Skip to Content

Pressure Ulcer

What is a pressure ulcer?

A pressure ulcer is an injury to the skin or tissue over a bony area. A pressure ulcer is also called a pressure sore, bedsore, or decubitus ulcer. Pressure ulcers can form over any bony area but are most common on the back, buttocks, hips, and heels.

What causes pressure ulcers?

  • Continuous pressure builds when you sit or lie on a bony area for too long. Pressure slows or stops the blood from flowing to the skin. This may hurt the skin and cause tissue damage. Pressure can start to cause damage to your skin and tissue about 2 hours after staying in the same position.

  • Shearing or friction happens when delicate skin is dragged across a surface, such as sheets. This may cause your skin to tear or a blister to form. Sliding up or down in bed or moving from the bed to a chair may tear your skin. Muscle spasms may cause your arms or legs to jerk and rub the sheets, causing tears in your skin.

What increases my risk for a pressure ulcer?

  • Long periods of time without moving

  • Short periods of increased pressure, such as sitting in a wheelchair

  • Not being able to control your urine or bowel movements

  • Dehydration or poor nutrition

  • Numbness

  • Poor blood flow to your limbs

  • Age over 65 years

  • Previous pressure ulcer

What are the stages of a pressure ulcer?

  • With a deep tissue injury , your skin is not broken. You may see purple or red skin, or a blister. Your skin may feel warm, spongy, or tight when you touch it.

  • At stage 1 , your skin is not broken, but it may itch or hurt. Your skin may feel warm, spongy, or tight when you touch it. The skin may stay red for more than an hour after pressure is removed from the bony area.

  • At stage 2 , the skin has broken. You may have an open sore and the area around it may be red and raw. Your skin may sink inward and look shiny or dry.

  • At stage 3 , the tissue below your skin is damaged. The area looks like a deep crater, or bowl-shaped hole. There may be more damage hidden under the skin than what you can see.

  • At stage 4 , the sore is very deep and your tendons, muscle, and bone may be damaged. You may be able to see the tendons, muscle, and bone in the wound.

  • With an unstageable wound , it is hard for healthcare providers to see what stage your pressure ulcer is in. This is usually because there is a lot of dead tissue or scabbing in the wound.

How is a pressure ulcer diagnosed?

Your healthcare provider will ask about your pressure ulcer and examine you. Tell him when your pressure ulcer started and if it is getting bigger or changing color. He may ask if you have pain or numbness over any bony areas. Tell him how you care for your skin at home. You may need any of the following:

  • A sample of fluid, tissue, or bone from your wound may show a bacterial infection. This will help your healthcare provider plan your treatment.

  • Blood tests may show if you have a bacterial infection.

  • An x-ray, ultrasound, or MRI may show the tissues around your ulcer and the bone under your ulcer. You may be given contrast liquid to help the bone and any infection show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.

How is a pressure ulcer treated?

You may need any of the following treatments depending on the stage of your pressure ulcer:

  • Bandages may be need to protect your skin or wound. Your healthcare provider will choose the best bandage for your wound. Bandage changes may include cleaning the wound with saline (saltwater). If your wound is deep, gauze that is wet with saline may be used to fill the wound. This is called packing the wound. A clean, dry dressing is placed over the packed wound to keep the skin dry. When the gauze dries, it is taken out and replaced with fresh, wet gauze.

  • Medicines may be given to decrease pain or to help treat or prevent a bacterial infection. Ask how to take these medicines safely.

  • Debridement is a procedure used to clean out dead tissue from a serious ulcer. Dead tissue may keep the wound from healing. Debridement allows healthy tissue to form so your wound can heal.

  • Negative pressure wound therapy (NPWT) uses a machine called a wound vac, wound vacuum, or pump to help with wound healing. Suction from the machine removes excess drainage from your wound and pulls wound edges closer together. NPWT promotes healthy tissue growth by increasing blood flow to your wound. NPWT also reduces bacteria that causes infections.

  • Surgery may be needed to close your wound. This is called a flap closure. A skin flap (piece of skin) is usually taken from an area close to the wound. One end of the skin flap often remains attached while the other end is moved to cover your wound. The skin flap is secured with stitches or staples.

What can I do to manage my condition?

  • Change your position often. Change your position every 2 hours if you are in a bed all day. Change your position every hour if you are in a wheelchair all day. Set an alarm to help remind you when it is time to turn. Keep a written turning schedule to help you remember to turn. If you are helping a person move in bed, lift him. Do not slide him. Keep the head of the bed as low as possible. This may help prevent damage to the skin from sliding down in bed.

  • Eat a variety of healthy foods. Healthy foods include fruits, vegetables, whole-grain breads, and fish. Foods that are high in protein may help your pressure ulcer heal. This includes lean meats, beans, milk, yogurt, and cheese. Nutrition shakes may also give you extra calories and protein if you have trouble eating or are underweight.

  • Do not smoke. Nicotine can damage your skin and slow wound healing. Do not use e-cigarettes or smokeless tobacco in place of cigarettes or to help you quit. They still contain nicotine. Ask your healthcare provider for information if you currently smoke and need help to quit.

How do I care for my skin?

  • Clean and cover your wound. You may need to keep a bandage over your wound to protect the skin from more damage. You may also need to clean your wound with saline. Ask your healthcare provider for more information about when and how to change your bandages.

  • Keep your skin clean, dry, and moisturized. Use mild soap and warm water to clean your skin. Do not rub or scrub when you wash. Do not use products that contain alcohol, because they can dry out your skin. Gently pat your skin dry. Do not rub your skin with a towel. Apply lotion or a moisturizer on your skin often.

  • Protect the skin over bony areas. Use pillows or foam wedges to keep bony areas from touching, and to relieve pressure. For example, put a pillow or foam wedge between your knees to keep them from pressing on one another. Place a pillow or foam wedge under you to keep your hip raised when you lie on your side. Do not rest directly on your hipbone. Put a foam pad or pillow under your legs from calf to ankle when you lie on your back. The pad or pillow should raise your heels so that they are not touching the bed.

  • Use medical equipment and pads. A draw sheet or large pad under you may help others move you up in bed. An overhead trapeze can help you change positions in bed. Mattresses and overlays made to provide more cushioning may help decrease the risk of pressure ulcers. Examples include a foam mattress pad and air or water mattresses. Ask about equipment that may be right for you and how you use it.

When should I contact my healthcare provider?

  • You have a fever.

  • You have green or yellow drainage or a bad smell coming from your pressure ulcer.

  • An area of your skin is very red and firm.

  • You have new pain, or pain that is getting worse.

  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.