Bed Sores Prevention and Treatment

Bed sores are ulcer-like injuries formed by prolonged pressure on the skin and can be a painful and dangerous thing to get. Here are some key information about their prevention, early intervention and treatment.

What Are Bed Sores?

Bed sores – medically known as pressure injuries or pressure sores –  are painful and broken areas of skin that have received inadequate blood flow due to consistent and prolonged pressure. This usually happens on bony areas of the body, such as the sacrum, hips, and heels. Bed sores are staged using a system that determines how severe the pressure injury is. Bed sores in stage 1 or 2 – where the skin is only mildly broken and no infection is present – can be easy to treat. Sores that are stages 3 or 4 are more complicated and will need longer to heal, as well as more interventions.

What Causes Bed Sores?

As pressure is persistently applied to one area of the body, the blood flow and thus oxygen flow to the area decreases, and the skin tissue deteriorates and eventually breaks open. Having moisture on the skin contributes to their cause, as moisture leads to the breakdown of skin more easily. Being unable to feel the pressure on sensitive areas of the skin can also increase the risk, because the person who develops the sore may not be able to feel the need to reposition themselves as frequently as required. Impaired mobility is also a contributing factor, as decreased mobility and flexibility means it’s difficult for a person to reposition themselves and shift their body weight, thus leaving sensitive areas of the body exposed to prolonged pressure. Finally, poor nutrition can contribute to the formation of bed sores, as having good nutrition is an imperative part of wound healing.

Who Is at Risk of Bed Sores?

People at risk of bed sores are those that have trouble either shifting their body weight or noticing the pressure on certain areas of the body. These include older adults, those with mobility issues, those that use wheelchairs, or those with diabetes, due to the risk of neuropathy and poorer circulation.

Older Adults

Older adults are at risk of poorer mobility, incontinence, diminished skin integrity and malnutrition. All of these are risk factors for developing pressure injuries. This risk is particularly high when the older adult has comorbidities that further affect any of these risk factors, such as diabetes and arthritis. The diminished skin integrity – a natural part of ageing – further diminishes the older person’s ability to feel the sensory needs to reposition or shift themselves, particularly while in bed or sitting down.

People Who Use Wheelchairs

People who use wheelchairs have consistent pressure on their sacral area in particular, which increases their risk of developing pressure injuries in that area. These become particularly difficult to heal, as the person who has acquired such an injury has to maintain the ability to alleviate the pressure on the area, which usually means lying on their side in bed. This reduces their ability to access their community by using a wheelchair, which can lead to longer term problems such as mental health issues and decreased community engagement.

People Who Have Impaired Mobility

People with impaired mobility may struggle with repositioning themselves with sitting or standing to alleviate prolonged pressure points. Moving around while sitting or turning in bed may be difficult, painful, or impossible for someone with mobility issues. This means that vulnerable areas of their body are exposed to prolonged pressure, and the risk of bed sores increases.

Those With Diabetes

Diabetes impacts the risk of bed sores in multiple ways. Firstly, diabetes impacts the wound-healing process due to the increase of blood glucose levels, as well as increased systemic inflammation. Untreated diabetes can also lead to neuropathy, in which damage occurs to peripheral nerves and vessels and sensory input is lowered – so the person with diabetes can’t feel the pain or discomfort signals to shift or reposition themselves. Lastly, people with diabetes have an increased risk of developing complications that narrow their blood vessels, which decreases the ability for the body to deliver infection-fighting blood to affected areas.

The Risks of Bed Sores

Bed sores can be dangerous to long-term health if they are left untreated. They can form quite quickly and insidiously, so it is imperative to identify them in their early days of arrival. Because the risk factor of developing a bedsore is the person in question not being able to receive the sensory information to turn or reposition themselves, this makes it tricky for the person to be able to identify when one is developing. Bed sores that have been left untreated and developed in their stage of severity may require surgery for debridement of the sore, or invasive negative-pressure wound care to reduce complications associated with them. If left untreated further, pressure sores can lead to a myriad of other health problems, like sepsis, cellulitis, bone and joint infections, and in worst cases, these complications due to infection can be fatal.

How to Prevent Bed Sores

Frequent Turning

Frequent repositioning and turning in bed and on chairs is imperative for the prevention of bedsores. This helps alleviate the pressure on areas that hold most of your body weight during time of sitting and lying. If the issue is to do with mobility or paralysis, you can consider getting some home help to receive assistance for repositioning in a chair or in bed. If pain is your barrier to repositioning yourself, consider accessing medical help for this. There are plenty of options for managing pain, such as medication, low-impact exercise, herbal supplements, or heat and ice therapy.

