Bedsore (decubitus ulcer)

Bedsores are open wounds that can be very painful. They form when continuous pressure is applied to the skin. They typically heal slowly. People who are very weak, paralyzed, or unconscious, often lie or sit, immobile, in one position for a long time. This increases the risk of bedsores (decubitus ulcers).

Bedsores (decubitus ulcers) almost always form in places where bones are located directly under the skin, for example on the tail bone, heels, hips, elbows, and shoulder blades, as well as the back of the head.

If the weight of the body places continuous pressure on the skin in these places when lying or sitting, they no longer receive sufficient blood supply, oxygen, and nutrients. Over time, this causes the skin to become thinner and it can even die. The bedsores that result are particularly painful if the affected person continues to lie or sit on the areas.

Healthy people quickly feel if the pressure on a part of the body is too great. However, an impaired perception of pain and some illnesses can promote the formation of bedsores.

• People with paralysis in the affected areas often no longer feel pressure and pain.
• People who have had diabetes mellitus for many years may have limited perception of pain. They do not notice if an area is under pressure for too long.
• When a circulatory disorder is present, areas of skin where pressure is applied receive a poor supply of oxygen and nutrients, for example in people with constricted blood vessels (atherosclerosis).
• If bedridden people do not eat enough, malnutrition is also a risk factor.
• The vulnerable body parts can be further affected by friction and shearing forces. This occurs, for example, if bedridden people are pulled across the underlay when repositioned.
• Incontinence: if the skin comes in contact with urine, feces, or sweat for hours, skin damage and irritation can occur more easily.

A recurrent bedsore is more likely to form on people who already have had a bedsore. Therefore, it is important to prevent bedsores to the greatest extent possible.

Those who must lie or sit still for longer periods of time should relieve vulnerable body parts regularly by repositioning or rotating the body; this is true even if mobility is restricted for only a few days. Moreover, sitting on reclining surfaces can also protect the skin from bedsores, for example, a special mattress or a sheepskin lining.

So that action can be taken quickly, vulnerable body parts should be checked regularly for the first signs of pressure. When caring for and positioning people with risk of decubitus ulcers, it is important to avoid friction and shearing forces. For example, affected parts of the body should not be pulled across the underlay when relocating. Moisturizing can be helpful if the skin is dry. In the case of incontinence, diapers or liners must be changed in a timely manner.

Dehydration can weaken the skin just as malnutrition and undernourishment can. Therefore, it is important to ensure sufficient fluid intake and balanced diet.

More information about bedsores and how they can be prevented can be found at gesundheitsinformation.de.

For some people it is possible to check themselves for the first signs of a bedsore in places where the body is vulnerable. A mirror can be helpful for this. Those who can hardly move or are completely immobile for a longer period of time often know the warning signals. If strength is greatly limited and movement is severely restricted, assistance may be necessary to observe the vulnerable body parts. Furthermore, the formation of pressure points typically appears on the backside of the body, for example on the buttocks and heels.

Choosing a suitable treatment depends on the type and severity of the bedsore. The objective of the treatment is to prevent putting further pressure on the bedsore. Regular repositioning and movement, positioning aids and a special mattresses help to relieve the affected body parts.

A local anesthetic and dressings with ibuprofen can be used for pain when treating wounds. Medication such as acetaminophen (paracetamol) or ibuprofen can also help with mild to moderate pain. If these medications are ineffective, the doctor can also prescribe stronger pain medication.

As much independent movement as possible can help to prevent bedsores. Caregivers can support and encourage people with bedsores to move as best they can. Conspicuous areas of the skin must be relieved as soon as possible and shown to the doctor or nurse.

Bedsores can be very burdensome because of both pain and possible feelings of shame. Therefore, people with decubitus ulcers need good support – both from a medical and personal perspective.

Family members can learn about various movement and positioning techniques. In many cases, health insurance providers and long-term care insurance funds will assume the costs for many aids. They can also provide special nursing beds. Furthermore, many cities have nursing care offices that can answer questions about decubitus ulcer prevention.