What are pressure ulcers or sores?

Pressure ulcers — also known as bed sores, pressure sores or decubitus ulcers — develop when the skin or tissue beneath the skin is damaged due to constant pressure or friction. Pressure ulcers often occur on bony areas, such as the heels and elbows. However, they can appear on any part of the body that is under pressure for a long time.

Pressure ulcers can be painful and uncomfortable and can take a long time to heal. They can also create sleep and mood disturbances, get infected and affect rehabilitation, mobility and long-term quality of life.

You should try to prevent pressure ulcers from forming if you are immobile or if you care for someone who is confined to a bed or chair.

How can I prevent pressure ulcers?

Pressure ulcers can be avoided, but often you may need help. If you have difficulty moving, preventing pressure ulcers might require a team effort, involving your health team, carer or a family member.

To protect your skin and prevent pressure ulcers, the following will help:

• Keep active and move as much as you can (for example, if you can't move your legs, try and move your upper body frequently).
• Eat a variety of nutritious foods, including plenty of fruits and vegetables.
• Drink plenty of fluids to make sure you are hydrated.
• Avoid smoking because this reduces blood flow to your skin.
• Avoid firm massage, especially over bony areas.
• Keep your skin dry as far as possible.
• If you feel any skin pain or a feeling of burning, tell your doctor.

There are several things that will help you care for your skin:

• Instead of soap, use a mild cleanser and dry the skin gently afterwards.
• Apply moisturisers if the skin is dry, flaky or seems to crack easily.
• Use barrier cream in skin folds.
• Use warm (not hot) water when having a bath or shower.

It is important to move around as often as you are able. Continuous pressure on the same areas can lead to a pressure ulcer developing very quickly. The following may help you avoid this:

• Change positions in bed at least every 30 minutes and, if you can, stand up and walk around.
• If you can’t stand, move as much as you are able — for example, lean forward or move side to side in your chair for 2 minutes to take the pressure off your bottom and hips.
• Try to avoid slumping or sliding forward in your chair.

Your healthcare team may use a range of special equipment to help reduce pressure in specific areas. This may include dynamic mattresses, cushions and heel wedges.

Check your skin twice a day and look for early signs of a pressure ulcer, such as:

• red areas that don’t fade
• blistered or bruised-looking skin
• shiny areas
• warm or hard patches
• broken or cracked skin

Look at your entire body, but pay particular attention to bony areas such as the heels, buttocks (tailbone), elbows and between skin folds, as well as under plasters, dressings, splints or tubes. You may need someone to help you with this, especially if you have reduced mobility.

The healthdirect Symptom Checker can help you decide what to do next.

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What increases the risk of developing pressure ulcers?

People who are confined to a bed or chair — for example due to stroke, spinal injury or dementia are at greater risk of developing extensive pressure ulcers. Other risk factors include:

• immobility — being confined to bed after an illness or surgery, or due to paralysis
• decreased sensory perception — decreased sensitivity and ability to feel pain
• malnutrition or obesity
• older age
• circulation problems — reduced blood flow to pressure points
• smoking
• incontinence
• diabetes and other health conditions that can affect blood supply

How can pressure ulcers be treated?

It is important to watch out for early signs of pressure ulcers and to contact your doctor if you notice any changes to the skin. Ulcers are best managed early on, and your doctor will assess whether your pressure ulcer can be managed at home, if you need a referral to a wound specialist or if you require treatment at hospital.

Use healthdirect’s Service Finder tool to locate your nearest GP or nurse clinic.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

Wound dressings can enhance healing. Your healthcare team will select the most appropriate treatment and dressing, depending on your specific pressure ulcer. There are 6 classes of dressings:

• film dressings
• hydroactive dressings
• hydrocolloid dressings
• hydrogel dressings
• foam dressings
• alginate absorbent fibre dressings

Depending on the type of pressure ulcer, a bandage may also be applied to keep the dressing in place or support the injured area.

To promote healing and recovery, it is important to eat a balanced diet that includes protein, carbohydrates, fats and sufficient fluids.

Other treatments may include antibiotics if the ulcer becomes infected, or debridement — a procedure used to clean the wound and remove any damaged tissue.

What are the 4 stages of pressure ulcers?

You might hear medical staff refer to pressure ulcers in stages. Stage 1 is less severe, while an ulcer can progressively increase in severity to stage 4.

The 4 stages of pressure ulcers are:

Stage 1	The skin is red, but not broken. When you press the skin, it does not turn white.
Stage 2	There is some damage to the outer layer of skin. The pressure ulcer looks like a shallow, open wound with a redish-pink centre. It can also look like a blister that may or may not have opened.
Stage 3	There is full loss or damage of the skin. The wound looks quite deep but is still limited to the skin layers.
Stage 4	There is full loss or damage of the skin — it is deep and goes all the way to the underlying bone, tendon or muscle.

What complications might come with pressure ulcers?

Pressure ulcers can be painful and become infected, and infection may spread from the skin (cellulitis), to blood (sepsis), muscle or bone. Treatment may require antibiotics, usually at home but sometimes in hospital. In very rare cases, chronic pressure ulcers can cause skin cancer. It's important to recognise pressure ulcers early and to act quickly to prevent complications.

Resources and support

For more information and support, try these resources:

• Read the Victorian Quality Council booklet on preventing pressure ulcers.
• Visit the Australian wound management website for more information on managing pressure injuries.
• Visit the Healthy Eating Active Living: Over 50s program
• See the Carer Gateway website on caring for someone with reduced mobility.
• For information on additional services for older people, visit the carers life course.
• Read about caring for ageing skin on the Australasian College of Dermatologists website.