Bedsore Stages: How Can You Spot and Prevent Them at Home?

What is a bedsore?

A bedsore, also called a pressure ulcer or pressure sore, is damage to the skin and the tissue beneath it caused by constant pressure, usually over a bony part of the body. Pressure squeezes the small blood vessels, so the tissue is starved of oxygen. Sliding down in bed or being dragged across sheets adds friction and shear, which makes damage more likely.

People most at risk are those who cannot change position on their own: after a stroke, spinal injury or major surgery, during long illness, in older age, or with diabetes, poor nutrition, incontinence or reduced feeling in the skin.

Where do bedsores form?

Check these areas every day:

• lower back and tailbone (sacrum);
• hips;
• heels and ankles;
• shoulder blades and spine;
• back of the head and ears;
• elbows;
• under medical devices such as tubes, splints or oxygen masks.

Bedsore stages explained

Stage	What you see	What it means
Stage 1	Red patch that does not fade when pressed; in darker skin, a purple, blue or darker area; may feel warm, firm or painful	Skin intact but damaged; heals if pressure is removed now
Stage 2	Shallow open sore or blister	Partial loss of skin
Stage 3	Deeper wound into the fat layer	Full skin loss; heals slowly
Stage 4	Very deep wound showing muscle, tendon or bone	Serious; high risk of bone infection
Unstageable	Base covered by yellow or black dead tissue	Depth hidden until cleaned
Deep tissue injury	Purple or maroon area or blood blister	Deeper damage that may open up

How can you prevent bedsores at home?

1. Change position regularly, day and night, using a schedule agreed with the nurse or doctor. Alternate between back and sides at an angle.
2. Use a pressure-relieving mattress or cushion, such as an air mattress, for anyone bedbound or in a wheelchair for long periods.
3. Float the heels with a pillow under the calves so the heels do not touch the bed.
4. Lift, do not drag, when moving the person; use a draw sheet.
5. Keep the skin clean and dry; change wet pads promptly and use a barrier cream for incontinence.
6. Support nutrition and fluids, with enough protein, as advised.
7. Check the skin daily, especially over bony areas, and act on any redness.
8. Do not massage red areas; relieve the pressure instead.

How are bedsores treated?

Stage	Usual treatment
1 and 2	Relieve pressure, protect the skin, suitable dressings, treat moisture
3 and 4	All of the above, plus removal of dead tissue, treating infection, specialist dressings, sometimes negative pressure wound therapy
Large clean deep sores	Surgical closure with a flap of nearby tissue in suitable patients

Surgery works only when the cause is controlled: pressure relief, nutrition, blood sugar and continence care must be in place, or the sore tends to return. Plastic surgeons also treat other slow-healing wounds; see chronic wound treatment and skin grafting surgery.

Myths about bedsores

• “Bedsores are a sign of neglect.” They can develop despite good care in very unwell people, though most are preventable.
• “Massage improves blood flow to red skin.” It can cause further damage.
• “A ring cushion helps.” Ring or donut cushions concentrate pressure around the edge and are not recommended.
• “A small sore on the surface is small underneath.” Deep damage can be much larger than the opening.

When should you see a doctor?

See a doctor or nurse for any open sore, any red area that does not fade within a day after pressure is removed, a dark or blistered area, a bad smell, pus, spreading redness, or fever. People with diabetes or poor circulation should have foot sores checked early; read about the diabetic foot.

What to ask

• What stage is this sore, and how deep is it?
• How often should we turn the patient, and which mattress is suitable?
• Is infection present, and does dead tissue need removing?
• Is surgery an option, and what must be in place first?

For assessment, dressings and surgical options, see bedsore treatment.