Bedsores: Why you really don't want to get this painful condition

Bedsores tend to occur in people who lie or sit in the same position for hours. — Filepic

My mother, who has dementia, developed a rather large wound on her buttocks. We took her to the doctor, who said it was a bedsore. What is a bedsore?

Bedsores are also known as pressure sores or pressure ulcers. They can also be called decubitus ulcers (decubitus means lying down).

Bedsores don’t only develop if you lie down in one position for a long time; they can also develop if you sit in one position for a long time.

They are actually skin and underlying tissue injuries as a result of prolonged pressure on a certain part of your skin.

Oh, can a healthy person develop a bedsore?

Usually no.

If you are healthy, you would be up and about, and tired of sitting or lying in one position all the time.

People who develop bedsores usually have underlying medical conditions that disable them from moving around.

They have to spend most of their time sitting on a chair or lying down, and are unable to change positions.

These people are usually dependent on others to change their position.

Many times, they have difficulty communicating and cannot speak easily to express their pain.

For example, people who have had a stroke or advanced dementia, or people in a prolonged coma or who have suffered a fracture and had to wear a plaster cast for a long time.

It is even worse if the patient has no caregiver to keep turning him or her.

Patients who did not receive proper nutrition due to being unable to eat, or neglect, also have it worse.

Any disease that impairs blood circulation to the skin, such as diabetes, also confers a higher risk of bedsores developing.

Can a bedsore develop anywhere?Bedsores usually develop on pressure points, especially on skin that covers bony areas, like the hips, back or sides of knees, tailbone, heels, ankles, back of the head, shoulder blades, etc – basically, any equipment or furniture a person spends a lot of time lying or sitting on.

Why do bedsores develop?

Bedsores develop when blood supply to your skin is cut off for more than two to three hours.

Yes, even hours matter.

That is why for some prolonged surgical procedures, the anaesthetist ensures that you get gel pads on pressure areas.

First, the impacted skin dies.

Then, the skin and tissue turns into a red, painful area which may turn purple.

If this is not treated, your skin can break open and be infected by bacteria.

There are four stages of bedsores. These are:

Stage 1: The whole area looks red and feels warm to touch (inflammation).

For people with dark skin, it may look like there is a blue or purple tint to the area.

They may complain that the area burns, is painful or itchy.

Stage 2: The area looks even more damaged and may have an open sore or blister.

It becomes very painful now.

There is discolouration on the skin around the wound.

Stage 3: There is a crater now because the tissue underlying the skin is damaged.

Stage 4: The whole area is severely damaged and the wound is large.

You may be able to see exposed muscles, tendons, bones and joints.

There is a high chance the area has been infected.

There is also a type of unstaged bedsore wound where there is full-thickness tissue loss.

However, the base of the ulcer is covered by slough instead.

Can you treat a bedsore?

Yes, of course.

First, the doctor or surgeon has to reduce the pressure and friction on the sore.

The patient has to be repositioned often.

You also need good and special mattresses and seating cushions to help you sit or lie down and to protect your skin.

If it has progressed to a wound, it will have to be cleaned and dressed.

A bandage will also speed healing because it is a barrier against infection and wetness.

If the bedsore has gone on to Stage 3 or 4, then you need to remove the damaged tissue.

This procedure is called debridement, and is best done in a surgical theatre.

Infected bedsores need to be treated with antibiotics.

If the crater of the bedsore is too large, you may require plastic surgery to pad it up.

This is done by removing a section of your muscle or skin tissue from elsewhere to become a flap for the area.

If it is skin, it is called a skin graft.

Sounds scary! I would rather it not progress to a bedsore. How can I, as a caregiver, prevent a bedsore in my patient or loved one?

You need to inspect the patient’s skin, especially the bony areas, every day.

If your patient is truly immobile, try turning and repositioning him every two hours during waking hours.

You can buy ripple mattresses or soft padding for chairs and wheelchairs.

Make sure your patient has good nutrition always.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email starhealth@ thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.