What is a pressure ulcer?

A pressure ulcer is damage to an area of skin and the tissue under it from constant pressure or rubbing on the skin. The ulcer can be small or it can get quite large. It may even go down to the bone. Pressure ulcers happen most often on the tailbone, shoulder blades, side of the hip joint, ankle, knee, elbow, and back of the heel.

Pressure ulcers may also be called bedsores or decubitus ulcers. Once a pressure ulcer develops, it can be hard to heal. It is much better to prevent pressure ulcers than to treat them.

You have a higher risk for pressure ulcers if you:

• Use a wheelchair
• Have a broken hip
• Have had a stroke that limits your ability to move
• Have a splint or cast

How can I help prevent pressure ulcers?

Take care of your skin.

• You or someone who cares for you needs to regularly check your skin. The goal is to find and fix problems before the skin breaks down.
  • Check your skin in the morning and before you go to bed at night.
  • Look for redness, dark areas, cracks, bruises, and blisters. Note any white spots or areas. Injured skin may turn white before it turns red. Watch for red, tender, or swollen areas on the skin. Pay special attention to any areas that stay red even when you are no longer putting pressure on the area.
  • Don’t massage a red area.
• Clean the skin right away if urine or bowel movement gets on it. Wash the skin gently with a soft cloth or sponge. If you have problems controlling urine or bowel movements, use pads or underwear that absorbs urine. The pads or underwear should have a quick drying surface that keeps moisture away from your skin.
• When bathing or showering, use a mild soap and warm water. Don’t use hot water, which can burn the skin.
• To prevent dry skin, put creams, ointments, or oils on the skin. Don’t use products that can dry the skin, such as alcohol wipes, disinfectant liquids or gels, or drying powders.

Change positions often.

• Limit pressure on bony parts of the body by changing positions often. You may need someone to help you do this if you are weak or disabled.
  • In bed, change your position at least every 2 hours. If you can, it is better to change position more often.
  • In a chair or wheelchair, change your position every 15 to 20 minutes.
• Be careful not to rub sensitive areas when you change position. Someone helping you can use a sheet to lift you so you don’t have to slide on the bed.
• Avoid lying directly on your hip bone when you are lying on your side. Choose positions that spread weight and pressure more evenly.
• Massage may help increase blood flow, but don’t massage reddened areas, sores, or bony parts of the body such as knees and elbows.
• Do exercises to relieve pressure and shift your weight. Your healthcare provider can recommend exercises for you.

Use devices and take other cautions to relieve pressure.

• Use a foam, gel, or air cushion or mattress to relieve pressure. Ask your healthcare provider which is best. Avoid donut cushions because they can block the flow of blood to skin inside the ring and create more pressure on the skin sitting on the ring.
• Use pillows or wedge cushions to support your back and lower legs, keep your heels off the bed, and keep your knees or ankles from touching each other. Ask your healthcare provider if if these cushions would be helpful for you.
• If you have an adjustable bed, raising the head of the bed too much or for too long may put too much pressure on your hips and buttocks, and can damage skin and tiny blood vessels. Keep the head of the bed at or below 30 degrees, if your healthcare provider tells you to do so.
• Keep sheets free of wrinkles and wear clothing without thick seams. Seams and wrinkles can put pressure on your skin if you sit or lie on them.
• Never put a heating pad on a part of your body that is numb.

Reduce swelling.

• Swelling often causes problems in the feet, ankles, and heels. Swelling can make it harder to move, and that increases your risk for pressure ulcers. If you have swelling in those areas, work with your healthcare provider to reduce it.
• Raise your feet above your heart several times a day. Keep your feet up at least 15 minutes each time, if you can.
• Ask your provider if compression stockings would be helpful for you. Compression stockings may help reduce swelling in your legs.

Avoid chafing, rubbing, or sliding.

• When changing your position, try to lift off the bed or seat, change your position, and settle down again. Whether you move yourself or have helpers, avoid sliding against the bed or seat.
• Sometimes a protective pad or covering helps, such as a soft boot over your heel. The boot decreases friction and pressure on your heel, keeping your skin from being rubbed. When you use a protective covering check the skin under it several times a day to be sure there is no redness, blistering, or irritation.

Eat well.

• Eat a healthy diet to keep your skin healthy. Healthy skin is less likely to be damaged. It’s very important to get enough protein and calories. Ask your healthcare provider if you should take nutritional supplements or talk with a dietician.
• Drink plenty of liquids unless your healthcare provider says you need to limit how much liquid you drink.
• Some studies show zinc and vitamin C help the healing of some wounds. Ask your provider about taking vitamins or minerals.