How to Prevent Bedsores (Pressure Ulcers)

Written by Natalie Grigson, Writer

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What Are Bedsores?

Bedsores², also known as pressure ulcers, can occur on areas of the skin that are consistently under pressure. This happens most commonly when people spend prolonged time in a bed or wear a cast for a long period. The bedsores result from the persistent friction or pressure against their skin.²

You might have also heard them referred to as pressure sores, pressure ulcers, pressure injuries, or decubitus ulcers.²

Stages of Bedsores

The symptoms of bedsores vary depending on how advanced they are. According to Johns Hopkins Medicine, bedsores can be divided into four stages, from least to most severe.²

Stage One: The area will likely feel warm to the touch and look either red, blueish, or purple-toned, depending on your skin’s color. At this point, it may feel like it burns, itches, or hurts.²

Stage Two: At this point, the area may have an open sore or look like a scrape or blister. The skin around the wound may appear discolored, and the person will likely be in a significant amount of pain.²

Stage Three: Bedsores that have progressed to this level will feel very painful and might have a “crater-like” appearance because there will now be damage below the skin’s surface.²

Stage Four: People with bedsores this far advanced will be in a lot of pain. There will be a large wound present, and the area around it will look significantly damaged and discolored. At this stage, the muscles, bones, tendons, and joints may be involved, and infection is likely.²

In some cases, people might not feel the pain of their bedsores if they have neuropathy, which causes loss of pain sensitivity³. Some of the risk factors for immobility and bedsores overlap with the risk factors for neuropathy, so it’s important that doctors and caregivers check the skin in pressure areas, even if the person doesn’t complain of pain.

Causes of Pressure Sores

As mentioned, pressure sores usually develop when somebody must remain bedridden for a very long time, and the surface of whatever they are lying or sitting on puts pressure on their skin.

One of the reasons a sore develops is that the constant pressure ends up cutting off blood flow to the skin.The outermost layer of skin quickly begins to die, and this can start happening in as little as two hours. As the dead cells break down, a bedsore or pressure sore begins to form.¹

Bedsores are even more likely to form when there is a combination of pressure, moisture (sweat, for example), and traction (a stretching of the skin).¹

These sores occur most often on the tailbone, hips, buttocks, heels of the feet, shoulder blades, back of the head, or the backs and sides of the knees.²

Bedsore Risk Factors

The following groups of people are at higher risk of developing pressure sores^{1, 2}:

Those who are bedridden or unconscious
Those in a coma or vegetative state
People who are unable to sense pain
Those with thinner skin, like the elderly
People currently wearing casts, splints, or other prosthetic devices
People with diabetes
Those with cancer
People with cerebral palsy
Dementia patients
Those who’ve experienced heart or kidney failure
People with peripheral artery disease
Spinal cord injury or spina bifida patients
Those with chronic venous insufficiency
Patients with circulation problems
People with poor nutrition

These risks are increased if the person is not turned, positioned correctly, provided with proper nutrition, or cleaned regularly, as moisture can also contribute to bedsores.²

This may be why pressure sores are more common in hospital wards that tend to be more busy, like the orthopedic surgery ward⁴.

Prevention Tips for Bedsores

The good news is there are ways to reduce the risk of bedsores. Johns Hopkins Medicine recommends the following tips²:

In a wheelchair – People in wheelchairs are advised to switch positions often, at least every 10 to 15 minutes. Even shifting your position every hour should help if you need someone to move you. Make sure the padding in your wheelchair is soft enough to help relieve pressure. People with a neuromuscular disease might want to consider using a standing wheelchair as well to take the pressure off their glutes.²
On bed rest – People on bed rest are highly prone to bedsores, so switching positions is crucial. It helps to switch at least every two hours. Make sure you don’t lie one leg over the other, but if you need help, you can even add a pillow between your legs. Make sure your bedding is smooth, and try raising your heels off the bed using a pad or foam.²
Immobile people – Immobile people might want to consider an air mattress, which is often recommended for maximum pressure relief. The cells in this mattress inflate and deflate alternately, which helps increase blood circulation and prevent bedsores. If you’re lifting someone immobile, keep in mind their bodies are easily injured, so it’s best to use sheets, a harness, or a lifting device instead of pulling on the legs or arms.

How Are Pressure Sores Treated?

If you already have bedsores, they are treatable, and the level of treatment depends on the severity of your bedsores.

The first step would be to remove pressure from the affected area. If you already have a wound, you’ll need to keep it clean and protected with gauze. You’ll also want to make sure that you’re consuming a healthy diet with plenty of vitamins, minerals, and protein.¹

If the bedsores have already progressed beyond Stage One or Two, you may need to have the damaged, infected, or dead tissue removed, or even receive a skin transplant to the area. If the bedsore has become infected, your doctor will likely put you on antibiotics.¹

Bedsores left untreated are more likely to turn into an infection, which can cause fever, chills, or even mental confusion, heart issues, and weakness.¹ Therefore, it is always a good idea to consult your doctor if you have a bedsore to get treatment right away.

If you’re looking for a sustainable sleep solution while you manage bedsores, explore our medically reviewed roundup of our Best Mattresses for Bedsores and Pressure Ulcers

Frequently Asked Questions

Are bedsores dangerous?

When bedsores first appear, they tend to be uncomfortable and painful, but not necessarily dangerous. However, if they are left untreated, they are more likely to become infected, which can be dangerous.

Are bedsores contagious?

No, bedsores are not contagious. Rather, they are injuries due to ongoing pressure on the skin.

What cream can I use to prevent bedsores?

Some doctors recommend using a barrier cream⁵ to help prevent bedsores. Barrier creams are applied directly to the skin and act as a safeguard between the skin and irritants – like moisture from sweat or urine, for example.⁵

Studies show⁶ that barrier creams can be useful in preventing bedsores in at-risk populations. Specifically, the barrier creams made from a hyperoxygenated fatty acid compound or silicone/antiseptic cream are the most effective, as well as those that contain hexyl nicotinate, zinc stearate, isopropyl myristate, dimethicone 350, cetrimide, and glycerol preparation.⁶

What is the beginning sign of a pressure sore?

According to England’s National Health Service⁷ (NHS), early signs of a pressure sore include discolored patches of skin. These are typically red on white skin and blue or purple on darker skin. Another sign might be if your skin is warm or spongy. It might also be hard, painful, and itchy. With time, these patches of skin can become blisters or open wounds that can worsen if left untreated.

Natalie Grigson

Writer

About Author

Natalie is a content writer for Sleep Advisor with a deep passion for all things health and a fascination with the mysterious activity that is sleep. Outside of writing about sleep, she is a bestselling author, improviser, and creative writing teacher based out of Austin.

Combination Sleeper

References:

1. “Bedsores (Pressure Injuries)”. Cleveland Clinic. Last modified February 24, 2024.

2. “Bedsores”. Johns Hopkins Medicine. Webpage accessed October 20, 2023.

3. “Neuropathy”. Yale Medicine. Webpage accessed April 18, 2024.

4. Borojeny, Lotfolah Afzali., et al. “The Incidence of Pressure Ulcers and its Associations in Different Wards of the Hospital: A Systematic Review and Meta-Analysis”. National Library of Medicine. 2020.

5. Nicol, Matthew. “Barrier cream”. DermNet. 2017.

6. “The Prevention and Management of Pressure Ulcers in Primary and Secondary Care: Barrier creams”. National Library of Medicine. 2014.7. “Pressure ulcers (pressure sores)”. The United Kingdom National Health System (NHS). Last reviewed July 6, 2023.