Overview
Pressure ulcers (pressuresores or bed sores) are areas of damage to your skin and the tissue underneath. You have a higher chance of getting them if you have difficulty moving.
Check if it's a pressure ulcer
Pressure ulcers usually from bony parts of the body, such as the heels, elbows, hips and tailbone.
Symptoms of a pressure ulcer include:
- discoloured patches of skin that do not change colour when pressed - the patches are usually red on white skin, or purple or blue on black or brown skin
- a patch of skin that feels warm, spongy or hard
- pain or itchiness in the affected area of skin
The ulcers usually develop gradually, but can sometimes appear over a few hours.
They can become a blister or open wound. If left untreated, they can get worse and eventually reach deeper layers of skin or muscle and bone.
See a GP if:
- you think you or someone you care for have a pressure ulcer
Ask for an urgent GP appointment or get help from NHS 111 if:
You or someone you care for have symptoms of a pressure ulcer and:
- hot, swollen or red skin - it can look blue or purple on brown or black skin
- pus coming our of the ulcer
- a high temperature
- severe pain or pain that's getting worse
You can call 111.
Treatments for pressure ulcers
How a pressure ulcer is treated depends on how severe it is.
Changing position and moving regularly is important to help relieve pressure on the ulcers and help stop new ones forming.
Other treatments include:
- specially designed mattresses and cushions
- dressings to protect the ulcer and help it heal
- creams and ointments
- antibioltics if the ulcer is infected
- cleaning the ulcer
If the pressure ulcer is severe or other treatments have not worked, you may need to have surgery to clean and close the ulcer.
Causes of pressure ulcers
Pressure ulcers are caused by something putting pressure on or rubbing your skin.
It can happen to anyone, but it's usually if you have problems moving, as this can mean the weight of your body is always putting pressure on the same area of skin, which can damage it.
You have a higher chance of getting a pressure ulcer if you:
- have problems moving
- have had a pressure ulcer before
- have been seriously ill in intensive care or have recently had surgery
- are underweight
- have swollen, sweaty or broken skin
- have poor circulation or fragile skin
- have problems feeling sensation or pain
Things you can do to prevent pressure ulcers
If you're being cared for at home, there are things you and your care team can do to lower your chances of getting a pressure ulcer.
Do
- change position regularly
- use specially designed mattresses and cushions
- check your skin every day for symptoms of a pressure ulcer
- try to stay active, if possible
- eat a healthy, balanced diet
Don't
If you're being cared for at home and think you're at risk of getting pressure ulcers, you can ask a GP for a risk assessment so your care team can make a plan to prevent them.
Treatment
Treatment for pressure ulcers (sores) typically include regularly changing your position, using special mattresses to reduce or relieve pressure, and dressings to help heal the ulcer. In some cases, surgery may be needed.
Changing position
Moving and regularly changing your position helps to relieve the pressure on ulcers that have already developed. It also helps prevent pressure ulcers developing.
After your care team has carried out an assessment of your risk of developing pressure ulcers, they will draw up a repositioning timetable. This states how often you need to move, or be moved if you're unable to do so yourself.
For some people, this may be as often as once every 15 minutes. Others may need to be moved only once every two to four hours.
You may also be given training and advice about:
- correct sitting and lying positions
- how you can adjust your sitting and lying positions
- how best to support your feet to relieve pressure on your heels
- any special equipment you need and how to use it
Mattresses and cushions
If you're at risk of getting pressure ulcers or have a minor ulcer, your care team will recommend a specially designed static foam or dynamic mattress.
If you have a more serious ulcer, you will require a more sophisticated mattress or bed system, such as a mattress connected to a pump that delivers a constant flow of air into the mattress itself.
There are also a range of foam or pressure-redistributing cushions available. Ask your carer about the types most suitable for you.
However, the National Institute for Health and Care Excellence (NICE), says there's limited evidence on what kinds of pressure-redistributing devices are best for the relief and prevention of pressure ulcers in different places, such as heels or hips.
Dressings
Specially designed dressings can be used to protect pressure ulcers and speed up the healing process.
These include:
- alginate dressings – these are made from seaweed and contain sodium and calcium, which are known to speed up the healing process
- hydrocolloid dressings – contain a special gel that encourages the growth of new skin cells in the ulcer, while keeping the surrounding healthy skin dry
- other dressing types – such as foams, films, hydrofibres/gelling fibres, gels and antimicrobial (antibiotic) dressings may also be used
Ask your carer about which type of dressing they're using for the management of your pressure ulcer.
Gauze dressings aren't recommended for either the prevention or treatment of pressure ulcers.
Creams and ointments
Topical antiseptic or antimicrobial (antibiotic) creams and ointments aren't usually recommended for treating pressure ulcers.
But barrier creams may be needed to protect skin that's been damaged or irritated by incontinence.
Antibiotics
Antibiotics may be prescribed to treat an infected ulcer or if you have a serious infection, such as:
Diet and nutrition
Eating a healthy, balanced diet that contains enough protein and a good variety of vitamins and minerals can speed up the healing process.
If your diet is poor, you may see a dietitian. They can draw up a suitable dietary plan for you.
It's also important to keep up fluid intake to avoid dehydration, as being dehydrated can slow down the healing process.
Removing damaged tissue (debridement)
In some cases, it may be necessary to remove dead tissue from the pressure ulcer to help it heal. This is known as debridement.
If there's a small amount of dead tissue, it may be removed using specially designed dressings.
Larger amounts of dead tissue may be removed using:
- high-pressure water jets
- ultrasound
- surgical instruments, such as scalpels and forceps
A local anaesthetic should be used to numb the area around the ulcer so debridement (if not being treated with a dressing) doesn't cause you any pain.
Surgery
Severe pressure ulcers might not heal on their own. In such cases, surgery may be needed to seal the wound, speed up healing, and minimise the risk of infection.
Surgical treatment involves:
- cleaning the wound and closing it by bringing the edges of the ulcer together
- cleaning the wound and using tissue from healthy skin nearby to close the ulcer
Pressure ulcer surgery can be challenging, especially because most people who have the procedure are already in a poor state of health.
Risks after surgery include:
Ask your surgeon about the benefits and risks of surgery if it's recommended for you.