Pressure sores overview

Also called bed sores, pressure sores, pressure areas, pressure ulcers or a pressure injury

A pressure sore is an area of damaged skin and tissue caused by spending long periods of time in bed or in a wheelchair.

Key points

  1. Pressure sores are also known as pressure injuries, pressure ulcers, bed sores or pressure areas. They are caused by staying in one position for too long, such as prolonged sitting or lying.
  2. Pressure sores usually form around bony areas of your body, such as your ankles, heels, hips and tailbone, as these areas take the weight of your body.
  3. They can develop in a matter of hours. The first sign of a pressure sore is usually a discoloured skin area that doesn't turn white when pressed.
  4. The main complication of a pressure sore is an infected wound. See your doctor immediately if you have any signs of infection such as temperature, fever and chills, a sore that drains pus, a smelly wound or increased redness or swelling around your sore.
  5. Most pressure sores are avoidable. There are lots of things you can do to prevent pressure sores and, if you do get one, there is a range of treatment available. 

What are pressure sores?

A pressure sore is an area of damaged skin and tissue often caused by staying in one position for too long. If you are sitting up in bed, sliding down can injure your bottom and heels. Prolonged pressure on an area of your skin stops the blood flow to that area. This cuts off the oxygen supply and causes skin cells to die.

Having a pressure sore can have a huge impact, both for the patient and their carer. It can cause pain and discomfort, feelings of anger and blame, and reduce quality of life through infection, delayed healing, altered body image and low mood. The human toll on patients, carers and their families/whānau should not be underestimated. Having a pressure sore also carry connotations of neglect and mismanagement on the part of carers and health professionals.

Who is at risk of getting a pressure sore? 

You are at risk of a pressure sore if you are unable to move around or change position easily, such as if you:

  • spend long periods of time in bed
  • sit in a wheelchair or chair for long periods
  • are immobile due to a serious illness or have just had a major surgery
  • are elderly or frail with thin fragile skin
  • have skin that is often wet from sweat, urine (pee) or bowel movements (poo)
  • have damp skin due to sweating
  • cannot feel pain or pressure on an area of your skin (due to stroke, diabetes, spinal cord injury or epidural).

A pressure sore usually forms around bony parts of your body, such as your ankles, heels, hips and tailbone, as these areas take the weight of your body. ​

Description Image

On your back

On your front

On your side

Sitting up

Image credit: How to prevent pressure injuries at home  

What are the symptoms of a pressure sore?

Pressure sores can develop in a matter of hours. The first sign is usually a discoloured area on your skin that doesn't turn white when you press on it. The injured skin may get progressively worse and eventually lead to an open wound. Other symptoms include:

  • pain, tenderness or itchiness on your skin
  • swelling
  • reddened skin
  • blisters
  • pus draining out from the affected area
  • the skin being hotter or colder than other areas of your skin.

How is a pressure sore diagnosed?

Your doctor or nurse will diagnose a pressure sore by examining your skin. They will establish how severe it is to determine what treatment is best for you. If they think the pressure sore is infected, they may take a swab around your skin to find out the cause of the infection.

Daily checks are needed to look for early warning signs such as red, purple or blue torn or swollen skin, especially over bony areas, or for signs of infection, such as skin warmth, swelling, cracks, calluses and wrinkles.

How is a pressure sore treated?

You may need care from a team of health professionals such your GP, a nurse specialising in wound care, an occupational therapist, a physiotherapist, a dietitian taking care of your diet, a skin specialist or a plastic surgeon, depending on your condition. They are involved in different aspects of your wound care. Treatment may include:

  • reducing pressure on the affected skin by changing position frequently and using pressure-redistributing devices such as pressure-relieving mattresses and cushions
  • prescribing medications to control pain or itchiness
  • dressings such as gel and foam-based dressings
  • taking care of the wound by keeping your skin clean and dry
  • maintaining good nutrition and hydration as a poor diet can slow the healing of a pressure sore
  • preventing complications such as infections.

If you have a large, deep sore that doesn't heal properly, your doctor may need to remove damaged tissue by surgery.

If you have a pressure, it is important to get it treated as soon as possible, If left untreated, 
you are at risk of developing infections such as cellulitissepsis or bone and joint infections.

See your doctor immediately if you have any signs of infection such as fever and chills, a sore that drains pus, smelly wound, increased redness, temperature or swelling around your sore.

How can I prevent getting a pressure sore?

If you are in bed:

  • change position every 2 or 3 hours – even a small shift in position can help
  • use pillows to stop your knees and ankles touching each other, particularly when lying on your side
  • try to avoid creases in your bed linen
  • if sitting up in bed, be aware that sliding down can cause injury to your bottom and heels
  • ask for help if you need it.

If you are seated:

  • relieve pressure by leaning forward or leaning side to side for a few minutes every half hour
  • if you can stand, stand for a few minutes
  • if you can walk, go for a short walk.

What else can I do to prevent pressure sores?

  • Eat a healthy diet and drink plenty of fluids.
  • Keep your skin clean and dry.
  • Ask your nurse/carer to help you with any incontinence/sweat.
  • Keep moving to relieve pressure.
  • Check for discolouration and soreness, including under and around medical equipment.

Talk to your nurse, occupational therapist, physiotherapist, doctor or dietitian, who can help you plan your care to prevent pressure injuries.

Read more about preventing pressure sores.

Learn more

The following links provide further information about pressure sores. Be aware that websites from other countries may have information that differs from New Zealand recommendations.  

How to prevent pressure injuries at home NZ Wound Care Society, Ministry of Health NZ, ACC NZ & Health Quality & Safety Commission NZ
Pressure injury prevention and treatment
 NZ Spinal Trust
Pressure ulcer DermNet, NZ
Bedsores (pressure ulcers) Mayo Clinic, US

References

  1. How to prevent pressure injuries at home NZ Wound Care Society, Ministry of Health NZ, ACC NZ & Health Quality & Safety Commission NZ
  2. Pressure ulcer DermNet, NZ
  3. Pressure injury prevention Health Quality & Safety Commission NZ
Credits: Health Navigator Editorial Team. Reviewed By: Rachel Fluke, Delivery Lead - Pressure Injury Programme, ACC Last reviewed: 11 Aug 2020