A bed sore, also known as a pressure sore or pressure ulcer, is an open wound on the skin that is common among people who are confined to their bed or a wheelchair for extended periods of time. Lying on a certain part of your body for long periods may cause your skin to break down and lead to bed sores.
It mostly affects the skin covering bony areas. The skin is thinner in places next to bone or cartilage. The most common places vulnerable to bed sores are the buttocks, shoulder blades, skin along the spine, backs of arms and legs, back of the head, lower back, heels, ankles and skin behind the knees.
Causes of Bed Sores
- One of the main causes of bed sores is undue pressure and friction on the skin. This can happen after lying or sitting on a certain area for long periods. It can also occur due to wearing soiled clothing or undergarments for long periods.
- People who have difficulty moving due to poor health, weakness, paralysis, sedation or coma are at higher risk of getting bed sores.
- Other common risk factors include fragile skin due to age, diabetes, loss of sensation in body parts, weight loss during prolonged illnesses, poor nutrition, dehydration, very dry skin and excessive smoking.
- Some conditions, like diabetes, may restrict the blood circulation, which in turn can cause tissue destruction in the patient’s skin and increase their risk.
A 2017 study published in the journal Oncotarget reports that diabetic patients having general surgery, hip surgery and cardiac surgery all had significantly higher bed sore risk than non-diabetic patients.
Symptoms of Bed Sores
The National Pressure Ulcer Advisory Panel defines the symptoms of bed sores in different stages as well as categories to indicate the extent of tissue damage. This differentiation helps for better diagnosis and treatment plan.
Depending on the stage, the patient may have any of the following symptoms:
- Discoloration of the skin
- Pain in the affected area
- Tearing or lesions on the skin
- Skin that doesn’t lighten to the touch
- Skin that’s softer or firmer than the surrounding skin
Stages of Bed Sores
Bed sores develop in 4 stages-
- Stage 1: In this stage, bed sores affect just the upper layer of the skin and the symptoms include pain, burning or itching in the skin.
- Stage 2: In this stage, bed sores spread a little deeper and the symptoms include discolored skin with open sore.
- Stage 3: By this stage, the sores reach the fat tissues with crater-like appearance and bad odor. There may be yellow (slough) or black (eschar) tissue present.
- Stage 4: This is the most serious stage, where the patient’s muscles and ligaments could also be affected. The symptoms of this stage include deep, open sores and at times visible tendons, muscles or bones.
Backention of Bed Sores
Despite excellent medical and nursing conditions, bed sores are likely to affect the bedridden patients, especially if they are vulnerable. But there are a few steps that can be taken to reduce the likelihood of developing bed sores.
- Inspect the patient’s skin daily, especially around bony areas like the spine, lower back, hips, tailbone, elbows and knees.
- Keep the skin clean and dry; free of wound drainage, sweat, urine or feces.
- Try to avoid exposing skin to dry, cold weather as dry skin is more susceptible to being damaged.
- Even if the patient is confined to a bed or a wheelchair, try to include some exercises in his/her daily routine. Consult an expert to learn exercises that you can do as per your capabilities.
- Avoid tight clothing, clothing with heavy seams and nylon underwear.
- Keep clothing and linen under the body smooth and free of wrinkles or bunches.
- Avoid smoking and tobacco-based products. These products can dry out the skin and reduce blood supply to the skin.
- Always keep the skin dry because moisture can worsen the skin condition.
- It is also extremely important to drink an adequate amount of water to keep the skin hydrated.
When to See a Doctor
If not checked in time, bed sores can lead to ulceration with a deep wound and develop signs of infection like pus. You must consult the doctor immediately for any signs of bed sores, in case the patient develops blisters or an open sore.
Signs of infection such as a foul smell from the sore, formation of pus on the site, redness and tenderness around the sore, swollen or tender skin and fever also need immediate medical supervision.
Strict hygiene measures should be practiced to promote healing of bed sores and reduce the risk of infection. You can also use some easy home remedies to minimize the patient’s discomfort and promote healing. Proper medical supervision is highly recommended.
Here are the some of the best home remedies for bed sores.
1. Change Positions
The first course of action for finding relief from bed sores is reducing the pressure and friction that resulted in bed sores in the first place. One of the best strategies to do so is to change the position of the patient’s body often. This will help reduce the stress and pressure on the skin that can irritate existing sores. It also reduces the risk of developing new sores.
Frequent turning and repositioning of the patients for reducing the mechanical load is one of the most important preventive measures for bed sores.
