Pressure ulcers (pressure sores)

Symptoms of pressure ulcers

Pressure ulcers can happen to anyone, but usually affect people confined to bed or who sit in a chair or wheelchair for long periods of time. They can affect any part of the body that's put under pressure. They're most common on bony parts of the body, such as:

• the heels
• elbows
• hips
• base of the spine

They often develop gradually, but can sometimes form in a few hours. Early symptoms include:

• part of the skin becoming discoloured – people with pale skin tend to get red patches, while people with dark skin tend to get purple or blue patches
• discoloured patches not turning white when pressed
• a patch of skin that feels warm, spongy or hard
• pain or itchiness in the affected area

Later symptoms of pressure ulcers

If the pressure ulcer gets worse, it can form:

• an open wound or blister
• a deep wound that reaches the deeper layers of the skin
• a very deep wound that may reach the muscle and bone 

When to get medical advice

You should contact your GP if you think you or a person you're caring for might have a pressure ulcer.

Get medical advice immediately if there is: 

• red, swollen skin
• pus coming from the pressure ulcer or wound
• cold skin and a fast heartbeat
• severe or worsening pain
• a high temperature (fever) of 38C (100.4F) or above

These symptoms could be a sign of a serious infection that needs to be treated as soon as possible.

If you're in hospital or a care home, tell your healthcare team as soon as possible if you develop symptoms of a pressure ulcer. It'll probably continue to get worse if nothing is done about it.

You should be regularly monitored and offered advice and treatment to reduce the risk of pressure ulcers. Sometimes they can develop even with the highest standards of care.

Treatments for pressure ulcers

Treatments for pressure ulcers depend on how severe they are. Some ulcers only require minor nursing care. Others can be serious and lead to life-threatening complications, such as blood poisoning.

Ways to stop pressure ulcers getting worse and help them heal include:

• special dressings that speed up the healing process and help to relieve pressure
• moving and regularly changing your position
• using specially designed mattresses or cushions, or dynamic mattresses that have a pump to provide a constant flow of air
• eating a healthy, balanced diet
• a procedure to clean the wound and remove damaged tissue

In the most serious cases surgery may be required. Your GP or healthcare team will recommend the best option for you.

People most at risk of getting pressure ulcers

Anyone can get a pressure ulcer, but the following things can make them more likely to form:

• people over 70 years of age are more likely to have mobility problems and have skin that's more easily damaged through dehydration and other factors
• being confined to bed with illness or after surgery
• inability to move some or all of the body (paralysis)
• being overweight
• having urinary incontinence and bowel incontinence
• having a poor diet
• having medical conditions that affect blood supply, make skin more fragile or cause movement problems – such as diabetes, peripheral arterial disease, kidney failure, heart failure, multiple sclerosis (MS) and Parkinson's disease

Preventing pressure ulcers

It can be difficult to completely prevent pressure ulcers. There are some things you or your care team can do to reduce the risk.

These include:

• regularly changing your position – if you're unable to change position yourself, a relative or carer will need to help you
• checking your skin every day for early signs and symptoms of pressure ulcers – this will be done by your care team if you're in a hospital or care home
• having a healthy, balanced diet that contains enough protein and a good variety of vitamins and minerals, particularly vitamin C and zinc – if you're concerned about your diet or caring for someone whose diet may be poor, ask your GP or healthcare team for a referral to a dietician
• stopping smoking – smoking makes you more likely to get pressure ulcers because of the damage caused to blood circulation

If you're in a hospital or care home, your healthcare team should be aware of the risk of developing pressure ulcers.

They should:

• carry out a risk assessment
• monitor your skin
• use preventative measures, such as regular repositioning

If you're recovering from illness or surgery at home, or are caring for someone confined to bed or a wheelchair, ask your GP for an assessment of the risk of developing pressure ulcers.

• Find out more about pressure ulcers on the NHS website

More useful links

• How to use your health services