Pressure ulcers are injuries that occur in the skin and underlying tissue due to prolonged pressure on the skin. They often develop on skin covering bony areas of the body, such as the heels, ankles, hips, and coccyx. Pressure ulcers are also known as pressure sores, pressure injuries, and bedsores.
People most at risk for pressure ulcers are those with medical conditions that limit their ability to change body positions or move, as well as those who spend extended periods in bed or in a chair.
Pressure ulcers develop over hours or days. Most heal with treatment, but some may never fully heal. There are steps that can be taken to prevent the spread of pressure ulcers and promote healing.
Symptoms
The symptoms of pressure ulcers include the following:
- Changes in skin color or texture.
- Swelling.
- Discharge resembling pus.
- A area of skin that feels warmer or cooler to the touch compared to surrounding areas.
- Skin ulceration.
Pressure ulcers are classified into several stages based on their depth, severity, and other characteristics. The degree of skin and tissue damage ranges from inflamed, intact skin to deep wounds involving muscles and bones.
Common areas affected by pressure ulcers include:
For individuals who use wheelchairs, pressure ulcers often develop on the skin over the following areas:
• Coccyx or buttocks.
• Scapulae and spine.
• The posterior sides of the arms and legs that rest on the chair.
Pressure ulcers may develop in individuals who are bedridden in the following areas:
• The back of the head or its sides.
• The shoulder blades.
• The hip, lower back, or coccyx.
• Heels, ankles, and the skin behind the knees.
Causes
Pressure on the skin that obstructs blood flow to the area leads to the development of pressure ulcers. Lack of movement can make the skin vulnerable to damage, which may result in pressure ulcers.
There are three main factors that cause pressure ulcers:
- Pressure. Continuous pressure on any part of the body can reduce blood flow to the tissues. Blood flow is essential for delivering oxygen and other nutrients to the tissues. Without these vital nutrients, the skin and surrounding tissues are damaged, which can lead to tissue death over time. Lack of movement can make the skin more susceptible to pressure-related damage. For individuals with limited mobility, the risk of pressure increases in areas that have little muscle or fat and are situated over bone. These areas include the spine, coccyx, shoulder blades, hips, heels, and elbows.
- Friction. Friction occurs when the skin rubs against clothing or bedding. It can make the skin more susceptible to injury, especially if the skin is moist.
Risk factors
The risk of developing pressure ulcers increases if you have difficulty moving and cannot change your body position when sitting or bedridden. Risk factors include:
• Immobility. This may be due to health conditions, spinal cord injury, or other causes.
• Urinary incontinence. The skin becomes more sensitive due to prolonged exposure to urine and feces.
• Sensory impairment. Spinal cord injuries, neurological disorders, and other medical conditions can lead to loss of sensation. If you do not feel pain or discomfort, you may not be aware of warning signs or the need to change your body position.
• Malnutrition and inadequate fluid intake. Individuals need to consume enough fluids, calories, proteins, vitamins, and minerals daily to maintain healthy skin and prevent tissue integrity from deteriorating.
• Medical conditions that affect blood flow. Health issues that impair blood circulation can increase the risk of tissue damage, such as pressure ulcers. Examples of such conditions include diabetes and vascular diseases.
• Age. If you are over 70, you are at higher risk of developing pressure ulcers.
Complications
Complications of pressure ulcers include the following:
- Cellulitis. Cellulitis is an infection that affects the skin and underlying soft tissues. It can cause a feeling of warmth and swelling in the affected area. The skin may appear inflamed or change color. Often, individuals with nerve damage may not feel pain in the area affected by cellulitis.
- Bone and joint infections. Infections caused by pressure ulcers can penetrate into the joints and bones. Joint infections, such as septic arthritis, can damage cartilage and tissue. Bone infections, also known as osteomyelitis, can impair the function of joints and limbs.
Prevention
Following these steps can help prevent pressure ulcers:
- Change your position regularly to avoid pressure on the skin.
- Take good care of your skin.
- Eat and drink regularly.
- Quit smoking.
- Manage stress.
- Exercise daily.
