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Pressure Sores: Stages, Risks, Treatment and More

by: Claire Nulla
September 29, 2023

People who are bedridden, immobile or wheelchair-bound face a health risk as blood flow decreases when they stay in one position for too long.

In this article, we will discuss pressure sores in detail, as well as its stages, risk factors, treatment and preventive measures.

What’s a pressure sore?

Pressure sores, also known as bedsores or pressure ulcers, are wounds that develop on the skin and underlying tissues due to prolonged pressure on an area of the body. They’re fairly common among individuals who are bedridden or have limited mobility, such as those who are confined to a wheelchair.

These sores often form in bony areas of the skin, such as:

  • Heels
  • Hips
  • Tailbone

Pressure sores can be extremely painful and can lead to serious complications such as infections and tissue damage


Pressure sores are divided into four stages based on their severity, with stage one being the mildest and stage four being the most severe.

Stage 1

At this stage, the skin may look or feel like the following:

  • Red or discolored
  • Warm or hard to the touch
  • Itchy or burning sensation

If Stage 1 pressure sores are left untreated, they can progress to more severe stages, which can be difficult to treat.

Stage 2

The pressure sores’ damage has reached the second layer of the skin and its underlying tissues, like the subcutaneous fat.

At stage 2, you might spot shallow open sore with a visible wound bed or serum-filled blister at these areas:

  • Hips
  • Back
  • Heels
  • Buttocks

Stage 3

The wounds, which have a crater-like appearance, have now extended through the skin and into the subcutaneous tissue layer. At this stage, pressure sores are way more painful and more prone to infection.

Stage 4

Pressure sores at this stage are extremely serious and require immediate medical attention. Patients with stage 4 pressure sores are at risk for life-threatening infections like osteomyelitis and sepsis.

Because stage 4 pressure sores are so severe, they often require surgical intervention. Surgery may involve removing damaged tissue or bone, or grafting skin onto the wound.

Risk factors for pressure sores

Those who have or are going through the following are at greater risk for developing pressure sores.

  • Immobility: When you can’t move or adjust your body due to medical conditions, such as paralysis, neurological disorders or post-surgery recovery, your skin is susceptible to pressure sores.
  • Poor nutrition: Not taking enough nutrients and being dehydrated hinder the skin’s ability to withstand pressure and friction, making it less elastic and more prone to injury.
  • Incontinence: Having no control over your pee or bowel movement can result in prolonged exposure of the skin to moisture, which can cause skin breakdown and increase the risk of pressure injuries.
  • Decreased mental status: Having a decreased mental status may affect the ability to communicate discomfort or pain, which delays detection and treatment of pressure sores.
  • Friction and shear: Friction occurs when two surfaces rub against each other, while shear occurs when one surface moves in a direction opposite to the other surface.

Treatment of pressure sores

Treatment plan varies depending on the stage and severity of the pressure sore.

For early stages, the most effective treatment includes:

  • Regular cleaning of the skin with mild soap and water
  • Frequent repositioning
  • Avoiding friction and moisture
  • Using topical ointments
  • Changing the wound dressing
  • Relieving pressure
  • Physical therapy

For advanced stages, treatment plan may surgical intervention, such as:

  • Surgical debridement
  • Skin grafting
  • Flap reconstruction
  • Negative pressure wound therapy

Prevention of pressure sores

For a more tailored approach to preventive measures, it’s better to consult with your healthcare provider.

They may recommend the following:

  • Daily skin inspection: Check the skin for early signs of skin damage, such as redness, swelling and irritation. If you observe any changes or abnormalities, report to the healthcare provider for appropriate treatment.
  • Skin cleansing and moisturization: Regular skin cleansing with mild soap and lukewarm water helps to remove dirt, sweat and oil buildup that can clog pores or lead to skin infections. Moisturizing is also important in keeping the skin hydrated, flexible and less prone to injury.
  • Use of pressure-relieving devices: These devices help reduce the amount of pressure on body parts that are prone to developing pressure sores. Common pressure-relieving devices include cushions, mattresses and bed overlays.
  • Frequent positioning and turning: This helps in relieving pressure on vulnerable areas, such as the back, buttocks and heels. When repositioning patients, ensure that all body parts are supported and aligned correctly.
  • Proper nutrition and hydration: Make dietary changes that include a diet rich in nutrients, including protein, vitamins and minerals. Increasing fluid intake to at least eight glasses of water per day helps as well.
  • Incontinence management: Use appropriate products that minimize the skin’s exposure to moisture, such as absorbent pads, briefs or diapers. These products should be changed as frequently as necessary to keep the skin dry and prevent the development of infections.
  • Friction and shear reduction: This includes the following:
    • Using lifting and transfer techniques instead of dragging patients when turning
    • Wearing loose-fitting clothing
    • Avoid massaging reddened or ulcerated skin areas

Key takeaway

Neglecting a small issue can quickly lead to more significant problems.

Often, people are unaware of the early signs of pressure sores, making it hard to intervene appropriately.

Early intervention is essential in managing pressure sores, and healthcare providers must be proactive in addressing any skin concerns that arise.
These two forces can cause damage to the skin and underlying tissues, disrupt blood flow and result in pressure sores, especially among immobilized individuals.