Not many people are familiar with the fact that being bedridden for an extended period of time can result in a physical problem in the form of a bedsore. Tragically, bedsores are often a sign of abuse or neglect, especially when they occur to those who live in long-term care facilities. Here you will find all the information you need to understand, treat and prevent bedsores.
What Are Bedsores?
Bedsores are also known as pressure sores or pressure ulcers. They occur as a result of prolonged pressure on the skin and underlying tissue in sensitive areas, most often the boney areas of the body such as the back, buttocks, hips, ankles and heels. Bedsores can develop quickly and can be difficult to treat because those who are most often affected are those with mobility issues that keep them from changing positions easily. Those who are bedridden or are confined to a wheelchair are at a high risk for developing bedsores. Symptoms vary depending on the stage of the bedsore. For a complete guide on the different stages of bedsores, see The Four Stages Of Pressure Ulcers.
Causes And Risk Factors
There are three factors that play a role in bedsores developing:
- Sustained Pressure: When the skin is trapped between a bony surface and the surface of a bed or wheel chair, blood flow can be interrupted because the pressure that depriving the area of blood flow is greater than the body’s ability to pump blood to that area.
- Friction: When someone tries to move after being in a certain position for a long period of time, as is the case with people in wheelchairs or those who are bedridden, friction between the skin and the surface he or she is resting on can contribute to bedsores. Friction is worse if the skin is moist, as in the case of those with urinary incontinence.
- Shear: Shear occurs when two surfaces move in opposite directions, such as when the head of a hospital bed is raised. As the head of the bed moves up, gravity pulls the body downward, resulting in a shear effect between a person’s back and the bed.
Those most at risk for developing bedsores are those who have limited mobility. Immobility can be caused by a number of problems:
- Poor health
- Obesity resulting in immobility
- Injury or illness requiring bed rest or wheel chair use
- Recovery after surgery
Other factors that contribute to bedsores include:
- Lack of sensory perception
- Poor nutrition or hydration
- Decreased mental awareness
- Weight loss
- Excessive moisture or dryness of skin
- Decreased circulation
- Muscle spasms
Your doctor will examine the site to determine if a bedsore is present. While evaluating your skin, your doctor will attempt to:
- Determine the size of the sore
- Check for signs of infection, such as bleeding, odor or debris in the wound
- Examine the surrounding area for any signs of spreading infection
- Examine other parts of the body to look for additional sores
After an initial exam, your doctor may perform additional tests, including:
- Blood tests to evaluate general health and nutritional status
- Tissue cultures to look for fungal or bacterial infection in the wound
- Tissue cultures to test for cancer in non-healing or recurring sores
Treatment of bedsores will depend on the stage of development. Bedsores that are in stages one and two will generally within several weeks or months of treatment and care. Bedsores that are in stages three and four are more difficult to treat, and require more extensive strategies.
Relieving pressure is the first step or bedsore treatment, regardless of the developmental stage of the wound. Repositioning the individual often is a crucial step in treatment of sores. Individuals confined to wheelchairs should be encouraged to reposition themselves as best as possible every 15 minutes, and a caregiver should reposition them every hour.
Those on bed-rest should change positions a minimum of every 2 hours. Special support surfaces such as pillows, cushions or special mattresses can be used to encourage positioning that relieves pressure and protects skin from further damage.
Damaged tissue must be removed from the wound site in order for the sore to heal. The technique used to remove damaged tissue will depend on the severity and location of the wound. Tissue removal techniques include:
- Surgically cutting away dead tissue
- Mechanically loosening and removing debris from the wound with methods such as a whirlpool bath or a pressurized irrigation device
- Specialty dressings applied to the wound to encourage the body’s natural enzymes to break down the dead tissue
- Application of chemical enzymes to the wound site to break down dead tissue
Additional treatment options may include:
- The use of pain medication
- Dietary supplements
- IV hydration
- Muscle relaxers
- Surgical repair
Prevention of bedsores is much easier than the treatment of bedsores, but even with proper care, they can occasionally develop though they are usually minor. Prevention strategies are tailored to the individual patients, but can include a variety of measures such as frequent repositioning, frequent bathing, protecting skin from friction and excessive moisture, daily skin inspection as well as proper diet to ensure a healthy weight is maintained.
There are also things like cushions and pads that can be helpful in relieving pressure in areas prone to bedsores. These cushions are made of a variety of materials including sheep skin, gel and foam.
Bedsores must be carefully cleaned and dressed often. Soap and water are effective during stage one, but for later stages, saltwater should also be used in cleaning every time the bandage is changed. A dressing should always be applied to keep the wound moist, provide a barrier form infection and promote healing.
With proper care and preventative measures the risk of bedsores can be virtually eliminated, ensuring patient comfort and improving quality of life. Be sure to speak with a physician or healthcare provider for additional information on supportive services to minimize the risk of bedsores.