Pressure ulcers/sores (Bed Sores): Symptoms, Causes, Diagnosis & Treatment

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Pressure ulcers/sores (Bed Sores): Symptoms, Causes, Diagnosis & Treatment

Bedsores, also known as pressure ulcers or pressure sores are localized damage to the skin and underlying tissue that usually occur over a bony prominence as a result of pressure or pressure in combination with shear and friction.

The healing of pressure sores may be slowed by the age of the person, medical conditions such as arteriosclerosis, diabetes or infection, smoking or medications such as anti-inflammatory drugs.

Bed sores can be very difficult to prevent in critically ill people, frail elders and individuals with impaired mobility such as wheelchair users.

The rate of pressure sores in hospital settings is high. In 2013, there were 29,000 documented deaths from pressure sores globally, up from 14,000 deaths in 1990.

Also read: Otitis Media

How does Bed Sores affect your body?

Pressure sores most commonly affect the skin overlying the sacrum, coccyx, heels or the hips. Other sites such as elbows, knees, ankles, back of shoulders, or the back of the cranium can also be affected.Pressure sores occur when pressure cuts off circulation to certain areas of skin and tissue since blood carries oxygen and other essential nutrients, the skin and tissue can start to die. In the most severe stage even bones, muscles, tendons, and joints can be damaged. Pressure ulcers are also susceptible to infection. The infection can slow down the healing process and can even enter the bone or the bloodstream. An infected pressure sore can lead to systemic infection, leading to multi-system organ failure and death from sepsis.

What are the causes of Bed Sores?

  • External pressure applied on the body, especially over the bony prominences can result in obstruction of the blood capillaries, which deprives tissues of oxygen and nutrients, causing ischemia, hypoxia, edema, inflammation, and, finally, necrosis and ulcer formation.
  • Friction damages the superficial blood vessels directly under the skin. The skin over the elbows and the back can be injured when patients are pulled or slid over bed sheets while being moved up in bed or transferred onto a stretcher.
  • Shearing is a separation of the skin from underlying tissues which can happen when a patient is partially sitting up in bed and their skin sticks to the sheet moving downward with the body towards the foot of the bed.
  • Moisture is also a common bedsore culprit. Sweat, urine, feces, or excessive wound drainage can exacerbate the damage done by pressure, friction, and shear.
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What are the risk factors of Bed Sores?

  • Immobility– Immobility increases the chances of bed sores. Immobility can be due to poor health or spinal cord injury and other.
  • Medical condition– Diseases like diabetes mellitus, peripheral vascular disease, malnutrition, cerebral vascular accident and hypotension can cause bedsores.
  • Age– People 70 years and older in age are at increased risk of bed sores.
  • Health problems– Dry skin, low body mass index, urinary and fecal incontinence, physical restraints, malignancy, and history of pressure ulcers are also few risk factors.
  • Smoking– Current smoking history also put a risk of bed sores.
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What are the symptoms of Bed Sores?

Stage I of bedsore causes:

  • Red skin which when pressed does not turn white.
  • Tender or itchy skin and may feel warm or cold and firm.

Stage II of bedsore:

  • Open sore that does not extend through the full thickness of the skin.
  • Sore surrounded by red or purple discoloration, mild swelling and some oozing.

Stage III of bedsore:

  • Ulcer or sore becomes a crater and that goes below the skin surface.

Stage IV of bedsore:

  • The sore developed into a crater deepens and reaches into a muscle, bone, tendon or joint.

Symptoms of infection in a bedsore:

  • Pus draining from the ulcer/sore.
  • Foul smelling odor from the sore.
  • Tenderness and increased redness in the surrounding skin.
  • Fever

How is Bed Sores diagnosed?

For patients using wheelchair or are on bed rest from quite a long time, signs of bedsores are observed. Appearance and predictable locations of bed sores on the body make them easy to diagnose. It is characterized as follow:

Stage I bed sores involve abnormal redness of the skin, with skin intact and is usually reversible.

Stage II is indicated by the redness progressing into an abrasion, blister or shallow crater. Stage II is also reversible.

