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 almost always form 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, in some cases, even to die. The resultant bedsores 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 and not notice if an area is under pressure for too long.
• In the event of circulatory disorders, the oxygen and nutrient supply to the areas of skin under pressure are even worse. This is the case for people with constricted blood vessels (atherosclerosis), for instance.
• Malnutrition is a risk factor for people who are bedridden.
• 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 into contact with urine, feces or sweat for hours, it can be damaged and irritated more easily.

Once people have had a bedsore, they are more likely to develop another one in the same place. It is therefore important to prevent bedsores to the greatest possible extent.

People who have to lie or sit still for longer periods of time should regularly relieve the pressure on vulnerable body parts by repositioning or rotating the body, even if mobility is restricted for only a few days.

Pressure-relieving surfaces for sitting or lying on can also offer protection, for example a special mattress or cushion.

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 a heightened risk of bedsores, it is important to avoid friction and shearing forces. For example, they should not be pulled across the underlay when repositioned.

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 detailed information on preventing bedsores 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, pressure points most commonly form on the back of the body, for example on the buttocks and heels.

Choosing a suitable treatment depends on the type and severity of the bedsore.

It is particularly important to avoid further pressure on the bedsore. Regular repositioning and movement, positioning aids and a special mattresses help to relieve the affected body parts.

There are many different wound dressings for bedsores. These should cover the wound, keep it moist and protect it from infection. The wound can be cleaned when the dressings are changed. If a deep wound has formed, dead tissue is also removed using debridement.

Local anesthetics, dressings with ibuprofen and correct positioning can be used to prevent pain when treating wounds.

Medication such as acetaminophen (paracetamol) or ibuprofen can also help with mild to moderate pain. If these medications are not effective enough, a doctor can also prescribe stronger pain medication.

Further information about treating bedsores can be found at gesundheitsinformation.de.

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 of many medical aids. They can also provide special nursing beds.

Many cities have nursing care offices that can answer questions about the prevention of bedsores.