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Health A-Z

Medical Content Created by the Faculty of the
Harvard Medical School

What Is It?

Bedsores, also called pressure ulcers or decubitus ulcers, are areas of broken skin that can develop in people who:

  • Have been confined to bed for extended periods of time

  • Are unable to move for short periods of time, especially if they are thin or have blood vessel disease or neurological diseases

  • Use a wheelchair or bedside chair (a hospital chair that allows a patient to sit upright next to the bed)

Bedsores are common in people in hospitals and nursing homes and in people being cared for at home. Bedsores form where the weight of the person's body presses the skin against the firm surface of the bed.

In people confined to bed, bedsores are most common over the hip, spine, lower back, tailbone, shoulder blades, elbows and heels. In people who use a wheelchair, bedsores tend to occur on the buttocks and bottoms of the feet.

This pressure temporarily cuts off the skin's blood supply. This injures skin cells. Unless the pressure is relieved and blood flows to the skin again, the skin soon begins to show signs of injury.

The pressure that causes bedsores does not have to be very intense. Normally, our skin is protected from being injured by pressure because we move frequently, even when asleep.

At first, there may be only a patch of redness. If this red patch is not protected from additional pressure, the redness can form blisters or open sores (ulcers). In severe cases, damage may extend through the skin and create a deep crater that exposes muscle or bone.

Muscle is even more prone to severe injury from pressure than skin. A bedsore can involve several layers of damaged tissue.

Although pressure on the skin is the main cause of bedsores, other factors often contribute to the problem. These include:

  • Shearing and friction — Shearing and friction causes skin to stretch and blood vessels to kink, which can impair blood circulation in the skin. In a person confined to bed, shearing and friction occurs each time a person slides across the bed sheets.

  • Moisture — Wetness from perspiration, urine or feces makes skin under pressure more likely to suffer injury. People who can't control their bladders or bowels (people who are incontinent) are at high risk of developing bedsores.

  • Decreased movement — Bedsores are common in people who can't lift themselves off the bed sheets or roll from side to side. Without these small movements throughout the day, skin that is pressing against the bed does not get a steady supply of oxygen and nutrients. Blood flow is inadequate in these parts of the skin. (People who can move without assistance have a lower risk of bedsores because they can shift their weight periodically.)

  • Decreased sensation — Bedsores are common in people who have nerve problems that decrease their ability to feel pain or discomfort. Without these feelings, the person cannot feel the effects of prolonged pressure on the skin.

  • Circulatory problems — People with atherosclerosis, circulatory problems from long-term diabetes or localized swelling (edema) may be more likely to develop bedsores. This is because the blood flow in their skin is weak, even before pressure is applied to the skin.

  • Poor nutrition —Bedsores are more likely to develop in people who don't get enough protein, vitamins and minerals.

  • Age — Elderly people, especially those over 85, are more likely to develop bedsores because skin usually becomes more fragile with age.

Bedsores can lead to severe medical complications, including bone and blood infections.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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