Pressure ulcers (pressure sores)

Pressure ulcers (also known as pressure sores or bedsores) are injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin.

They can happen to anyone, but usually affect people confined to bed or who sit in a chair or wheelchair for long periods of time.

Symptoms of pressure ulcers

Pressure ulcers can affect any part of the body that's put under pressure. They're most common on bony parts of the body, such as the heels, elbows, hips and base of the spine.

They often develop gradually, but can sometimes form in a few hours.

Early symptoms

Early symptoms of a pressure ulcer include:

• part of the skin becoming discoloured – people with pale skin tend to get red patches, while people with dark skin tend to get purple or blue patches

• discoloured patches not turning white when pressed

• a patch of skin that feels warm, spongy or hard

• pain or itchiness in the affected area

A doctor or nurse may call a pressure ulcer at this stage a category one pressure ulcer.

Later symptoms

The skin may not be broken at first, but if the pressure ulcer gets worse, it can form:

• an open wound or blister – a category two pressure ulcer
• a deep wound that reaches the deeper layers of the skin – a category three pressure ulcer
• a very deep wound that may reach the muscle and bone – a category four pressure ulcer

When to get medical advice

If you're in hospital or a care home, tell your healthcare team as soon as possible if you develop symptoms of a pressure ulcer. It'll probably continue to get worse if nothing is done about it.

You should be regularly monitored and offered advice and treatment to reduce the risk of pressure ulcers, but sometimes they can develop even with the highest standards of care.

If you're recovering from illness or surgery at home, or are caring for someone confined to bed or a wheelchair, contact your GP surgery if you think you or the person you're caring for might have a pressure ulcer.

Get medical advice immediately if there is: 

• red, swollen skin
• pus coming from the pressure ulcer or wound
• cold skin and a fast heartbeat
• severe or worsening pain
• a high temperature (fever) of 38C (100.4F) or above

These symptoms could be a sign of a serious infection that needs to be treated as soon as possible.

Treatments for pressure ulcers

Treatments for pressure ulcers depend on how severe they are.

For some people, they're an inconvenience that requires minor nursing care. For others, they can be serious and lead to life-threatening complications, such as blood poisoning.

Ways to stop pressure ulcers getting worse and help them heal include:

• applying special dressings that speed up the healing process and may help to relieve pressure
• moving and regularly changing your position
• using specially designed static foam mattresses or cushions, or dynamic mattresses and cushions that have a pump to provide a constant flow of air
• eating a healthy, balanced diet
• a procedure to clean the wound and remove damaged tissue (debridement)

Surgery to remove damaged tissue and close the wound is sometimes used in the most serious cases.

Read more about the treatments for pressure ulcers.

Who's most at risk of getting pressure ulcers

Anyone can get a pressure ulcer, but the following things can make them more likely to form:

• being over 70 – older people are more likely to have mobility problems and have skin that's more easily damaged through dehydration and other factors
• being confined to bed with illness or after surgery
• inability to move some or all of the body (paralysis)
• obesity
• urinary incontinence and bowel incontinence
• a poor diet
• medical conditions that affect blood supply, make skin more fragile or cause movement problems – such as diabetes, peripheral arterial disease, kidney failure, heart failure, multiple sclerosis (MS) and Parkinson's disease

Preventing pressure ulcers

It can be difficult to completely prevent pressure ulcers, but there are some things you or your care team can do to reduce the risk.

These include:

• regularly changing your position – if you're unable to change position yourself, a relative or carer will need to help you
• checking your skin every day for early signs and symptoms of pressure ulcers – this will be done by your care team if you're in a hospital or care home
• having a healthy, balanced diet that contains enough protein and a good variety of vitamins and minerals – if you're concerned about your diet or caring for someone whose diet may be poor, ask your GP or healthcare team for a referral to a dietitian
• stopping smoking – smoking makes you more likely to get pressure ulcers because of the damage caused to blood circulation

If you're in a hospital or care home, your healthcare team should be aware of the risk of developing pressure ulcers. They should carry out a risk assessment, monitor your skin and use preventative measures, such as regular repositioning.

If you're recovering from illness or surgery at home, or are caring for someone confined to bed or a wheelchair, ask your GP for an assessment of the risk of developing pressure ulcers.

Page last reviewed: Sun May 2020 Next review due: Wed Feb 2020