Pressure Ulcer (Bedsores): Stages, Causes, and Treatment Options

Pressure Ulcer (Bedsores): Stages, Causes, and Treatment Options

Pressure ulcers, commonly known as pressure injuries or bedsores, are still a major healthcare concern, impacting millions of individuals each year. Every year, an estimated one to three million people in the United States get pressure ulcers. Their prevalence varies by care settings, affecting from 5% to 15% of hospitalized patients and more than 11% of nursing home residents. In this blog, lets understand how pressure ulcers develop, who is at risk, and how they can be prevented to improve patient outcomes and quality of life. ¹

What Are Bedsores?

Bedsores are skin wounds caused by consistent pressure over time. People who are confined to a bed or wheelchair for extended periods of time are more likely to suffer from them. These painful sores can swell, become infected, and, in some cases, be fatal. ²

What Are Other Names For Bedsores?

Bedsores may also be referred to by several other names, including:

• Decubitus ulcers
• Pressure injuries
• Pressure sores
• Pressure ulcers
• Pressure wounds²

How Common Are Bedsores?

Experts estimate that over 2.5 million people in the United States get bedsores each year, which can affect people of all ages and backgrounds. ²

What Causes Bedsores?

Bedsores occur when continual pressure restricts or prevents blood flow to the skin. Without adequate blood supply, skin tissue can begin to deteriorate in as little as two hours. Cells in the outer layer of the skin begin to die, and if the damage worsens, a pressure ulcer can emerge.

Bedsores are more likely to occur when pressure is paired with: ²

• Moisture from sweat, pee, or stool weakens the skin.
• Friction or pushing on the skin, such as sliding down in an elevated bed or wheelchair.

Who Is At Risk For Bedsores?

People with delicate or thin skin, as well as those who can't move freely, are more likely to develop bedsores. This includes those who: ²

• Are in a coma or vegetative state
• Have paralysis
• Use wheelchairs for mobility
• Wear splints, casts, or prosthetic devices

What Are The Signs Of Bedsores?

Bedsores can be painful and itchy, but people with reduced sensation may not feel them at all. Their appearance and symptoms can vary depending on the stage and severity of the wound. ²

Who Is At Risk Of Developing Pressure Ulcers?

Bedsores can affect anybody with limited movement, but some medical problems put children and adults at a higher risk. These conditions generally fall into three main categories and include: ²

• Cancer
• Cerebral palsy
• Chronic venous insufficiency
• Dementia
• Diabetes
• Heart failure
• Kidney failure
• Malnutrition
• Peripheral artery disease
• Spinal cord injuries or spina bifida

What Are the Different Stages of Bedsores?

Here’s the four stages of bedsores: ²

Stage 1

The skin appears red or pink but there is no open wound. People with darker skin tones may find the color change more difficult to perceive. The area may feel painful, warmer or cooler than the surrounding skin. It may also feel slightly firmer or softer to the touch.

Stage 2

A shallow open wound forms with a pink or crimson base. There may be visible skin loss, abrasions, or fluid-filled blisters.

Stage 3

The sore deepens and spreads to the fatty layer beneath the skin (subcutaneous tissue), resulting in a more prominent lesion.

Stage 4

The wound develops quite deep, exposing underlying muscles, tendons, and possibly bone.

What Complications Can Bedsores Cause?

Bedsores can raise the risk of serious and potentially fatal infections including cellulitis and septicemia. In severe circumstances, they might develop to sepsis or necessitate amputation. Bedsores cause almost 24,000 deaths worldwide each year. ²

Some people may also develop sinus tracts, which are aberrant pathways that connect pressure sores to deeper tissues in the body. Depending on how far these channels stretch, issues could include:

• Bloodstream infections (bacteremia) can proceed to meningitis or endocarditis.
• Infections of the bones or joints, like osteomyelitis or septic arthritis.
• Group A streptococcal infections range from cellulitis to necrotizing fasciitis (flesh-eating illness).

What Are the Treatment Options for Bedsores?

Pressure injuries may be treated as follows:

• Wash the wound with soap and water or a saline (sterile saltwater) solution.
• Covering the wound with specific dressings that promote healing, such as hydrogels, hydrocolloids, alginates (derived from seaweed), or foam dressings.
• Advanced therapies, such as placental wound grafts, contain natural growth factors that enhance tissue repair and speed up healing in chronic or severe wounds.
• For deeper or more serious ulcers, your healthcare professional may undertake debridement, which is the removal of dead tissue. This can be accomplished using surgical instruments or drugs that assist disintegrate injured tissue.²

When Should You See a Doctor for Bedsores?

If you observe the following symptoms and are at risk for bedsores: ²

• Skin color changes
• Signs of infection
• Skin discomfort, soreness, or unusual heat

Conclusion

Bedsores are more than just skin wounds, they are a serious health concern that can lead to pain, infection, and life-threatening complications if left untreated. The good news is that most bedsores are preventable with early care, regular movement, proper skin hygiene, and timely medical attention. Recognising the warning signs and seeking treatment early can make a significant difference in recovery and overall health. If you or a loved one is at risk, staying informed and proactive is the best step toward preventing complications and promoting healing.

Frequently Asked Questions

1. What complications can bedsores cause?

Untreated bedsores can lead to serious infections, sepsis, bone infections, or even amputation. In severe cases, they can be life-threatening. ²

2. When should I see a doctor for bedsores?

You should seek medical care if you notice skin color changes, signs of infection, or tenderness, pain, or warmth in the affected area. ²

3. What are the stages of bedsores?

Bedsores progress from Stage 1 (red or pink skin with no open wound) to Stage 4 (deep wounds exposing muscle or bone), with each stage indicating increasing severity. ²