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Overview
What Is a Pressure Ulcer?
A pressure ulcer is damage to the skin and the tissue underneath it caused by prolonged pressure, friction, or shearing forces. It often develops over bony areas such as the tailbone, hips, heels, elbows, or back of the head. People who spend long periods in bed or a chair, or who cannot change position easily, are at higher risk. A pressure ulcer is also called a pressure injury, bedsore, bed sore, or decubitus ulcer.
Symptoms
Pressure Ulcer Symptoms
- Persistent redness or discoloration (nonblanching erythema).
- Skin that feels warmer than the surrounding area.
- Skin that feels firmer or softer than nearby tissue.
- A blister.
- An open sore.
- Wound drainage.
- A foul odor.
- Visible fat, muscle, tendon, or bone.
Causes
What Causes Pressure Ulcers?
Sustained pressure compresses small blood vessels, reducing the oxygen and nutrients that reach the skin and deeper tissue. Friction can rub and damage the outer skin, while shear occurs when skin stays in place as deeper tissues move, stretching or tearing tissue. Moisture from urine, stool, sweat, or drainage weakens the skin and makes it more vulnerable to injury. These forces commonly affect tissue over a bony area.
- Remaining in one position in bed or a chair for a long time can restrict blood flow to pressure points.
- Sliding down in bed or being pulled across sheets can create friction and shear.
- Reclining against medical devices, tubing, braces, or casts can place pressure on the skin.
- Exposure to urine, stool, sweat, or wound drainage can keep skin moist and easier to damage.
Risk Factors
Pressure Ulcer Risk Factors
Can often be addressed
Limited repositioning, inadequate nutrition or hydration, moisture exposure, smoking, and poorly fitted equipment can increase risk and may be improved with a care plan.
May not be changeable
Older age, paralysis, reduced sensation, severe illness, poor circulation, diabetes, and a history of pressure ulcers can make prevention more difficult.
Anyone who cannot independently change position or feel discomfort needs regular skin checks and an individualized pressure-relief plan. Several risk factors may occur together, so caregivers and clinicians should consider mobility, sensation, circulation, nutrition, moisture, and equipment at the same time.
Complications
Pressure Ulcer Complications
- Cellulitis, an infection of the surrounding skin.
- An abscess, or a pocket of pus beneath the skin.
- Osteomyelitis, an infection that reaches the bone.
- Sepsis, a life-threatening response to infection.
- Delayed or difficult wound healing.
- Loss of tissue, muscle, or function near the wound.
Act promptly
Signs of an infected pressure ulcer
Seek urgent medical advice for fever, increasing redness or warmth, pus, foul odor, rapidly worsening pain, confusion, or feeling very unwell.
Diagnosis
How Pressure Ulcers Are Diagnosed and Staged
A clinician diagnoses a pressure ulcer by examining the skin and wound and asking about mobility, sensation, pain, and how long the change has been present. They may also assess nutrition, hydration, circulation, moisture exposure, and signs of infection. Tests such as blood tests or imaging may be used when a deeper infection or bone involvement is suspected. The wound is then described using pressure ulcer stages to show how much tissue is affected.
| Stage | What it means | Typical appearance |
|---|---|---|
| Stage 1 | Skin is intact but pressure damage is present. | Persistent discoloration or a change in temperature, firmness, or sensation. |
| Stage 2 | Partial-thickness skin loss. | A shallow open sore or blister without exposed fat, muscle, tendon, or bone. |
| Stage 3 | Full-thickness skin loss. | Deeper tissue is visible, but muscle, tendon, cartilage, and bone are not exposed. |
| Stage 4 | Full-thickness skin and tissue loss. | Exposed or directly palpable muscle, tendon, cartilage, or bone. |
| Unstageable | The full depth cannot be confirmed. | Slough or eschar obscures the base of the wound. |
Treatment & Management
Pressure Ulcer Treatment and Management
Immediate Pressure Relief and Wound Care
Treatment starts with relieving pressure through regular repositioning, off-loading devices, and suitable mattresses or cushions. Care may also include managing moisture, supporting nutrition and hydration, and treating pain. A clinician may cleanse the wound, select an appropriate dressing, and remove dead tissue through debridement when needed. Antibiotics are used when there is an infection; they are not routinely needed for every ulcer.
Care for Deeper or Nonhealing Ulcers
For stages 3, 4, or unstageable ulcers that do not improve with standard care, advanced medical interventions are necessary. This may involve specialized wound dressings, negative-pressure wound therapy (vacuum-assisted closure) to promote tissue growth, or surgical procedures such as skin grafts and flap reconstruction to clean and close the deep wound.
Prevention
How to Prevent Pressure Ulcers
- Change position regularly according to an individualized care plan.
- Check pressure-prone skin every day and whenever discomfort or dampness is noticed.
- Use a pressure-redistributing mattress, cushion, or heel protection when recommended.
- Keep skin clean and dry, and manage urine, stool, sweat, and wound drainage promptly.
- Support adequate nutrition and hydration with help from a clinician or dietitian when needed.
- Use safe transfer techniques to reduce friction and shear.
- Report any persistent discoloration, blister, or open area promptly.
Outlook and Prognosis
Pressure Ulcer Outlook and Prognosis
The outlook depends on the stage, wound size and location, blood flow, nutrition, infection, overall health, and whether pressure can be consistently relieved. Early pressure damage may improve or resolve when pressure is removed promptly and the skin is protected. Deeper tissue loss, infection, poor circulation, and ongoing immobility can make healing slower and may require prolonged treatment, sometimes for months.
Long-Term Care and Recurrence
Even after a pressure ulcer heals, the affected skin remains fragile and highly susceptible to breaking down again. Long-term management requires a lifelong commitment to daily skin checks, continuous use of pressure-relieving equipment, and maintaining a strict repositioning schedule to prevent recurrence.
When Should You See a Doctor
When Should You See a Doctor for a Pressure Ulcer?
Know when to act
Get pressure damage assessed early
Contact a healthcare professional promptly for persistent discoloration, a blister, an open wound, worsening pain, drainage, odor, or any suspected stage 2 or deeper pressure ulcer. Seek emergency care for confusion, severe weakness, trouble breathing, fainting, or other signs of sepsis.
