Pressure ulcers, or “decubitus ulcers,” are closed or open wounds that occur due to interrupted blood flow. These ulcers most commonly develop as a result of sitting or lying in one position for too long, so doctors sometimes refer to them as bedsores.

Individuals most at risk of developing pressure ulcers are those with mobility issues and those on bed rest.

This article describes what pressure ulcers are and lists the different stages of pressure ulcers and their associated symptoms. It also outlines the risk factors of developing pressure ulcers and provides information on diagnosis and treatment.

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A pressure ulcer develops when there is excessive and sustained pressure on a particular part of the body. This causes a lack of sufficient blood flow to the area, resulting in a closed or open wound.

Pressure ulcers can occur anywhere on the body, but most commonly affect bony areas such as the:

  • elbows
  • knees
  • tailbone
  • ankles
  • heels

Doctors classify pressure ulcers in four stages, depending on their severity. A stage 2 pressure ulcer is one that has progressed to affect both the top and bottom layers of the skin but has not yet affected the fatty tissue beneath.

Below are the different stages of pressure ulcers and their associated symptoms.

Stage 1

A stage 1 pressure ulcer affects only the epidermis, which is the upper layer of the skin. At this stage, the skin typically remains unbroken.

Symptoms associated with stage 1 pressure ulcers include:

  • skin discoloration
  • skin that is sore to the touch
  • skin that is warmer and firmer than surrounding tissues
  • localized burning or itching
  • the area remaining the same color when a person presses it instead of turning white

Stage 2

When a pressure ulcer reaches the second stage, the sore has broken through the top layer of the skin and part of the layer below. This typically results in a shallow, open wound.

A stage 2 pressure ulcer may appear as a shallow, crater-like wound or a blister containing a clear or yellow fluid.

Some symptoms associated with stage 2 pressure ulcers include:

  • pain
  • an ulcer containing pus or liquid
  • swelling and discoloration around the sore

Stage 3

When a pressure ulcer reaches the third stage, the sore has progressed beyond the layers of skin and into the fatty tissues below. There is a high possibility of infection at this stage.

Symptoms associated with stage 3 pressure ulcers include:

  • pus or a greenish fluid from the sore
  • possible necrosis, which is dead tissue
  • odor
  • fever

Stage 4

A stage 4 pressure ulcer is the most serious. This is because it extends into the tissues below the fatty tissue, such as the muscles, ligaments, and tendons. In some cases, it can even extend into the bone.

Symptoms associated with a stage 4 pressure ulcer include:

  • pain
  • purple color in the area
  • firm or mushy texture in the area
  • necrosis

A person who remains in one position for an extended period of time is at high risk of developing a pressure ulcer. Likewise, a person who does not receive treatment for a stage 1 pressure ulcer is at high risk of developing a stage 2 pressure ulcer, and so on.

It is important that people with mobility issues have someone available to help them move at regular intervals, such as moving in their bed or chair. This will help prevent pressure sores from developing.

According to 2015 research, risk factors for developing a stage 2 pressure ulcer include:

  • having a stage 1 pressure ulcer
  • having any condition that reduces feelings of pain
  • low blood circulation
  • being unable to move
  • having a low or high body mass index or weight
  • malnourishment
  • decreased mental state or mental awareness
  • incontinence
  • being of older age

In order to reduce the risk of pressure ulcers, people should reposition the body frequently to help redistribute their weight and alleviate sustained pressure on one particular area. A person who cannot move easily may require assistance from another person, such as a carer or family member.

A doctor or nurse will diagnose pressure ulcers by looking at the ulcer and comparing it with the surrounding skin. They will also assess comorbidities, such as diabetes and spinal cord injuries.

Treatment for a stage 2 pressure ulcer typically includes the following:

  • Bandaging: This keeps the wound dry and reduces the risk of infection.
  • Cleaning: Rinsing the ulcer with saline helps clean the wound.
  • Debriding: This involves a healthcare professional removing the damaged tissue so that the wound can heal correctly.
  • Reducing pressure: Removing pressure from the ulcer helps prevent it from worsening and allows the body to begin the healing process.
  • Ensuring adequate nutrition: Malnutrition is a risk factor for pressure ulcers. It is important that individuals with bedsores receive enough vitamins and minerals to help the body repair itself.

Healing from a stage 2 pressure ulcer can take between 3 days and 3 weeks, depending on the severity of the ulcer.

Pressure ulcers can lead to multiple complications, including:

  • prolonged bed rest
  • the infection spreading to the bone, blood, or heart
  • amputation
  • respiratory issues
  • urinary tract infections (UTIs)
  • expensive medical treatments

Pressure ulcers are sores that occur when blood circulation cuts off from parts of the body due to excessive and prolonged pressure.

Doctors classify pressure ulcers in four stages, according to their severity. Stage 2 pressure ulcers are when the wound extends into the bottom layers of the skin. They often present as round, crater-like sores or large, liquid-filled blisters.

A person should talk with a healthcare professional if they believe they are at increased risk of developing a pressure ulcer. Anyone who has a pressure ulcer, regardless of its stage, should seek a formal diagnosis and begin the appropriate treatment as soon as possible to help prevent further complications.