If flexibility and a limited range of motion is your issue, you can work on this by moving your body. Consider joining a gym, or try low-impact sports such as aqua aerobics, walking, yoga, or pilates to increase your range of motion and confidence with moving. No matter your barrier to repositioning, remember to make it a priority – setting alarms and writing down reminders to reposition the side you’re lying on isn’t a bad idea. If you have problems receiving sensory input to do this, these kinds of reminders will be invaluable. You may even enlist a loved one to send you a reminder each evening to remember to turn throughout the night!

Pressure-Relieving Aids

Using aids around the house to soften the pressure on your body when you sit or lie down are invaluable in preventing bed sores. Special air mattresses for bedsores can be bought for your home that mitigate the development of pressure areas. They work to evenly distribute the pressure along your body as you sleep, so that blood circulation isn’t impaired in areas like your hips and sacrum as you sleep. Soft pads to put on top of chairs and couches are helpful, too. They have a soft gel inset that cushions and protects your sacrum area when you are sitting down – and they’re super helpful to use on wheelchairs too. Other pressure-relieving aids like sticky cushions to place around your heels when you sleep can also be utilised to prevent sores from developing. Sheepskin rugs are also commonly used to relieve pressure while sleeping – simply place them on the bed you’ll be sleeping to alleviate pressure on hips, sacrum and back.

Minimising Moisture on Skin

Incontinence can be an issue for older adults and those living with disability. For those that use incontinence pads, or are prone to bladder or bowel accidents, skin integrity can be compromised. If pads aren’t changed frequently enough or skin is not cleaned thoroughly enough, this can compromise the protective barrier of the skin. When skin is constantly exposed to moisture, it is far more susceptible to breaking down. When this is coupled with the fact that the area vulnerable to the most moisture – the sacrum – is also the area that receives the most pressure when you’re sitting down, the risk of developing a pressure injury increases.

To prevent exposure to moisture and skin breakdown, ensure your bladder and bowel routines are under control. Make sure to change pads as soon as possible after use, or if you use enemas or catheters to eliminate, get into a routine for voiding to minimise accidents. If you are struggling with managing incontinence by yourself, you can speak to your GP for help or consider employing some extra help at home to stay on top of your daily activities and hygiene.

Have Assistance to Check for Developing Sores

Checking key areas on the body that are susceptible to these sores are imperative. You can check how intact pressure areas are by gently pressing your fingers into the pressure area and then noticing if the area balances or not. If it blanches, the blood flow to the area is good. If it is non-blanching, the area is at risk of becoming a bed sore. However, checking these things yourself can be difficult. Two things that increase your risk of sores developing – limited mobility and lack of sensory perception – also decrease your ability to assess yourself for developing pressure sores. You can ask a trusted loved one to check key pressure areas for you, or get a trusted nurse in the home to conduct a thorough skin assessment for you.

Quit Smoking

Smoking impacts your circulation and body’s ability to heal, both of which impact the healing of pressure sores. If you are at risk of pressure sores, or have sores developing, quitting smoking increases your chances of the sore healing more quickly and effectively.

Eat Well

Good nutrition works wonders for wound healing. By making sure you eat a healthy balanced diet, full of fresh fruit, vegetables, protein and healthy, high fibre carbohydrates, you are giving your body the best chance at healing pressure sores before they get worse. Remembering to keep your saturated fat and sugar intake low is a key aspect of this.

How to Treat Bed Sores

If you notice a bed sore forming, the most important thing to do is keep off that pressure area as soon as possible! You may need to alter your sleeping or sitting position to give the pressure area time to heal and to prevent it from deepening. Your best home remedy for a developing bedsore is simply the key rule – stay off it!

Home remedies for bed sores also include simple dressings. Using a barrier wound dressing during this time is of utmost importance, too. A barrier dressing provides cushioning for when pressure may be applied to the area, and helps to prevent infection. If the bed sore is mild, you can wash it with soap and water and cover it with one of the cushioned dressings at home. If the bed sore has broken skin, it has a greater chance of infection, and diligence is required when taking care of the wound dressing. It will need to be washed with saline and dressed properly. You can access a trusted nurse within the privacy and comfort of your own home to assist you with this.

Again, a healthy diet, quitting smoking, and maintaining good circulation are all key elements to making sure the bed sore heals quickly and effectively.

Treatment for bed sores can also include pain management. If the sore is painful, painkillers can help reduce the inflammation and ease the pain. Paracetamol or NSAIDs like ibuprofen can make the pain easier to handle – but make sure you consult with your GP before beginning any pain management.

If the pressure injury is in advanced stages, your GP may refer you to have surgery to get rid of the infection to allow space for healthy tissue to grow. They will refer you to a surgeon who can help get rid of the infectious tissue so you can begin the healing process.