Pressure ulcers

Pressure ulcers are areas of damage to the skin and the tissue underneath. They happen when a part of your skin is put under pressure.

You may also hear them called pressure sores or bed sores.

You're more likely to get pressure ulcers if you have difficulty moving, for example if you're confined to lying in a bed or sitting for long periods of time.

Pressure ulcers usually form on the bony parts of the body that don't have much body fat covering them. The heels, elbows, hips and tailbone are common places.

The symptoms show up as patches of skin that:

• are discoloured and don't change colour when you press them (the patches are usually red on white skin, or purple or blue on black or brown skin)
• feel warm, spongy or hard
• become painful

Pressure ulcers usually come on gradually, but sometimes they appear quite quickly.

Sometimes a pressure ulcer can blister or become an open wound. If it isn't treated, it will keep getting worse and might deepen to reach the muscle or bone.

On brown or black skin, pressure ulcers can be harder to see. This means you may not notice them until they're more severe.

You or someone you care for has symptoms of a pressure ulcer and also has any of these signs. See a doctor urgently, or call the 16263 health line:

• 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

• you think you or someone you care for has a pressure ulcer

Pressure ulcers can happen to anyone, but they're more common if you have problems moving. The weight of your body keeps pressing on the same areas of skin, and that 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

You're also more likely to get one if you're underweight.

Pressure ulcers can vary in severity.

Health professionals 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. It 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 can be difficult to detect in darker skin tones.

In a grade 2 pressure ulcer, 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, and it can be red or pink. You won't see 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 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. 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 a grade 4 pressure ulcer have a high risk of developing an infection.

A suspected deep tissue injury (SDTI) happens when the top layer of the skin isn't broken, but doctors think there's a problem underneath it.

An 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

An ungradable or unstageable pressure ulcer is one where the area is covered by dead body tissue. Because of this, doctors can't tell how deep the wound goes. They may be able to work out the grade or category of the pressure ulcer once the dead tissue has been removed.

Mucosal pressure ulcers affect the soft, delicate areas of the body, known as mucosal membranes. These include the:

• tongue
• nostrils
• mouth

Mucosal membranes don't have layers of skin like the rest of the body, so these ulcers can't be graded. That's why they're called mucosal pressure ulcers.

A doctor can usually diagnose pressure ulcers just by looking at the affected area. Still, it's better to stop them from developing in the first place.

To help find out if you're at risk of pressure ulcers, healthcare professionals will look at:

• your general health
• your ability to move
• any problems that affect your posture
• any symptoms of an infection
• your mental health
• any pressure ulcers you've had before
• urinary incontinence or bowel incontinence
• your diet
• how well your blood circulation system is working

You may also be referred for other tests.

If you're at risk of pressure ulcers, check your skin for areas that are:

• discoloured
• unusually spongy or tough to the touch

Use a mirror to look at parts of your body that are hard to see, like your back or buttocks.

If you notice any signs of damage, contact your doctor or your healthcare team.

How your pressure ulcer is treated depends on how severe it is.

Changing position and moving regularly matters, because it takes pressure off the ulcers. It can also 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 surgery. This is to clean and close the ulcer.

Pressure ulcers don't heal at the same speed in everyone. How quickly yours heals 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 your pressure ulcer isn't healing, speak to a doctor.

Pressure ulcers happen when something presses on your skin. They can also happen when something keeps rubbing against it, a bed or a wheelchair, for example.

There are some things you can do to lower your chances of getting a pressure ulcer.

• change position regularly
• use specially designed mattresses and cushions
• keep your skin as clean and dry as you can
• check your skin every day for signs of a pressure ulcer
• stay active if you can
• eat a healthy, balanced diet

Pressure ulcers can become infected. There are different types of infection, including:

• cellulitis
• sepsis
• bone and joint infections

Other complications of pressure ulcers can include:

• pain
• distress
• longer hospital stays
• reduced quality of life