Pressure ulcers: Causes, Stages, Risk factors and Management

Pressure ulcers: Causes, Stages, Risk factors and Management
Pressure ulcers: Causes, Stages, Risk factors and Management

let’s talk about something called pressure ulcers, also known as bedsores. They’re quite common, especially in person who can’t move around much.

So, what exactly are pressure ulcers? Well, they’re like little sores that happen when you’re stuck in one position for too long. You know how sometimes your skin gets all red and sore if you sit or lie down in the same spot for ages? That’s a pressure ulcer.

These sores usually pop up over bony areas like your tailbone, heels, hips, or elbows. When you stay in one position, it squishes those areas and cuts off the blood flow. And when your skin doesn’t get enough blood, it starts to get damaged, which can lead to ulcers.

Now, there are a few things that can make pressure ulcers more likely to happen. Stuff like not moving around much, poor blood flow, not eating well or drinking enough, and even things like friction from rubbing against surfaces or being too wet can all play a part.

So, in a nutshell, pressure ulcers are like little wounds that happen when your skin gets squished for too long. They can be pretty uncomfortable and annoying, but the good news is, there are things we can do to help prevent them and treat them if they do pop up.

Causes and Risk Factors of Pressure Ulcers:

  • Immobility or limited mobility: Being unable to change positions frequently can lead to pressure ulcers.
  • Poor circulation: Reduced blood flow to certain areas of the body can increase the risk of developing pressure ulcers.
  • Malnutrition: Not getting enough nutrients can weaken the skin and make it more prone to damage.
  • Dehydration: Lack of adequate hydration can affect skin elasticity and increase susceptibility to pressure ulcers.
  • Advanced age: Older adults may have thinner skin and reduced mobility, making them more susceptible to pressure ulcers.
  • Certain medical conditions: Conditions such as diabetes and paralysis can impair sensation or mobility, increasing the risk of pressure ulcers.
  • Prolonged bed rest or wheelchair use: Spending extended periods in one position without relief can lead to pressure ulcers due to constant pressure on the skin.

Symptoms of Pressure Ulcers:

  • Early signs: Redness, warmth, or discoloration of the skin over bony prominences may indicate the onset of a pressure ulcer.
  • Progression: As the ulcer advances, it may develop into an open wound with exposed tissue, resembling a shallow crater.
  • Other symptoms: Pain, itching, swelling, and foul odor may accompany pressure ulcers, especially in more advanced stages.

Stages of Pressure Ulcers:

Pressure ulcers Stages
  • Stage 1:
    • In this stage, the skin is intact but may appear red, pink, or discolored.
    • The affected area may feel warm or firm to the touch.
    • The skin may not blanch (turn white) when pressed.
    • This stage indicates early tissue damage and increased risk of ulceration if not addressed.
  • Stage 2:
    • In this stage, the skin is partially lost or damaged, forming a shallow open wound.
    • The ulcer may present as an abrasion, blister, or shallow crater.
    • The underlying tissue may be red or pink and may appear moist.
    • This stage indicates partial thickness skin loss and requires careful wound care to prevent progression.
  • Stage 3:
    • In this stage, the ulcer extends into the deeper layers of tissue, such as the dermis and subcutaneous fat.
    • The wound may appear as a deep crater with visible tissue loss.
    • The ulcer may involve undermining (tissue destruction beneath intact skin) or tunneling (narrow channels extending from the wound).
    • This stage requires comprehensive wound management and may involve surgical intervention.
  • Stage 4:
    • In this stage, the ulcer extends through all layers of the skin and into underlying muscle, bone, or supporting structures.
    • The wound may present as a deep crater with extensive tissue loss and exposed muscle, tendon, or bone.
    • The ulcer may be associated with significant undermining or tunneling.
    • This stage represents full-thickness tissue loss and poses a high risk of complications, including infection and osteomyelitis (bone infection).

Physiotherapy management of pressure ulcers


  • Change positions regularly to avoid putting too much pressure on one spot.
  • Use pillows or special cushions to support bony areas like heels and tailbone.
  • If lying down, switch sides or sit up for a while to give pressure points a break.

Range of Motion Exercises:

  • Do simple exercises to keep joints moving and prevent stiffness.
  • Move ankles, knees, and shoulders gently to improve circulation and flexibility.
  • Even if you can’t move much, doing these exercises regularly can help.

Pressure Relief Techniques:

  • Shift your weight often if sitting or lying down for a long time.
  • Lean forward slightly or use cushions to reduce pressure on bony areas.
  • Caregivers can help by learning these techniques and reminding you to change positions.

Education and Training:

  • Learn how to take care of your skin and prevent pressure ulcers.
  • Know the signs of pressure ulcers, like changes in skin color or feeling.
  • Eat well, drink enough water, and keep your skin clean and dry to stay healthy.

Collaborative Care:

  • Work with your healthcare team, including physiotherapists, nurses, and doctors.
  • They’ll create a plan tailored to your needs and help you stay on track.
  • By working together, you can get the best care possible and prevent future problems.

Remember, taking care of your skin and staying active with physiotherapy exercises can make a big difference in preventing and managing pressure ulcers. Working with your healthcare team and staying informed is key to staying healthy and comfortable.

Pressure ulcers: Causes, Stages, Risk factors and Management

So the conclusion is:

Physiotherapy is crucial in the overall care of individuals with pressure ulcers, working alongside other healthcare professionals to address prevention, treatment, and rehabilitation. By focusing on factors like positioning, exercise, pressure relief, and education, physiotherapists play a significant role in improving outcomes and enhancing the quality of life for those affected by pressure ulcers. Early intervention and a comprehensive approach are key to preventing pressure ulcers and maintaining healthy skin function. Working together with healthcare teams and staying proactive can make a big difference in managing pressure ulcers effectively.



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