Bedsores: Symptoms, Types, Causes and Treatment

Bedsores, also known as pressure ulcers or decubitus ulcers, are serious skin and tissue injuries that can develop in anyone who remains in the same position for too long. They are a significant concern for individuals with limited mobility, such as those confined to a bed or wheelchair. Understanding the symptoms, types, causes, and treatment options for bedsores is crucial for both patients and caregivers. This comprehensive guide draws on the latest research and clinical evidence to help you recognize, prevent, and manage these potentially life-threatening wounds.

Symptoms of Bedsores

Recognizing the early signs of bedsores can make a critical difference in patient outcomes. The symptoms may start subtly but can progress rapidly if not addressed.

Stage	Description	Risk Level	Source
Redness	Non-blanchable redness	Early	3 2
Swelling	Puffy or edematous skin	Early	1
Pain	Discomfort or throbbing	Mild-Severe	1
Open Wound	Loss of skin, deep tissue	Advanced	1 2 3

Table 1: Key Symptoms

Early Symptoms

The earliest signs of bedsores are often easy to overlook. They include:

• Persistent redness on the skin, especially over bony areas like the tailbone, heels, ankles, and shoulder blades 3.
• Swelling or puffiness around the affected area, which may feel warmer than the surrounding skin 1.
• Mild discomfort, itching, or tenderness.

These symptoms signal the need for immediate action to relieve pressure and enhance circulation.

Progression of Symptoms

If the underlying causes are not addressed, symptoms can escalate quickly:

• Skin may break open, forming a shallow ulcer.
• Pain intensifies, sometimes becoming throbbing and severe 1.
• Exposed deeper tissues, such as muscle, ligaments, or even bone in advanced cases 1 3.
• Foul-smelling discharge or pus may indicate infection.

Severe Symptoms

At the most advanced stage, bedsores can result in:

• Large, deep wounds that may cover significant areas (e.g., both buttocks) 1.
• Severe pain and risk of infection spreading to bloodstream or bone 1.
• Necrosis (tissue death) and systemic symptoms like fever, which can be life-threatening 2.

Types of Bedsores

Bedsores are classified by their severity, ranging from mild skin redness to deep wounds involving muscle and bone. Accurate classification guides treatment and predicts potential complications.

Stage	Depth of Damage	Key Features	Source
Stage 1	Superficial	Redness, intact skin	3
Stage 2	Partial thickness	Blister/open sore	3 7
Stage 3	Full thickness	Deep wound, visible fat	3 1 7
Stage 4	Deep tissue/bone	Muscle, bone exposed	1 3 7

Table 2: Bedsore Types by Stage

Stage 1: Superficial

• Characterized by intact skin with persistent redness.
• The area may feel warm, swollen, or tender.
• No open wounds yet; early intervention can reverse damage 3.

Stage 2: Partial Thickness

• The top layers of skin are damaged, resulting in a blister or shallow open sore 3 7.
• The area is painful, and the risk of infection increases.
• Immediate wound care is needed to prevent progression.

Stage 3: Full Thickness

• The bedsore extends through the dermis into the fat layer beneath the skin 3 1.
• The wound may appear as a deep crater, often with yellowish dead tissue.
• Healing is more difficult and takes longer; specialized dressings and care are required 7.

Stage 4: Deep Tissue/Bone

• The most severe form, with damage reaching muscle, ligaments, and even bone 1 3 7.
• These wounds are large, can be foul-smelling, and often become infected.
• Require complex, multidisciplinary treatment and can be life-threatening 1.

Causes of Bedsores

Understanding the underlying causes of bedsores is vital for prevention and effective management. Multiple risk factors interplay, making some individuals more susceptible than others.

Cause	Mechanism	High-Risk Groups	Source
Pressure	Blood flow restriction	Immobile, paralyzed	3 2
Friction	Skin rubbing on surface	Bedridden, frail elderly	1 3
Moisture	Skin breakdown	Incontinent, sweaty	1
Shear	Tissue sliding, tearing	Poorly positioned patients	3

Table 3: Major Causes of Bedsores

Prolonged Pressure

• The most significant cause is sustained pressure over bony prominences, which restricts blood flow and starves tissues of oxygen and nutrients 3 2.
• Common sites include the sacrum (tailbone), heels, elbows, and hips.

