Skin Care After Spinal Cord Injury

What is a pressure sore?

Having a spinal cord injury (SCI) can cause serious problems for your skin. You may develop pressure sores. Pressure sores are also are called pressure ulcers, decubitus ulcers, bed sores, or ischemic ulcers. A pressure sore is when an area on or under the skin is dead or dying.

What causes pressure sores?

Pressure sores are caused when the blood flowing to the area is slowed down or stopped. This happens most often when you sit or lie on a bony area for too long. Bladder or bowel accidents can make your skin wet which makes your skin even weaker. You may not be able to feel a skin cut or scratch until it becomes a larger problem. Sliding from the bed to a chair or having muscle spasms can rub or tear your skin.

What are the signs and symptoms of a pressure sore?

Pressure sores are described based on the stage they are in. Stage one is the earliest sign and stage four is the latest. It is easier to heal a stage one pressure sore that has grown to stage four.

  • Stage one: There is a reddened area on your skin that does not turn white when it is pressed. This is the first sign that you might be developing a pressure sore.

  • Stage two: A blister or open sore has developed and the area around the sore may be red and irritated.

  • Stage three: The area now looks like a crater and the tissue below the skin is damaged.

  • Stage four: The muscle and bone is damaged because the sore is so deep. Tendons and joints may also be damaged. This is the last sign of a pressure sore. It is hard to heal a stage four pressure sore.

How do I take care of my skin and prevent pressure sores?

It is much easier to prevent a pressure sore than it is to heal it. Follow these guidelines to help prevent pressure sores:

  • Keep your skin clean and dry.

    • Inspect your skin completely two times each day. Use a mirror or ask a family member or someone else do it for you. Look at the areas that most easily get sores. These include your tailbone, hips, or base of your buttocks. These also include the bony areas of your foot and heel.

    • Shower or bathe often, making sure to wash between the folds of your skin. Use an electric shaver to keep from nicking your skin when shaving. Bladder or bowel accidents can make your skin wet, which makes your skin even weaker. Wash and gently dry your skin as soon as possible after a bowel or bladder accident. Change your clothes as soon as possible if they are wet. Use lotion on your skin. Do not use powder.

  • Move often to avoid sitting or lying in the same position for too long.

    • Do pressure shifts at least every 15 to 20 minutes. The kind of pressure shifts that you can do may depend on where your spinal cord is injured. Always make sure your wheelchair is locked before beginning any pressure shifts.

    • Change position at least every two hours when you are in bed. If you are unable to turn yourself, ask someone to help you.

    • Exercise often. Caregivers help you with range of motion exercises. These exercises keep your muscles, tendons, and ligaments strong and limber and increase blood flow to your skin.

  • Eat a healthy diet. Eat a variety of healthy foods. Eating healthy foods may help you feel better and have more energy. It may also help you heal faster. Good skin care requires eating enough protein, vitamins, and minerals. Caregivers may suggest that you take food supplements to make sure you are getting enough of these important things. Do not take any vitamins, herbs, or food supplements without first talking to caregivers. Eat different foods from the following groups every day:

    • Bread, cereal, rice, and pasta.

    • Vegetables.

    • Fruits.

    • Milk, yogurt, and cheese.

    • Meat, poultry (chicken), fish, dry beans, eggs, and nuts.

    • Ask your caregiver how many servings of fats, oils, and sweets should be included in your diet.

  • Drink enough liquids. Drink 6 to 8 (8 ounce) cups of healthy liquids each day. Follow your caregiver's advice if you must change the amount of liquid you drink. For most people, healthy liquids to drink are water, juices, and milk. Limit the amount of caffeine in your diet. Caffeine may make you urinate too much and lose too much body fluid. Caffeine may be found in coffee, tea, soda pop, and sports drinks and foods. Try to drink enough liquid each day, and not just when you feel thirsty.

  • Prevent injury by protecting your skin.

    • Avoid wearing clothes that are too tight or too loose. Clothes with thick seams, buttons, or zippers can also cause sores.

    • Use special equipment for sitting or lying that can protect your skin. Check with your caregivers to get specially adjusted seat cushions, mattresses, pillows, and sheepskin.

    • Avoid moving or doing things that rub, scratch, or cut your skin. Take special care when transferring from bed to wheelchair to commode. Sliding from one place to the next can pull or stretch your skin and tear it. Lift yourself or have caregivers lift you rather than sliding or being pulled.

  • Quit smoking. It is never too late to quit smoking. Smoking harms the heart, lungs, and the blood. You are more likely to have a heart attack, lung disease, and cancer if you smoke. Most important for someone with an SCI, smoking decreases oxygen to the skin. This makes it easier to get a pressure sore and slows healing. You will help yourself and those around you by not smoking. Ask your caregiver for more information on how to stop smoking if you are having trouble quitting.

What should I do if I see a pressure sore starting?

When you see signs of a pressure sore it means that damage is already happening. You need to act fast. The only way for the sore to heal is to keep pressure off of it. This may mean that you have to stay in bed, but staying in bed may put you at risk for developing other problems. You can develop a pressure sore in another area, have respiratory (breathing) problems, or develop a urinary tract infection. Caregivers will work closely with you to help the pressure sore heal.

Do not:

  • Do not massage the area of the ulcer. Massaging the area can cause further damage to the skin.

  • Do not use a donut-shaped or ring-shaped cushion. These cushions can slow blood flow to that area and cause worse problems.

Where can I go for support?

  • Having a spinal cord injury is life changing for you and your family. Accepting that you have a spinal cord injury is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with a spinal cord injury.

  • You may want to join a support group. This is a group of people who also have spinal cord injuries. Ask your caregiver for the names and numbers of support groups in your town. You can contact the following for more information.
  • National Spinal Cord Injury Association
    1 Church Street, Suite 600
    Rockville , MD 20850
    Phone: 1- 800 - 962-9629
    Web Address:
  • American Spinal Cord Association
    2020 Peachtree Road, NW
    Atlanta, Georgia , 30309-1402
    Phone: 1- 404 - 355-9772
    Web Address:

Contact your caregiver if:

You have:

  • A reddened area on your skin that does not blanch (turn white) when it is pressed.

  • A blister or open sore has developed on your skin, and the area around it is red and irritated.

  • A skin area looks like a crater.

  • A deep sore that may be draining blood or fluid.

  • Signs and symptoms of an infection. These may include greenish or yellowish drainage coming from the sore. These may include a bad smell coming from the sore.

  • You have chest pain or trouble breathing that is getting worse over time.

Seek care immediately if:

  • You have a fever.

  • You suddenly feel lightheaded and have trouble breathing.

  • You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about good skin care and preventing pressure sores. You can then discuss choices with your caregivers. Work with them to decide what choices may be best for you. You always have the right to refuse and make your own decisions.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.

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