Pressure ulcers
Pressure ulcers
Pressure ulcers happen when constant pressure on part of the skin damages both the skin and the tissue beneath it. People also call them pressure sores or bed sores.
You are more likely to develop pressure ulcers if moving around is difficult for you, for example if you spend long periods lying in bed or sitting in one position.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
When to See a Doctor
When to get medical advice
Phone 111 or contact your GP practice urgently if:
You or someone you care for has symptoms of a pressure ulcer and:
- hot, swollen or red skin – it can look purple or blue on brown or black skin
- pus coming out of the ulcer
- a high temperature
- severe pain or pain that’s getting worse
Contact your GP practice if:
- you think you or someone you care for has a pressure ulcer
Who’s most at risk of pressure ulcers?
Pressure ulcers can happen to anyone, but it’s more common if you have problems moving. This is because the weight of your body puts pressure on the same areas of skin which can damage it.
You have a higher chance of getting a pressure ulcer if you have:
- problems moving
- had a pressure ulcer before
- been seriously ill in intensive care
- recently had surgery
- swollen, sweaty or broken skin
- poor circulation
- fragile skin
- problems feeling sensation or pain
It’s also more likely if you’re underweight.
Severity of pressure ulcers
Pressure ulcers can vary in severity.
Healthcare professionals in Scotland use a grading system to describe how severe pressure ulcers are. In other places, a category or staging system may be used.
The higher the grade or category, the more severe the pressure ulcer is.
A grade 1 pressure ulcer is the least severe type of ulcer.
A grade 1 pressure ulcer may:
- be painful
- feel warm or cool
- feel either warm and spongy, or hard
- cause the affected area of skin to become discoloured
It may not:
- turn white when pressed
- have an open wound
This stage of pressure ulcer might be difficult to detect in darker skin tones.
In grade 2 pressure ulcers, some of the outer surface of the skin (epidermis) or the deeper layer of skin (dermis) is damaged. This can lead to skin loss.
The ulcer looks like an open or burst blister. This can be red or pink. It won’t have any yellow or white in the wound.
In a grade 3 pressure ulcer, skin loss can affect the entire thickness of the skin. The tissue underneath is also damaged, but the bone, muscle or tendon are not.
The ulcer looks like a deep wound and there might be signs of of dead tissue. For example, there may be white, yellow or green discharge coming from the wound.
A grade 4 pressure ulcer is the most severe type of pressure ulcer.
The skin is severely damaged and the tissue around it begins to die. This is called tissue necrosis. The bone, muscles or tendons underneath may be damaged.
People with grade 4 pressure ulcers have a high risk of developing an infection.
Suspected deep tissue injury (SDTI)
A SDTI occurs when the top layer of the skin isn’t broken, but it’s thought there’s a problem underneath the skin.
A SDTI may mean:
- the surface of the skin isn’t broken
- the skin is purple or brownish red
- there’s a blister filled with blood
- the skin breaks down and causes deep tissue loss
- the depth of the wound isn’t known
Ungradable/unstageable
An ungradable or unstageable pressure ulcer means the area is covered by dead body tissue. Healthcare professionals won’t be able to tell how deep the wound is. They may be able to find out what grade or category the pressure ulcer is after dead tissue has been removed.
Mucosal pressure ulcer
Mucosal pressure ulcers affect soft and delicate areas of the body (mucosal membranes) like:
- tongue
- nostrils
- mouth
Mucosal membranes can’t be graded because they don’t have layers of skin like the rest of the body. This means they’re called mucosal pressure ulcers.
Causes
What causes pressure ulcers?
Pressure ulcers happen when something presses on your skin for too long, or when your skin rubs against something. For example, this can happen from a bed or a wheelchair.
Diagnosis
Pressure ulcers can often be diagnosed simply by looking at the affected area. Still, it is always better to stop an ulcer from forming in the first place than to treat one afterward.
To work out whether you are at risk of pressure ulcers, your healthcare team will usually look at:
- your general health
- how easily you are able to move around
- any problems that affect your posture
- any symptoms suggesting an infection
- your mental health
- whether you have had pressure ulcers before
- whether you have urinary or bowel incontinence
- your diet
- how well your blood circulation is working
You may also be sent for further tests if needed.
Checking for pressure ulcers
If you are at risk, it helps to check your skin regularly for areas that are:
- discoloured compared to the skin around them
- unusually spongy or tough to the touch
A mirror can be useful for checking parts of your body that are hard to see on your own, such as your back or buttocks.
If you notice any signs of skin damage, contact your GP or your healthcare team without delay.
Treatment
Treatment for pressure ulcers
The type of treatment you get will depend on how severe the pressure ulcer is.
Changing position and moving regularly is important to help relieve pressure on the ulcers. It can also help to stop new ones from forming.
Other treatments include:
- specially designed mattresses and cushions
- dressings to protect the ulcer and help it heal
- creams and ointments
- antibiotics (if the ulcer is infected)
- cleaning the ulcer
If the pressure ulcer is severe or other treatments haven’t worked, you may need to have surgery. This is to clean and close the ulcer.
How quickly do pressure ulcers heal?
How quickly pressure ulcers heal will be different for everyone.
It can depend on:
- your treatment plan
- how severe the ulcer is
- your nutrition
- if there’s an infection
- if you have any other health conditions
If you’re worried that you ulcer isn’t healing, speak to a healthcare professional.
Prevention
There are simple habits that can help lower your chances of developing a pressure ulcer.
Do
- change position regularly
- use specially designed mattresses and cushions
- keep skin as clean and dry as possible
- check your skin every day for signs of a pressure ulcer
- try to stay active, if possible
- eat a healthy, balanced diet
Don't
- do not smoke
Complications
Pressure ulcers can get infected. Different types of infection can occur, including cellulitis, sepsis, and infections of the bone and joints. Other complications can include pain, distress, longer hospital stays and a reduced quality of life.