Friction and Shear

• Friction occurs when the skin rubs against bedding or clothing, damaging the outer layer 3.
• Shear forces happen when skin moves in one direction while underlying tissues move in another, causing deeper injury (e.g., when a patient slides down in bed) 3.

Excessive Moisture

• Moisture from sweat, urine, or feces softens the skin, making it more prone to breakdown 1.
• Incontinence is a major risk factor.

Other Contributing Factors

• Poor circulation, often due to conditions like diabetes or vascular disease, increases risk 1.
• Malnutrition and dehydration impair the body’s ability to repair tissue.
• Advanced age, neurological impairment, and chronic illness can all contribute 2.

Treatment of Bedsores

Managing bedsores requires a comprehensive approach, combining pressure relief, wound care, infection control, and sometimes surgical intervention. The choice of treatment depends on the stage and severity of the ulcer.

Treatment Type	Approach	Effectiveness/Considerations	Source
Pressure Relief	Repositioning, special beds	Essential for prevention	3 8
Dressings	Alginate, hydrocolloid, foam	No clear best; case-dependent	6 7
Antimicrobials	Topical agents, antibiotics	Unclear benefit; evidence low	4 7
Advanced Care	NPWT, surgical flaps	Limited evidence, sometimes used	5 8 1

Table 4: Approaches to Bedsore Treatment

Pressure Relief and Support Surfaces

• Frequent repositioning is the cornerstone of both prevention and treatment. Caregivers should shift the patient’s position at least every two hours 3.
• Special support surfaces, like alternating pressure mattresses and immersion water beds (e.g., Beaufort-Winchester Water Bed), can significantly reduce pressure and promote healing 8.

Wound Care and Dressings

• Diverse dressings are available, including alginate, hydrocolloid, foam, and protease-modulating types 6 7.
• Current evidence does not support one dressing over another; clinicians should select based on wound characteristics, exudate control, patient comfort, and cost 6 7.
• Saline gauze remains a standard comparator in clinical studies, but newer dressings may offer advantages in some cases 7.

Infection Control

• Topical antiseptics and antibiotics are sometimes used, but high-quality evidence of their benefit is lacking 4.
• Overuse of antimicrobials can hinder healing or promote resistance, so these should be reserved for infected wounds 4.
• Regular wound cleaning and debridement (removal of dead tissue) are crucial.

Advanced Treatments

• Negative pressure wound therapy (NPWT) may be considered for deep or stubborn ulcers, though evidence for its superiority is limited 5.
• Surgical intervention, such as rotation flaps (moving healthy tissue to cover the wound), may be required for large or non-healing stage 4 ulcers 1 8.
• Multidisciplinary care, including nutrition support, physiotherapy, and infection management, optimizes outcomes.

Additional Considerations

• Pain management is important, especially for advanced ulcers which can cause significant suffering 1.
• Nutritional support and hydration are essential, as malnutrition impedes wound healing 2.
• Patient and caregiver education is vital to prevent recurrence.

Conclusion

Bedsores remain a serious health challenge, especially among individuals with limited mobility. With early recognition, prompt intervention, and comprehensive care, their impact can be minimized. Here’s a summary of the main points:

• Symptoms: Range from mild redness and swelling to deep, painful wounds with exposed tissue or bone.
• Types: Classified by stage (1-4), reflecting increasing severity and depth of tissue damage.
• Causes: Primarily due to prolonged pressure, friction, moisture, and shear—especially in those with immobility or poor circulation.
• Treatment: Relies on pressure relief, careful wound care, infection control, and sometimes surgical intervention. Despite many available dressings and therapies, no single treatment has proven universally superior.

Key takeaways:

• Early detection and prevention are critical.
• Repositioning and support surfaces are the foundation of care.
• Treatment should be individualized based on wound characteristics and patient needs.
• Evidence for advanced therapies is limited; more research is needed for best practices.

Empowering patients, caregivers, and clinicians with this knowledge is essential in the fight against bedsores. By staying vigilant and proactive, we can reduce suffering and improve quality of life for those at risk.