Another study published in the Journal of Rehabilitation Research & Development in 2013 stated that one of the important aspects of preventing bed sores is by providing relief to the tissues that are higher at risk of facing pressure or friction, though more research is required to study which repositioning techniques would best help prevent the formation of bed sores.
If the patient has enough upper body strength, then advise him/her to reposition every few hours using a device like a trapeze bar.
- If the patient is in a wheelchair, then ask him/her to try to shift his/her weight every 30 minutes.
- Caretakers should use bed linens to help lift and reposition the patient to reduce the risk of friction and shearing. This should be done every 2 to 3 hours.
2. Saline Water
For treating bed sores, especially Stage II bed sores, the bed sores must be cleaned with salt water to remove loose, dead tissue.
Bed sores that are not cleaned properly are more prone to infection and inflammation. Saline water will reduce excess fluid.
Eastern African Medical Journal published a study in 1993 in which 53 patients with different types of ulcers were treated with varying strengths of hypertonic saline 0.3, 0.9, 1.2, 1.5, 2 and 3 osmoles, and it was concluded that in case of solutions of 1.5 mmols and above, healing was faster in ulcers that were not due for grafting.
- Mix 2 teaspoons of salt in a cup of water.
- Boil it, then allow it to cool.
- Use this solution to clean the affected body area.
- Allow the area to dry thoroughly, and then cover it with a bandage.
- Repeat a couple of times a day.
The natural antiseptic properties of honey soothe the mild bed sores in the skin. It can provide relief from pain, reduce itching and promote healing. Honey can also reduce the risk of infection.
According to a study published in Journal of Wound, Ostomy and Continence Nursing in 2005, healing in subjects who had used honey dressing was almost 4 times the rate of healing when compared to another anti-microbial dressing.
Another study published in the South Asian Journal of Cancer in 2012, reported that honey dressing resulted in significant healing and pain reduction.
Furthermore, 2015 a study published in the Asian Journal of Medical Sciences reported honey as being a safe, satisfying and cost-effective topical dressing material for bed sores.
- Apply pure honey to the affected body area and cover it with a clean bandage. Follow this treatment once daily.
- You can also spread honey over a large banana leaf. Ask the patient to lie down on this banana leaf for a few hours. Repeat daily.
Turmeric accelerates the healing process of bed sores. It also has anti-inflammatory, antiseptic and antioxidant properties that help the patient’s body deal with the symptoms and fight infection.
In fact, it is the compound curcumin found in turmeric that aids in wound healing.
- Clean the affected area with sterile water or a saline solution. Sprinkle enough turmeric powder to cover the wound. Cover the area with a clean bandage. Repeat 3 times daily for quick healing.
- You can also ask the patient to drink warm turmeric milk twice daily.
5. Aloe Vera
Due to its healing and soothing properties, aloe vera can also promote healing of bed sores and control infection.
Plus, it keeps the affected skin moisturized, which ensures a quick recovery.
As per a study published in the Iranian Journal of Medical Science in 2016 aloe vera gel is a beneficial and cost-effective treatment for patients with chronic ulcers.
- Cut open an aloe vera leaf and extract the gel.
- Apply this gel on the affected area and rub gently for a few minutes.
- Allow it to dry on its own, then wipe it off with a clean damp cloth.
- Repeat 3 times a day.
You can use aloe vera gel powder, cream or ointment to help promote healing in the patients.
6. Olive Oil
Being rich in fatty acids, olive oil will keep the patient’s skin healthy and protect it from damage caused by constant pressure. Plus, massaging it onto the patient’s body will improve blood circulation.
A 2013 study published in Trials, reports that regular use of olive-oil-based formulas helped in preventing the occurrence of bed sores in immobilized patients.
Another 2015 study published in International Journal of Research in Medical Sciences reported that olive oil has potential benefits for preventing bed sores in I.C.U. patients.
- Apply some warm extra virgin olive oil all over the patient’s legs, limbs and back.
- Gently massage until the oil penetrates deep into the skin.
- Apply 3 or 4 times daily to heal the sores and prevent new sores from appearing.
7. Dietary Changes
The nutritional needs of people with bed sores are very high. To reduce the risk of infection and promote wound healing, the body needs extra protein, calories and vitamins and minerals.
For instance, vitamin C is necessary for the health of skin and blood vessels, it is often recommended for those suffering from bed sores.
Zinc is another important mineral that promotes wound healing by repairing damaged skin tissues. Protein depletion also adversely affects healing.
A 2004 study published in the Journal of Wound Care reported the effectiveness of oral nutritional supplements rich in protein, arginine, vitamin C and zinc to be effective in healing the bed sores.
For a wound healing diet, follow the guideline provided by your doctor or nutritionist.
