to pressure ulcers. So, your doctor recommends taking nonsteroidal anti-inflammatory drugs and naproxen sodium to alleviate pain. These medications are helpful before and after wound care or repositioning. Your doctor also advises using topical medication for wound care.

Healthy Diet

Along with the methods to manage pain and promote wound healing, your doctor recommends a good diet. A healthy diet is essential for good nutrition. It promotes speedy recovery.

Surgery To Manage Bed Sores

Large bed sores that fail to heal might require surgery. One method of surgical repair is to use a pad of your muscle, skin, or other tissue to cover the wound and cushion the affected bone (flap surgery).

Preventing Bed Sores

You can take some steps to prevent pressure ulcers. The main point is to avoid any stress on the skin. These ulcers develop on your skin due to the stress. So, frequent repositioning is necessary to prevent the condition. Also, you need to take good care of your skin, include a good diet for maintaining good nutrition and drink water to prevent the condition. Making certain lifestyle changes like quitting certain bad habits and including some habits can make great changes. Here are some of the tips:

Avoid Stress On Skin

You need to avoid stress on the skin. Here are some of the effective methods to eliminate stress on skin:

Repositioning

Repositioning is one of the most effective preventive strategies to relieve stress or pressure. So, it helps avoid the development of pressure ulcers. Repositioning means you need to move the person into a different position. It will help remove or redistribute pressure from a particular part of the body. Here are some of the tips for repositioning in a chair or bed:

• You need to shift the weight frequently. To reposition, you can ask someone for help or provide help when your loved ones experience the condition. Repositioning about once an hour will offer relief.
• People who have upper body strength can try and lift themselves to avoid pressure ulcers. Try to do wheelchair pushups. It means you need to raise the body of the seat you sit by pushing on the arms of the seat.

Invest In A Specialty Wheelchair

When a person is restricted to a wheelchair, they face a high risk of developing problems like pressure ulcers. It develops due to the cutting off blood supply from a particular area of the skin when you sit in the wheelchair for a long duration. Therefore, when you stay in a specific position, it results in the condition. It is better to invest in a specialty wheelchair. These wheelchairs allow you to tilt them. It helps relieve the pressure.

Select Cushions And Mattresses To Avoid Bed Sores

When you or your loved ones sit or lie down for a long time, then it is important to feel more comfortable. Choosing the right cushions and mattress will offer pressure relief. The foam-based or gel-filled models with effective designs can improve air-flow to the posterior regions. So, using the products in a wheelchair or bed can prevent physical stress. Using such a special mattress and keeping the body well positioned is important to prevent the condition. While choosing, try not to use doughnut-shaped ones as they focus on putting pressure on the surrounding tissue.

Bed Repositioning

Adjusting your position frequently is essential to avoid pressure ulcers. If possible, you need to try adjusting the elevation of the bed. Try not to raise it more than thirty degrees to avoid putting excess pressure on your tailbone. Elevating at the specific angle will also avoid the possibility of shearing. If it is not possible to get an adjustable bed, then try to install a bedside rail. It aids people with repositioning without depending on others. Adjusting between the right side, left side, and back every one to two hours will avoid physical stress on the body. You have new mattresses available that help with repositioning without anyone’s help. The alternating pressure mattresses have air compartments that inflate and deflates within a small time (usually six minutes) interval. So, it helps reposition pressure across your body.

Tips For Skin Care To Manage Bed Sores

It is important to take good care of the skin to manage pressure ulcers. So, you need to consider the following tips for skincare:

Keep Skin Clean And Dry

It is important to wash the skin after applying a gentle cleanser and pat dry. People who are bedridden need this cleansing routine daily to restrict the skin’s exposure to dampness, urine, and stool.

Protect Sensitive Skin To Avoid Bed Sores

When a person is bedridden or wheelchair-bound, their skin becomes sensitive. So, it becomes a necessity to take steps to protect the skin from decubitus ulcers. Using barrier creams on the skin is essential to shield the skin from urine and stool.

