Bedsores & Pressure Ulcers: Causes, Symptoms, Treatment & Prevention

Preventing Bedsores (Pressure Ulcers)

Bedsores & Pressure Ulcers: Causes, Symptoms, Treatment & Prevention

What is a Bedsore?

Bedsores aren’t only caused by lying in bed. And they are not necessarily a sign of neglect or poor medical or home care. Bedsores, which are also called pressure ulcers, decubitus ulcers or pressure sores, are injuries to the skin and underlying tissue. They are caused by any kind of prolonged pressure on a particular area of the body. People with spinal cord injuries (SCI) are especially prone to them. Research studies estimate that two-thirds of people with spinal cord injuries develop bedsores at some point.

The reason? People with paralysis can’t change positions easily, and they don’t feel the discomfort that signals that their body needs to change position, so they stay in one position too long, causing damage to the skin.

It’s important to know that bedsores are a serious medical condition that can develop quickly and turn into life-threatening infections if not treated.

What do people with spinal cord injuries have to say about their own experience with bedsores? Take a look:

Bedsores most often develop on the bony parts of the body that have little padding of muscle and fat — the spine, tailbone, buttocks, shoulder blades, hips, heels and elbows. Any part of the body that rests against the wheelchair or presses against the surface of a firm mattress for a prolonged period of time is in danger of developing a bedsore.

Here’s why: the prolonged pressure temporarily cuts off blood supply to the skin, which causes damage to the cells. Surprisingly, the pressure doesn’t even have to be intense. Normally, our skin is protected from injury because we move frequently—mostly unconsciously–even while we sleep. People with SCI don’t move automatically, so they train themselves to do “pressure releases,” which reposition their bodies, as part of their everyday lives. These, too, can become almost automatic over time.

These drawings illustrate the parts of the body that are likely to develop bedsores:

Spinal cord injury expert, Mary Zeigler, explains how to position your body in bed to avoid bedsores:

Bedsores are classified by stages, depending on the extent of skin damage. It’s critical to spot a developing bedsore early, to get the pressure off the affected area right away and to call in medical professionals to advise on and supervise treatment.

Stage 1–First sign of a possible skin sore is a reddened, darkened or discolored area on light skin. Darker skin may look purple, bluish or shiny. The spot may feel hard or warm when touched. There may be pain, or blisters or a bruised appearance. When you press on the area, it stays red and doesn’t return to normal after about 30 minutes. The skin is unbroken.

It’s important to recognize that even though the early signs of skin damage that you see on the surface may look minimal, they are only part of the picture. There may be damage from pressure on blood vessels against the underlying bone, causing damage to the muscles and tissues under the skin.

Stage 2—The top layer of skin (epidermis) is broken; it looks like a shallow open sore. There may be mild swelling, oozing or pus.

Stage 3—The ulcer becomes deeper, extending into the fatty tissue below the skin’s surface. Look for signs of infection—pus, odor, fever, drainage. Wounds at this stage often need specialized wound care.

Stage 4—The wound is deeper, extending into the muscle and May go as far down as the muscle, tendon or bone. There is a high possibility of infection. Surgery is often needed to repair the wound.

In this video, spinal cord injury expert Mary Ziegler outlines bedsore stages and their treatment

Some bedsores are called “unstageable” because the base of the wound is covered by so much dead tissue or scarring so that it’s impossible to tell the extent of the damage until the dead tissue has been removed in a process called “debriding.” Frequently, it reveals a Stage 3 or 4 bedsore.

Suspected Deep Tissue Injury shows no break in the skin, but a lot of bruising or blistering and tenderness at the surface. There is damage due to pressure going on underneath the skin where the bone meets the tissue. Deep tissue injuries often develop into Stage 3 or 4 bedsores.



If you suspect you’ve spotted a developing bedsore, the first thing to do is to take the pressure off the area involved, and to keep it clean and dry to prevent development of a full-blown ulcer. Then have a medical professional take a look to see if there are signs of infection.

If an infection has developed, a doctor may order tests to determine if the infection has spread to muscles or bones or another part of the body. Tests may include blood tests, lab tests of tissue samples, x-rays, MRI’s or a bone scan. Infections are treated with antibiotic ointments, pills or intravenously.

Depending on the stage of the bedsore, healthcare professionals may use a protective film or lubricant on the areas of unbroken skin near the bedsore to keep the sore from spreading. Special dressings are usually applied to the bedsore itself to promote healing or to remove small areas of dead tissue. Large areas of dead tissue may require surgery. Deep bedsores may need skin grafts or reconstructive surgery.

How long does it take for a bedsore to heal?

Time to heal depends on the stage of the bedsore:

Stage 1 – It’s possible to reverse this type of bedsore in about three days if you take the pressure off the site as soon as you spot it. Fast action is critical.

Stage 2— Healing time is 2-3 weeks. Get the pressure off, and consult your health care provider right away. There may be an infection that needs treatment.

Stage 3 –Healing time is 1-4 months, depending on the extent of the infection. Special wound care is often required to deal with the infection. A bed with a pressure-relieving mattress can be ordered by your healthcare provider if needed.

Stage 4—Healing can take from three months to two years. Surgery is frequently required.

Physical therapists are often involved in the treatment of a serious bedsore; they can also help find ways to prevent a recurrence:

Most people with SCI learn to make skin inspections part of their daily routine, usually before they get dressed in the morning. You can use a long-handled mirror to do it yourself or have a family member make a visual check of the areas where pressure sores are likely to develop: tailbone, buttocks, hips, heels and elbows.

SCI medical expert Kim Eberhardt-Muir explains how to do a daily skin check for signs of bedsores

A caregiver’s experience with bedsore prevention

The most important thing you can do to prevent bedsores is to change positions frequently. It’s good to change position every two hours while in bed. While sitting in a wheelchair, shift your weight every 15 minutes, and reposition your body once every hour. Ask for help with repositioning.

Do wheelchair push-ups—Lift your body up off the seat by pushing against the arms of the chair.

In this video, medical expert Mary Ziegler describes how to release pressure when sitting in a wheelchair

Get the right wheelchair seat cushions–Ask your social worker or physical therapist about ordering individually-fitted seat cushion for your wheelchair. There are many bedsore-preventing types of cushions, made of foam, gel or filled with air. Don’t use a rubber ring, or doughnut; they block blood flow to the skin inside the ring.

Consider a wheelchair that tilts back or reclines—they allow you to change your posture and redistribute your weight and reduce pressure.

How to choose a wheelchair cushion

Look into nighttime pressure relief—consider an egg-crate foam mattress topper, a waterbed or a sheepskin mattress cover to reduce the likelihood of bedsores. There are also therapy mattresses that automatically alternate pressure to prevent bedsores.

Beware shear and friction – which come from dragging the body across the bed sheets.

It’s true that a bedsore can develop in a few hours

Keep skin clean and dry—use gentle soaps, avoid irritants and watch for buttons, tight shoes or wrinkles and heavy seams that can irritate the skin.

Eat well and stay hydrated—be sure you get enough protein, vitamins, minerals and fluid to maintain healthy skin.

Inspect your skin every day—Bedsores can develop very quickly.


What is a Bedsore?