8. Use Special Support
Those who are at a higher risk of developing pressure sores or even suffering from them must opt for pressure-relieving support surfaces such as special mattresses and overlays.
Special pressure-relieving support surfaces are available in two forms.
The first are certain types of mattresses and overlays that are made out of wool or animal skin or contain materials such as silicone or gel. They help distribute the pressure over a larger area.
In the second type, the pressure applied to different parts of the patient’s body is changed at regular intervals. The air-filled mattresses or overlays are pumped up with larger or smaller amounts of air in different places.
If the patient is using a wheelchair, you can also consider getting a chair cushion that fits the patient’s body shape better. Ask the patient to sit on a foam or gel seat cushion that fits the wheelchair.
- Liang M, Chen Q, Zhang Y, et al. Current neurology and neuroscience reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362422. Published February 28, 2017.
- National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury. The National Pressure Ulcer Advisory Panel – NPUAP. http://www.npuap.org/national-pressure-ulcer-advisory-panel-npuap-announces-a-change-in-terminology-from-pressure-ulcer-to-pressure-injury-and-updates-the-stages-of-pressure-injury/. Published April 13, 2016.
- Staff H. Stages of Pressure Injuries. MyHealth.Alberta.ca Government of Alberta Personal Health Portal. https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=zm2442. Published June 14, 2017.
- Lyder CH. Pressure Ulcers: A Patient Safety Issue. https://www.ncbi.nlm.nih.gov/books/NBK2650/.
- Peterson MJ, Gravenstein N, Schwab WK, Oostrom JHvan, Caruso LJ. Participatory design and validation of mobility enhancement robotic wheelchairPatient repositioning and pressure ulcer risk—Monitoring interface pressures of at-risk patients. Journal of Rehabilitation Research & Development (JRRD). https://www.rehab.research.va.gov/jour/2013/504/peterson504.html. Published 2013.
- How to care for pressure sores: MedlinePlus Medical Encyclopedia. MedlinePlus. https://medline.gov/ency/patientinstructions/000740.htm.
- Lim JK, Saliba L, Smith MJ, McTavish J, Raine C, Curtin P. Normal saline wound dressing–is it really normal? British Journal of Plastic Surgery. https://www.ncbi.nlm.nih.gov/pubmed/10657448. Published January 2000
- Mangete ED, West KS, Blankson CD. Hypertonic saline solution: an effective wound dressing solution. East African medical journal. https://www.ncbi.nlm.nih.gov/pubmed/8513736. Published February 1993
- Yapucu U, Eşer I. Effectiveness of a honey dressing for healing pressure ulcers. Current neurology and neuroscience reports. https://www.ncbi.nlm.nih.gov/pubmed/17413836. Published 2007.
- Saha A, Chattopadhyay S, Azam M, Sur PK. The role of honey in healing of bed sores in cancer patients. Current neurology and neuroscience reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876612/. Published 2012.
- Khadanga S, Dugar D, Karuna T, et al. Effects of Topical Honey Dressing in Decubitus Ulcer. The Initiation. https://www.nepjol.info/index.php/AJMS/article/view/11616.
- Dam A, Datta N, Mohanty UR, Bandhopadhyay C. Managing Pressures Ulcers in a Resource Constrained Situation: A Holistic Approach. Indian Journal of Palliative Care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276828/. Published 2011.
- Tejada S, Manayi A, Daglia M, et al. Wound Healing Effects of Curcumin: A Short Review. Current neurology and neuroscience reports. https://www.ncbi.nlm.nih.gov/pubmed/27640646.
- Avijgan M, Kamran A, Abedini A. Current neurology and neuroscience reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103537/. Published May 2016.
- Lupiáñez-Pérez I, Morilla-Herrera JC, Ginel-Mendoza L, et al. Trials. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016603/. Published 2013.
- Madadi ZAA, Zeighami R, Azimian J, Javadi A. The effect of topical olive oil on prevention of bed sore in intensive care units patients. International Journal of Research in Medical Sciences. http://www.msjonline.org/index.php/ijrms/article/view/1720. Published 2015.
- Nutrition – Diet crucial in pressure sores – INMO. https://www.inmo.ie/Article/PrintArticle/3838.
- Frías L, Lage MA, Maristany CP, Xandri JM, Wouters-Wesseling W, Wagenaar L. The effectiveness of oral nutritional supplementation in the healing of pressure ulcers. Current neurology and neuroscience reports. https://www.ncbi.nlm.nih.gov/pubmed/15469215. Published September 2004.
- Can special mattresses and overlays prevent pressure ulcers? Current neurology and neuroscience reports. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0079409/. Published September 23, 2015.