Change Bedding And Clothes

A clean environment will limit the risk of developing pressure ulcers. So, changing the bedding and clothing is frequently necessary. Sheets and clothes of breathable fabric will avoid the development of decubitus ulcers and avoids the spread of bacteria. Avoid using clothes with buttons that can irritate the skin. Watch for the wrinkles on the bedsheet as they can also cause skin irritation. Apply powder on the sheets to reduce friction while you try to reposition.

Daily Skin Inspection

You or the caretaker must inspect the skin closely to check for any warning signs of a decubitus ulcer. Combine changing of clothes with skin inspection is the best way to check for skin exposure to friction or shearing.

Proper Nutrition For Preventing Bed Sores

When you bedridden due to an injury or lose mobility, then you are at risk of developing decubitus ulcers. Changing a diet is essential to ensure quick healing and prevent the development of pressure ulcers. So, you need to talk to your healthcare provider to make changes to the diet. Since nutrition plays an important role in the healing process, you must include protein, vitamins, and minerals in the diet as recommended. Here are the necessary nutrients you must have in your diet:

Protein

You need to include more protein in your diet if you are vulnerable to developing pressure ulcers. So, include the foods rich in protein like:

• Fish
• Meat
• Eggs
• Dairy products
• Pulses
• Nuts
• Beans

You need to include at least one of the foods at each meal. Also, drink one pint of milk a day or mil products like cheese, milk puddings, or yogurt to ensure good protein levels.

Iron

You need iron to maintain the hemoglobin levels in your blood. Iron is also important for your body’s healing. Therefore, eat foods rich in iron like:

• Fish
• Eggs
• Meats

Iron from these food products is easily absorbed by the body. Other food sources also contain iron, but it is not easily absorbed. Here is the list of other foods:

• Dried fruit
• Beans
• Green vegetables
• Pulses

Take Vitamin C

Vitamins are essentials for the body, especially vitamin C. It is an important vitamin necessary for the absorption of iron from the body. This vitamin is also necessary for your healing process. You can include fresh fruits and vegetables containing the vitamin for better health. Since this vitamin is not stored in your body, you need a daily supply of vitamin C.

Zinc

Zinc is essential for your body as it aids in the formation of new skin tissue. It also helps pressure ulcers to heal well. So, you need to add food items containing zinc like:

• Beans
• Lean red meat
• Milk
• Shellfish
• Cheese
• Lentils
• Cereal products

Drink Water To Avoid Bed Sores

When you are dehydrated, it affects the quality of your skin. Dehydration can result in dryness of your skin and makes it fragile. So, you need to stay hydrated. Drink at least 1.5 liters to 2 liters of water to keep your skin moist from inside. You can also drink other fluids apart from the water like milk, coffee, tea, juice, etc. But, refrain from consuming alcohol as it can only make dehydration worse.

Manage Ideal Body Weight

Your body weight can increase or decrease the risk of pressure ulcers. When you are overweight, it makes you susceptible to developing decubitus ulcers. While underweight people can see slow wound healing of the newly developed ulcer. Therefore, it is important to maintain the ideal weight for the quick healing process. Lose weight if you are overweight. For underweight people, getting enough nutrition is necessary. So, talk to the doctor for including a diet that will help the body get all the nutrients it requires. Your doctor can suggest simple changes in the diet to help with the process.

Conclusion

The healing of bed sores depends on the stage of your condition. But, with early diagnosis, you can get the necessary treatment and pave the path to a speedy recovery. You need to follow a routine suggested by the doctor to manage the condition more effectively. If you have a care team, then you need to take time to consistently apply the regimen. Using the right products and adopting preventive measures will help treat the condition and prevent the development of pressure ulcers. With medical intervention, you will learn how to treat the existing pressure ulcers and prevent future ones. Such effective steps will ensure a quick recovery and maintain your quality of life.

References

https://www.medicalnewstoday.com/articles/173972

https://www.hopkinsmedicine.org/health/conditions-and-diseases/bedsores#:~:text=Bedsores%20are%20ulcers%20that%20happen,problem%20among%20frail%20older%20adults.

https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893