Stag III is identified as crater-like sore or ulcer that has begun to extend beneath the skin and this stage may be life-threatening.

Stage IV is identified as skin loss with extensive destruction or damage to muscle, bone and tendons or joint capsules. This stage IV may be fatal.

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How to prevent & control Bed Sores?

To help prevent bedsores especially in a person who is confined to a bed or chair:

  • Relieve pressure from vulnerable areas. Change position, every two hours when in bed and every hour when sitting in a chair. Use pillows to raise arms, legs, buttocks and hips. Relieve pressure on the back with a foam mattress, a water mattress or a sheepskin.
  • Reduce shear and friction and avoid dragging the person across the bed sheets. Either lift the person or have the person use an overhead trapeze to briefly raise the body.
  • Inspect the skin at least once each day. Early detection can prevent stage I from becoming worse.
  • When cleaning or disinfecting the skin, avoid using irritating antiseptics, hydrogen peroxide, povidone iodine solution or other harsh chemicals.
  • Eat healthy food including calories, protein, vitamins and minerals.
  • Regular exercise increases blood flow and speeds healing. Bedridden people can do stretches and simple exercises.
  • Keep the skin clean and dry. Clean it with plain water and if needed a gentle soap.

Treatment of Bed Sores- Allopathic Treatment

Treatment of bedsores include changing position, using special mattresses to relieve pressure, dressings to heal the sore, certain medications to relieve the pain and in some cases surgery. Damaged tissues are removed using high-pressure jets or using instruments like scalpels or forceps, after numbing the area using local anesthetic.

Certain types of dressing includes:

  • Alginate dressings– These dressing are made from seaweed and contain sodium and calcium, which are known to speed up the healing process.
  • Hydrocolloid dressings– These contain a special gel that encourages the growth of new skin cells in the ulcer, while keeping the surrounding skin dry.
  • Other dressing types– Foams, films, hydrofibres or gelling fibers, gels and antimicrobial dressings may also be used.

Medications used:

  • Nonsteroidal anti-inflammatory drugs– NSAIDs like ibuprofen, naproxen sodium and others are given to reduce pain.
  • Antibiotics– Oral or tropical form of antibiotics are given to fight infection.

Treatment of Bed Sores- Homeopathic Treatment

  • Arnica– This is for bedsores that have made the skin turn blue-black in appearance and may also be accompanied by soreness, itchiness and a feeling as if the bed is too hard to lie down on.
  • Apis Mellifica– This remedy treats bedsores that are rose coloured and accompanied by a burning sensation and pain on the spot that worsens with touch.
  • Carbo Veg– Bed sores formed in areas where the skin turns blue due to cold but where the skin simultaneously sweat excessively can be treated with this medicine.
  • Arsenic Album– This is indicated for ulcers that give off an offensive discharge and are often quite painful which worsens at night and with the cold.
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Bed Sores- Lifestyle Tips

  • Maintain a good hygiene and cover the bedsores with a bandage or dressing.
  • Frequently turn and move in between.
  • Remove the dead tissue from the pressure sore by changing the bandage and dressing.
  • Take pain medicine 30 to 60 minutes before changing the dressing.
  • Add calories, protein, and other nutrients (vitamin C and zinc help heal wounds) to your diet.

What are recommended exercise for person with Bed Sores?

Bed ridden patients can practice arm and leg life. Raising each arm or leg for 10 seconds, repeating it for at least 10 times.

In the similar way palm stretch exercise can also be practiced.

Bed Sores & pregnancy- Things to know

  • Bed sores during pregnancy is usually common, especially during third trimester due to restricted movement.
  • Bed sores also can occur due to sleeping only on one side during pregnancy.
  • Women should inspect for bedsores every day to prevent it from getting worse.
  • However, bedsores does not cause any adverse effect both to the mother and the baby and can be treated with regular cleaning and dressing.

Common complications related to Bed Sores

  • Cellulitis
  • Bone and joint infections. An infection from a pressure sore can burrow into joint
  • Cancer
  • Sepsis

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