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Pressure Sores
Pressure sores, also called bed sores, or decubitus ulcers, occur when the skin breaks down from constant pressure, especially sitting or lying in one position. This pressure cuts off the blood supply to the underlying skin, fat and muscle. These ulcers usually occur over bony prominences: tailbone, buttock, heel, shoulder blade, elbow and possibly the back of the head. However, pressure sores are not limited to these areas and can occur other places as well.
Sores may also develop from friction to the skin. This is called shear and may result from sliding across a bed or wheelchair. The skin is much more likely to break down if it is moist or infected, so that incontinence can add to the problem.
Several interacting risk factors have been identified in the development of pressure sores:
- Immobility or inactivity.
- Decreased sensation.
- Bowel or bladder incontinenc.
- Poor nutrition.
- Older age.
- Obesity - the extra weight causes sores.
- Underweight - the bony prominences cause sores.
- Dry skin.
- Moist skin.
- Smoking.
- Diabetes, anemia, or cardiovascular disorders.
- Cognitive confusion.
Pressure sores begin benignly but if untreated they may progress to more advanced stages:
- Stage 1 - A small area of warm, reddened or purpled skin that does not return to its natural color when pressed.
- Stage 2 - The outer layer of skin breaks down. Blistering and swelling as well as warmth and redness may be seen.
- Stage 3 - Live tissue dies. The area that is ulcerated extends to the deep skin layers and to the fat and muscle immediately beneath the skin. This hole or crater has a foul smell.
- Stage 4 - The sore or ulcer extends down to the deep muscle, possibly down to the bone. Infection may occur and may tunnel under the skin increasing the size of the sore.
The best way to treat a pressure sore is to avoid developing one in the first place. Pressure sores can be prevented in the following ways:
- If you can, keep mobile.
- If not advised differently by your physician, drink a lot of fluids and eat a well-rounded diet.
- If you are not mobile, your position must be changed at least every two hours.
- Your bed should be fitted with a mattress or a mattress pad which is capable of alternating and distributing the pressure applied by the body to the mattress.
- You should use padding or boots for pressure points such as heels.
- If you use a wheelchair, it is important that you sit on a seat cushion that distributes your weight. A gel-filled cushion is often recommended. Ask your physician or physical therapist about a seat evaluation.
The treatment of pressure sores or decubitus ulcers becomes more difficult as the sore advances in severity.
A Stage 1 ulcer is usually well managed by eliminating the source of the pressure. This should result in a rapid resolution of the early pressure sore.
Stage 2 sores can be treated by medication and protective coverings, under the advice of a physician or wound specialist who may be a nurse or physician.
The treatment for a Stage 3 or 4 ulcer is often long-term dressings, a special bed, medications and antibiotics if there is insufficient healing. There will be a need for regular nursing assessments.
It is thus imperative to see your physician if you suspect that a pressure sore or decubitus ulcer has begun.
Source - The MS Information Sourcebook produced by the Information Resource Center and Library of the National Multiple Sclerosis Society. © 2001 The National Multiple Sclerosis Society. All rights reserved. Reproduced with permission.
