Pressure sores
Anyone can get a pressure sore if they sit or lie still for too long without moving.
People who are old or very ill are most likely to get them. Careful nursing and foam mattresses can help to prevent pressure sores.
We've brought together the best and most up-to-date research about pressure sores to see what treatments work. You can use our information to talk to your doctor and decide which treatments are best for you.
What are pressure sores?
Pressure sores are areas of damaged skin that become open wounds. When you sit or lie down you naturally shift your position from time to time, even when you're asleep. But if you can't move yourself because you’re too ill, you could get a pressure sore.
Experts think pressure sores start when the weight of your body presses down on the skin underneath. This pressure stops your blood circulating properly through the skin.
The skin cells die and the skin breaks down. Friction from being moved, or slipping down in bed, also can damage your skin. Areas of skin over the bony parts of your body are most at risk.
Anyone who has difficulty moving can get a pressure sore. But you are more likely to get one if you:
• Are very old
• Are seriously ill or unconscious
• Have had surgery
• Don't eat or drink enough
• Have poor circulation
• Can't feel pain (this can happen if your spinal cord is injured or if you have nerve damage)
• Are very overweight (obese)
Pressure sores can take a long time to heal.
What are the symptoms?
Like other wounds, pressure sores may hurt, weep, bleed, and get infected.
You are most likely to get a pressure sore where your skin gets squashed between bone and your bed or chair: for example, at the bottom of your backbone, over your hip bone, or on the back of your heel.
If you are looking after someone who is likely to get a pressure sore, you need to know the warning signs.
You should tell a doctor or nurse immediately if you find any signs of skin damage, like a discoloured patch. Other warning signs include swelling, blisters, hard or cracked skin, and patches of skin that are shiny, too warm, too cold, or too dry.
What treatments work?
There are a number of things you can do to prevent pressure sores. If you get a pressure sore, there are lots of treatments you can try.
Treatments to prevent pressure sores
If you are at risk of getting pressure sores, you should lie on a foam mattress that provides extra support, not on an ordinary hospital mattress. This will spread your weight and protect your skin.
Good research shows you're much less likely to get a pressure sore if you lie on this type of foam mattress. They are available in hospitals, in nursing homes, and for use at home.
People in intensive care units are often too ill to move themselves. An inflatable bed can help keep their skin healthy by stopping their hips and other weak points from bearing too much weight. In one study, people cared for on inflatable beds were much less likely to get pressure sores than people cared for on ordinary intensive care beds.
A medical sheepskin mat laid over the top of your mattress also may prevent pressure sores.
If you are having surgery, you can lie on a special mat called an overlay, which is placed on top of the operating table. Lying still during a long operation can damage your skin.
Using an overlay can help to lower your chances of getting a pressure sore.
There are many other types of mattresses, overlays, and cushions that are intended to help people avoid pressure sores. But there’s not enough research to say if they work.
They include:
• Mattresses with inflatable compartments
• Cushions made from gel or foam
• Remote-control beds
• Mattresses filled with gel, water, beads, or silicone.
© BMJ Publishing Group Limited 2015. All rights reserved.
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Some inflatable beds have special features designed to keep your skin dry if you have trouble with incontinence. There’s not much research on these, but what there is suggests they don’t work.
Things you can do for yourself
The best way to prevent a pressure sore is to change your position regularly. If you can't do it yourself, a health professional or your carer should do it for you.
There hasn't been any good research to prove that being moved regularly prevents pressure sores. But experts agree that it makes good sense, provided the person moving you is properly trained. Your skin should be protected during moves, so it doesn't rub or drag along the mattress.
Inspecting your skin for early warning signs of pressure sores also is important.
You can also help yourself by:
• Drinking plenty of liquids
• Eating a healthy diet
• Stopping smoking.
All these things are important for your circulation to work well.
Treating pressure sores
One type of bed called an air-fluidised bed may help heal pressure sores. It works a bit like a waterbed, cradling your body and helping spread the weight.
There hasn't been enough good research to know whether any other devices can help heal pressure sores. These include:
• Inflatable or rippling beds or mattresses
• Waterbeds
• Different types of foam mattresses or overlays
• Cushions with different fillings.
It's important to keep your pressure sore clean and clear of any dead tissue. A gentle wash with salt water is usually enough. Removing more stubborn dead tissue is called debridement.
We don't know if debridement helps pressure sores to heal. But most experts agree that it's best to remove dead tissue. Nurses can do this with:
• A blade or sharp knife (a scalpel)
• Special dressings
• Chemicals.
Despite lots of research, it's unclear which method works best.
Dressings are placed directly over your pressure sore to protect it and keep it clean and moist while it heals. There are many different types of dressings. None of them have been tested properly in high-quality studies.
A nurse should decide on the best dressing for you. Guidelines for doctors and nurses recommend foam dressings, hydrogels (gel dressings that help keep the sore moist and clean), and hydrocolloid dressings (dressings designed to soak up excess moisture).
Several other treatments have been tested to see if they help heal pressure sores. But there’s not enough research to show whether they work. They include:
• Suction treatment to remove excess moisture
• Electrical therapy
• Ultrasound massage
• Laser treatment.
What will happen to me?
If you discover pressure sores early, there's a good chance you can stop them getting worse.
Most pressure sores heal eventually. But big pressure sores can be hard to treat and heal slowly. You may need to spend many months being nursed in hospital or at home.
Pressure sores usually affect just the skin. But, rarely, pressure also damages deeper tissues such as muscle. If these tissues die, a deep wound appears that may go down as far as the bone.
Where to get more help
The National Institute for Health and Care Excellence (NICE) has some information about the care you can expect and the types of devices that should be used to prevent and treat pressure sores. You can find out more at http://www.nice.org.uk/CG029.
© BMJ Publishing Group Limited 2015. All rights reserved.
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This information is aimed at a UK patient audience. This information however does not replace medical advice.
If you have a medical problem please see your doctor. Please see our full Conditions of Use for this content. These leaflets are reviewed annually.
