What are pressure ulcers?

A pressure ulcer is a breakdown of skin and underlying tissue that develops when you are bedridden or have to stay in one position for a long time. Pressure ulcers can occur if you lie in bed or sit in a chair for long periods of time without shifting your weight. They may also be caused by rubbing or friction on the skin.

Pressure ulcers used to be called bedsores.

How do they occur?

Pressure ulcers are caused by pressure or rubbing of weight- bearing parts of the body. Areas where bones are close to the skin are especially prone to such ulcers. Constant pressure on the skin squeezes the tiny blood vessels that supply the skin with nutrients and oxygen. When skin is starved of nutrients and oxygen for too long, the tissue dies and a pressure ulcer forms.

The following risk factors increase your chance of getting pressure ulcers:

• bed or chair confinement

• inability to move without help

• loss of bowel or bladder control (the moisture from stool or urine may irritate the skin)

• poor nutrition, resulting in unhealthy skin

• decreased alertness, possibly from health problems, medications, or anesthesia

• low body weight or recent weight loss resulting in a lack of fat tissue over bony areas such as the hips, heels, and ankles.

What are the symptoms?

Pressure ulcers appear over bony parts of the body where there is irritation or pressure. The symptoms develop in stages:

• Stage I: A reddened or darkened area of skin appears and does not go away within 30 minutes after you change your position to put less pressure on the area.

• Stage II: The skin cracks, blisters, peels, or breaks.

• Stage III: The skin opens up and may ooze or drain. The ulcer is completely through the skin and may start to involve underlying tissues. Some yellow tissue may be seen.

• Stage IV: A deep ulcer develops. Muscle is visible. Bone may also become visible.

How are they diagnosed?

The doctor or nurse will examine your skin.

How are they treated?

Treatment depends on the severity of the condition. Pressure ulcers need prompt and ongoing care in the early stages to try to avoid tissue damage and infection.

If you have any of the symptoms listed above, you should:

• Tell your doctor or nurse.

• Keep pressure off the area. For example, if the ulcer is on your back, try to lie on your stomach or side.

• Keep the ulcer clean and protect it from urine and stool. Several products can be used to clean and protect the skin. Your health care provider can help you.

• Do not massage the area. Massage may cause more tissue damage. Also, do not massage any of the bony parts of your body.

• If the skin is broken, your health care provider can recommend a product that will help the ulcer heal. It will also protect the area from infection and protect the skin around the ulcer.

• Turn or otherwise change your position every 1 to 2 hours.

• Eat a healthy diet. Talk with your health care provider and dietician about your diet and nutritional supplements.

• Ask your health care provider about special products that can help reduce pressure on the skin. Ask about a mattress and chair cushion to reduce pressure. Do not use doughnut cushions to reduce pressure; they may make the condition worse.

• Tell your health care provider right away if you develop a fever, notice an odor or change in the color of drainage from an ulcer, or develop redness around an ulcer.

• If you are unable to move easily, pillows may be placed under your legs from midcalf to ankle to keep your heels off the bed. Never place pillows under your knees.

• Exercise your body by tensing and relaxing your muscles, wiggling fingers and toes, and rotating your wrists and ankles to keep them as flexible as possible. If you can't do this, have someone bend and straighten your arms and legs every day to keep you from getting stiff.

• Lightly powder your sheets or use sheepskin to reduce friction. Someone helping you to reposition can use a sheet to lift you so you don't have to slide on the bed.

• Try not to elevate the head of your bed more than 30 degrees except at mealtimes.

How long will the effects last?

Pressure ulcers can take a long time to heal if they are completely through the skin. The rate at which the broken skin heals depends on your general health, diet, and home care. It is best to try to prevent pressure ulcers.

How can I help prevent pressure ulcers?

To prevent a pressure ulcer or keep one from getting worse or infected, follow these guidelines:

• Call your doctor or nurse as soon as you notice the redness, change in skin color, or break in the skin.

• Change your position frequently (at least every 1 to 2 hours) and check your skin every day. If you can move yourself in a chair, shift your weight every 15 minutes.

• Use soft pillows or sheepskin to keep parts of your body from rubbing together.

• Try to keep the weight of sheets and blankets off the area with ulcers.

• Have someone help you gently clean with soap and water the areas where ulcers can develop, especially if the bed has become soiled with sweat, urine, or stool. Creams are available to protect the skin from urine and stool.

• Keep the sheets and bedclothes dry, clean, and free of wrinkles.