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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.
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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 of a pressure ulcer include:
A doctor or nurse may call a pressure ulcer at this stage a category one pressure ulcer.
The skin may not be broken at first, but if the pressure ulcer gets worse, it can form:
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:
These symptoms could be a sign of a serious infection that needs to be treated as soon as possible.
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:
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.
Anyone can get a pressure ulcer, but the following things can make them more likely to form:
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.
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.
Treatment options for pressure ulcers (sores) typically include regularly changing your position, using special mattresses to reduce or relieve pressure, and dressings to help heal the ulcer. In some cases, surgery may be needed.
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Moving and regularly changing your position helps to relieve the pressure on ulcers that have already developed. It also helps prevent pressure ulcers developing.
After your care team has carried out an assessment of your risk of developing pressure ulcers, they will draw up a repositioning timetable. This states how often you need to move, or be moved if you're unable to do so yourself.
For some people, this may be as often as once every 15 minutes. Others may need to be moved only once every two to four hours.
You may also be given training and advice about:
If you're at risk of getting pressure ulcers or have a minor ulcer, your care team will recommend a specially designed static foam or dynamic mattress.
If you have a more serious ulcer, you will require a more sophisticated mattress or bed system, such as a mattress connected to a pump that delivers a constant flow of air into the mattress itself.
There are also a range of foam or pressure-redistributing cushions available. Ask your carer about the types most suitable for you.
But according to the National Institute for Health and Care Excellence (NICE), there's limited evidence on what kinds of pressure-redistributing devices are best for the relief and prevention of pressure ulcers in different places, such as heels or hips.
Specially designed dressings can be used to protect pressure ulcers and speed up the healing process.
These dressings include:
Ask your carer about which type of dressing they're using for the management of your pressure ulcer.
Gauze dressings aren't recommended for either the prevention or treatment of pressure ulcers.
Topical antiseptic or antimicrobial (antibiotic) creams and ointments aren't usually recommended for treating pressure ulcers.
But barrier creams may be needed to protect skin that's been damaged or irritated by incontinence.
Antibiotics may be prescribed to treat an infected ulcer or if you have a serious infection, such as:
Eating a healthy, balanced diet that contains enough protein and a good variety of vitamins and minerals can speed up the healing process.
If your diet is poor, you may see a dietitian. They can draw up a suitable dietary plan for you.
It's also important to keep up fluid intake to avoid dehydration, as being dehydrated can slow down the healing process.
In some cases, it may be necessary to remove dead tissue from the pressure ulcer to help it heal. This is known as debridement.
If there's a small amount of dead tissue, it may be removed using specially designed dressings.
Larger amounts of dead tissue may be removed using:
A local anaesthetic should be used to numb the area around the ulcer so debridement (if not being treated with a dressing) doesn't cause you any pain.
Severe pressure ulcers might not heal on their own. In such cases, surgery may be required to seal the wound, speed up healing, and minimise the risk of infection.
Surgical treatment involves:
Pressure ulcer surgery can be challenging, especially because most people who have the procedure are already in a poor state of health.
Risks after surgery include:
Ask your surgeon about the benefits and risks of surgery if it's recommended for you.