Pressure ulcers are wounds that occur when someone sits or lies in one position for too long. Also referred to as bed sores or pressure sores, pressure ulcers can affect anyone. They are, however, more prevalent in people on bed rest and those confined to wheelchairs. Pressure ulcers develop due to the prolonged force exerted on the skin. They can develop on any part of the body but are more common in bony areas. These include areas like the heels, knees, ankles, elbows, and tailbone.

Pressure sores develop over time. Sometimes, if the pressure is too much, they can form in a few hours. People who get pressure ulcers usually suffer from conditions that limit their movement. Medical conditions, like incontinence, can also cause pressure ulcers. If discovered early and treatment is started, pressure sores will heal completely. Without treatment, these wounds can cause life-threatening complications like infections and cancer.

Types of Pressure Ulcers

There are four main types of pressure ulcers. They are grouped depending on the degree of tissue damage.

Stage 1 

At this stage, the pressure ulcer has only affected the upper layer of the skin. There is no visible wound. Common symptoms include red or dark patches, soreness, mild itching, and burning. The area will also feel warmer and firmer than the surrounding areas. Stage 1 sores usually heal within two to three days.

Stage 2 

This stage occurs when the sore extends past the top layer of the skin and into the lower layer. The skin at this stage can break into an open wound. You may also develop a blister filled with pus that may or may not break. The area will appear swollen, red, and will feel warm to the touch. Pus or clear fluid may also ooze out. Stage 2 sores may take up to three weeks to heal.

Stage 3 

The sores have progressed past the second layer of the skin and into the fatty tissue. The ulcer at this point resembles a crater and fatty tissue may be exposed. At this stage, the risk of infection is very high. Common symptoms include redness, pus, a foul odor, or a discolored discharge. The doctor will prescribe antibiotics and may also remove the dead tissue so that the wound can heal. Stage 3 pressure sores take about a month to heal and, in severe cases, it may take up to 4 months.

Stage 4

This is the last stage and requires urgent medical attention. The pressure sores at this stage will have already extended past the subcutaneous fatty tissue. The tendons, ligaments, and muscles are all affected. The sore will also extend to the bone and cartilage in more advanced stages. You are at a higher risk of infection at this stage.

Some of the symptoms may include visible muscles, extreme pain, and foul-smelling pus. The wound will also have dark dead tissue and eschar. Eschar is a hard and dark substance formed when wound tissue dies. Surgery is the best option to treat stage 4 pressure ulcers. Recovery time can range from three months to two years.

Other Types of Pressure Ulcers

Two other types of pressure ulcers can occur that may be hard to diagnose.

Unstageable Pressure Ulcers: This kind of sore is hard to diagnose since there is no telling how deep the wound is. The bottom layer is covered by yellow, brown, or green debris. The only way to make a diagnosis is by cleaning the wound to assess the extent of the damage.

Suspected Deep Tissue Injury: Like unstageable pressure ulcers, this type is also hard to diagnose. The top layer appears like a Stage 1 or 2 pressure sore but the underside layer is a Stage 3 or 4.

Symptoms of Pressure Ulcers

Symptoms of pressure ulcers depend on how deep the sore goes. In the early stages, common symptoms may include:

• Discoloration of the skin where lighter skin people develop red patches and darker skin people develop blue or purple patches
• A discolored patch that doesn’t turn white when pressed
• The affected area may feel firm, spongy, or warm
• The area may also be itchy and painful

When pressure sores progress to the deeper tissues, symptoms are more severe. The risk of infection also increases. Symptoms may include:

• Breaks in the skin that results in an open blister or wound
• The sore deepens to the tendons, bone, and cartilage

Diagnosis of Pressure Ulcers

A physical exam is the best way to diagnose pressure ulcers. The doctor will inspect the area and will stage the sore depending on its appearance and how deep it goes. Some sores are hard to diagnose. The doctor may need to remove the dead debris to see how deep the ulcer has progressed.

How to Treat Pressure Ulcers

Pressure ulcer treatments depend on the progression of the ulcer and how severe it is. Sometimes, changing positions and cleaning the area will relieve the symptoms.

In severe cases, the sore can get infected — leading to blood poisoning. Treatment options involve preventing the ulcer from worsening and promoting healing.

• Dress the area to prevent infection and promote healing
• Change positions regularly or move about if you can
• Use of special static or dynamic foam cushions or mattresses to relieve pressure
• Eat a healthy diet and remain hydrated to promote healing
• Debridement, a procedure, is used to remove dead tissue to promote healing
• In severe cases, surgery may be recommended to remove the damaged tissue and close the sore

How to Manage Pressure Ulcers

For someone confined to a bed or wheelchair, bedsores are sometimes hard to prevent. However, there are things you can do to prevent bedsores from worsening or recurring.

• Changing position regularly if you can or have a caregiver do that for you
• Check the skin daily for early signs of pressure sores
• Address bed sores as soon as they start developing
• Eat a healthy well-balanced diet with enough protein, minerals, and vitamins
• Quit smoking since smoking affects blood circulation, leaving you at risk of developing bedsores

FAQ

1. What are the most serious complications of bedsores? When discovered early, bedsores are treatable. Serious complications arise when the wound becomes infected. Blood poisoning, accelerated heartbeat, mental confusion, and fatigue may arise.
2. Can pressure ulcers lead to long-term damage? If the wound is too deep and becomes infected, the infection can spread to other organs. This can lead to skin infection, bone infection, and blood infection. In severe cases, it can also lead to heart infection and meningitis.

Healthier Me Today is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice in seeking treatment, always consult with your healthcare professional. Stay healthy!