You may have heard the term bedsore or pressure ulcer used on a medical drama on TV, or in the nursing home where your grandparent lives. If you are wondering what exactly a bedsore is and if it is dangerous, don’t miss this quick expert guide:
Bedsores are also known as pressure ulcers and are risky skin conditions where tissue starts to break down due to both pressures from a bony part of the body as well as restricted blood flow. Most common among people who are the bed or chair-limited, bedsores are a consequence of limited mobility and prolonged time spent in bed or a recliner. Bedsores progress through 4 diagnosable stages including:
Stage 1 – a reddish discoloration of the skin indicates that pressure on internal issues from a protrusive bone is starting to affect blood flow and tissue health. If the skin blanches, which means when it is pressed it goes white briefly and flushes red again, this indicates blood is still flowing to the tissue. If it does not, this means it is non-blanchable, and a pressure ulcer is beginning to form. Note: Darkly pigmented skin may be hard to administer a blanch test on.
Common locations of bedsores include:
• Tailbone (coccyx)
• Shoulder blades
• Hip bones
• Heels to the feet
Stage 2 – skin that is broken open or deteriorated at the location of bedsore indicates the formation of an ulcer which can be tender and painful. Stage 2 bedsores may look like an abrasion or skin scrape, and the damaged skin and tissue may blister or even look like a shallow crater in the open flesh.
Stage 3 – as the ulcer expands into deeper and deeper layers of skin, the crater grows larger with infection spreading to underlying fatty tissue, damaging and killing it off. A medical professional like a wound specialist or nurse will perform debridement, or removal of infected, damaged, or dead tissue, to give the healthy tissue left a fighting chance.
Stage 4 – the ulcer has now degraded multiple full-thickness layers of tissue to reveal fascia, cartilage, muscle, tendons, and even bone. Life-threatening infection is taking place. Clumpy, stringy avascular tissue called slough, and darker devitalized tissue called eschar (indicates necrosis or tissue death) may be present.
Risk Factors for Developing Bedsores:
Immobility – both remaining in the same position in bed or recliner due to immobility can increase the risk of pressure ulcers, as can simply being unable to move and exercise your limbs (which is necessary to keep blood circulating to sensitive tissues).
Age – as you age, your skin regenerates and becomes weaker and less elastic. This can make you more prone to skin wearing away or breaking at the site of bedsore.
Incontinence – if the pointed bone inside the body is responsible for pressing into tissue and cutting off blood flow, it’s strain, moisture, and contaminants on the outside of the body that foster skin breakdown. Incontinence often leads to contact with contaminants like urine and feces on parts of the body prone to pressure ulcers, like the tailbone.
Being underweight – the less fat and muscle padding you have in your body to cushion against bonier areas, the more likely you are to experience unwanted pressure at those bony points. So often, the conditions which immobilize you can also affect your ability to keep on weight, whether it’s from loss of appetite or difficulty eating or drinking (dysphagia).
Malnutrition may often source the lack of weight gain as well, and indirectly increase the risk for bedsores. Missing out on critical nutrients like protein, zinc, calcium, potassium, and Vitamin C, which fuel tissue repair and blood circulation, can make tissue even weaker and more vulnerable to developing an ulcer.
Sleeping/sitting surface – mattresses made of foam, springs, and cotton batting can increase the risk for bedsore if someone spends most of their day on one. Those types of material simply don’t distribute weight as well as memory foam, gel, or an alternating air pressure mattress. An air mattress for bedsore prevention, for example, can regularly shift a patient’s body, taking the load off susceptible pressure points and redistributing weight.
Additional risk factors include having circulation issues associated with everything from smoking to conditions like diabetes, as well as cognitive decline which impairs a person from communicating when they are feeling pain at certain pressure points.
Treating a Bedsore
Stage 2 bedsores can quickly progress to stage 3 and 4, so recognizing and treating them is critical to survival. Once a bedsore is acknowledged by a doctor, nurse, or caregiver, a wound care specialist will go about diagnosing and customizing immediate treatment. This will involve measuring the length, width, and depth of the wound as well as educating caregivers and staff about managing it – from debridement of dead tissue to cleansing, treating and dressing the wound, and using barrier creams to stave off further skin breakdown.