Causes and prevention of pressure sores

Pressure sores are wounds that develop when constant pressure or friction on one area of the body damages the skin. Constant pressure on an area of skin stops blood from flowing normally, so the cells die, and the skin breaks down.

Other names for pressure sores are bedsores, pressure ulcers and decubitus ulcers.

Causes of pressure sores

Pressure sores happen if you can’t move around and so stay in one position for a long time. We normally move about constantly, even in our sleep. This stops pressure sores from developing.

People who are unable to move around tend to put pressure on the same areas of the body for a long time. If you are ill, bedridden or in a wheelchair, you are at risk of getting pressure sores.

Several things can increase your risk of pressure sores, including:

• being unable to move around easily due to old age, illness, being unconscious, having a spinal cord injury or recovering from surgery
• weight loss - you may have less padding over bony areas
• sliding down in a bed or chair - pressure on the skin cuts off blood supply because the skin is being pulled in different directions (called shearing)
• friction or rubbing of the skin, for example, against sheets
• a poor diet
• lack of fluid (dehydration)
• moist skin - for example, due to sweating or incontinence
• thin, dry or weak skin
• other medical conditions, such as diabetes
• having had a previous pressure ulcer or having one at the moment
• smoking
• low levels of red blood cells (anaemia)
• cancer drugs, anti inflammatory drugs, steroids or blood thinners (anticoagulants)
• severe mental health problems

Preventing pressure sores

It is much better to prevent pressure sores than to treat them. The National Institute for Health and Care Excellence (NICE) has guidelines on pressure sores. Separate guidelines are also available in Wales, Scotland and Northern Ireland.

They all recommend that a member of the health care team looking after you should assess your risk of developing pressure sores. They should also create a plan to prevent them. 

The areas of skin most at risk of getting sore depend on whether you are lying down or sitting. The following diagrams show the areas most at risk:

Tips to prevent pressure sores

The following tips can help to prevent pressure sores:

Relieving direct pressure

• change position and keep moving as much as possible
• ask for a painkiller if you have pain and find moving position painful
• stand up to relieve pressure if you can
• ask your carer to reposition you regularly if you can't move
• change position at least frequently, this may be from as often as every 15 minutes to every 6 hours depending on your situation
• use special pressure relieving mattresses and cushions
• don't drag your heels or elbows when moving in your bed or chair
• equipment is available to help you move in bed. Speak to your GP or healthcare team to find out more

Skincare

• keep your skin clean and dry
• avoid scented soaps as they can be more drying
• moisturise your skin thoroughly after washing
• avoid using talcum powder as this dries the skins natural oils
• keep your skin well moisturised
• do not massage or rub the skin to prevent pressure ulcers

General tips

• make sure the bedsheets are smooth and not wrinkled when you are lying in bed
• sheets should be cotton or silk like fabric
• eat a well balanced diet
• have at least 2 litres of fluid a day
• tell your doctor or nurse if you notice any skin changes or discomfort as soon as possible