Pressure ulcers (pressure sores)
Sitting or lying still without shifting your position can cause damage to your skin and the underlying tissues, known as pressure ulcers (they are also referred to as pressure sores or bedsores). Some people are more likely to develop pressure ulcers, but they are usually preventable.
Most people will naturally shift their position after a while when they are in a sitting position or lying down. When asleep, for example, people will normally shift their position up to 20 times during the night. However, some people are too ill or weak to be able to do this on their own, and if the body stays in the same position for a period of time, the skin can become damaged. Although pressure ulcers can be treated with dressings and creams, in some people they can be more severe and lead to life-threatening complications.
In the UK about 500,000 people will develop at least one pressure ulcer each year. Around 1 in 20 people admitted to hospital because of a sudden illness will develop a pressure ulcer.
How do pressure ulcers occur?
Your blood cannot circulate properly through your skin if there is pressure from the weight of your body pressing down on it. Without the blood circulating properly, you starve your skin of oxygen and nutrients, causing the skin cells to die and break down. This can happen if there is a large amount of pressure for a short period of time, or a small amount of pressure over a longer period of time. The time it takes for a pressure ulcer to form will depend on the amount of pressure and also how vulnerable a person is to damage. A pressure ulcer can form in only 1 or 2 hours, or it may take a few days before an ulcer is apparent.
Being on a hard surface such as a wheelchair or bed can add to the pressure. In addition, if you slip down or are pulled, the layers of your skin can shear if they slide over each other, and if you are dragged across a seat or mattress as someone moves you, your skin can undergo rubbing or friction. Involuntary muscle spasms can also put pressure on the skin, and moisture can break down the skin. These can all contribute to the formation of pressure ulcers, especially in skin covering the bony areas of your body.
Who is at risk of developing pressure ulcers?
People who have restricted mobility – they find it difficult to move themselves about – or who have an underlying health condition that affects their blood supply or skin are most at risk of developing pressure ulcers. These include people who are:
- Elderly, especially over 70 years old, or very young
- Seriously ill
- Drowsy or unconscious
- Recovering after an operation
- Experiencing restricted movement due to a serious injury such as a broken hip
- Very overweight or obese
- Not eating or drinking enough and, therefore, not getting enough nutrition or fluids to keep their skin healthy
- Experiencing urinary incontinence (cannot control their bladder) or bowel incontinence (lacking control in passing poo), which makes the nearby skin moist and more susceptible to pressure ulcers
- Cigarette smokers with poor blood circulation
- Unable to feel pain such as diabetics with damaged nerves
- Paralysed, such as people who have a spinal cord injury or who have had a stroke
- Wearing a prosthesis (such as an artificial leg), plaster cast or body brace