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Bedsores

Overview

Bedsores are ulcerated lesions that develop due to consistent pressure on a certain part of your body. They are also known as pressure ulcers or decubitus ulcers. They develop due to multiple factors, but the most common reason is prolonged sitting or lying down in the same position due to any kind of disability. Bedsores can be treated if they are detected at an early stage. If they become severe, it can lead to a life-threatening condition that requires treatment and care in a medical setting. 

Causes

Bedsores are caused due to limited blood supply to the skin regions, which are under constant pressure. Bedsores can occur in multiple ways. External pressure is the most common factor which occurs primarily on bony areas such as shoulder blades, hips, tailbone, heels of feet, etc. If you are lying too long in the same position or sitting for too long such as in a wheelchair, the external pressure on the affected regions can limit the blood supply. This leads to the breakdown of skin tissues and forms ulcers. 

Bedsores can also occur due to increased friction. If you already have moist or sensitive skin, rubbing against the bed or chair surface can cause skin damage. This can happen while shifting a patient from wheelchair to bed, stretcher to a hospital bed, etc. Another way you may develop bedsores is the shearing of skin. It occurs when you sit in an elevated position on a bed, and your body starts to slide down. The skin over bony regions may stick to the bed sheet or cover as the rest of your body slides. This can separate the skin from the underlying tissues due to movement in opposite directions. 

Risk Factors And Epidemiology

Several risk factors are associated with the development and progression of bedsores. Age is a major risk factor, and adults over 70 are particularly at higher risk. Bedridden patients or those on wheelchairs are also at increased risk. This may be due to systemic illnesses, extreme weakness, lack of mobility, physical disability, etc. Lack of sufficient nutrition or water intake can weaken the skin over bony regions. This can be exacerbated by moisture due to sweating, urinary incontinence, high humidity, etc. People with diabetes or other diseases that limit blood flow to certain body parts are also at risk. Those who have issues related to their central nervous system, such as spinal cord injury, brain injury, Alzheimer’s disease, etc., may also develop bedsores.  

A higher percentage of bedsores have been noticed in patients undergoing treatment in the intensive care unit (ICU). There is no gender prevalence associated with this condition. 

Signs And Symptoms

Signs and symptoms of bedsores may vary depending on their onset and severity. Mild bedsores can appear with blanched skin over high-pressure areas, small-sized ulcers or blisters, and changes in temperature and skin color of the affected region. Moderate to severe bedsores may involve the deeper skin and underlying tissues. The affected areas become painful and tender to touch. Ulcers may also be accompanied by swelling and pus discharge. Extremely severe bedsores can involve underlying muscles and bones, leading to severe complications and the risk of multiple infections. 

Diagnosis

Bedsores are diagnosed upon their clinical presentation. Diagnosis involves taking a detailed history of the patient, which requires onset, duration, and severity of symptoms, history of immobility or disability, diet and water intake, presence of another systemic illness, etc. This is followed by a clinical examination of the ulcerated lesion, and it is given a stage number depending on its severity. Routine tests such as CBC, ESR, random blood sugar, etc., may be necessary if your doctor suspects the risk of underlying disease or infection. 

Differential Diagnosis

Bedsores need to be differentiated from a few other conditions such as diabetes ulcers, ecthyma gangrenosum, pyoderma gangrenosum, venous ulcer, warfarin ulcer, etc.

Treatment

Bedsores require certain measures to limit their progression to the underlying tissues. Bedridden patients or those in wheelchairs need support and care from another person to adjust their position and change it every once in a while to relieve pressure. The use of special mattresses or pillows can also assist in distributing the pressure. Ulcerated lesions require constant care. The affected regions need to be debrided and cleaned regularly to limit the severity of symptoms. The dressings of these ulcers also need to be changed as guided by your doctor. Dietary supplements and adequate water intake are also recommended. If the patient develops an underlying infection of the skin, muscles, or bones, it needs to be treated immediately using the necessary prescribed medications. Surgical repair may be suggested in severe cases. 

Medication

An antibiotic regimen is prescribed in case of underlying infections or pus discharge. These include imipenem, meropenem, doripenem, ciprofloxacin, metronidazole, etc. Corticosteroids may also be prescribed in limited cases to relieve symptoms. 

Prognosis

Mild to moderate bedsores can be managed well with pressure distribution and other supportive care methods. Severe bedsores may take weeks or months to recover to a certain extent by utilizing proper treatment modalities. Lack of treatment can decrease the life span of an affected person. 

Prevention

Bedsores can be prevented by techniques that relieve pressure over susceptible areas. This can be done by changing positions, using special pillows or mattresses if you are bedridden, lifting yourself every once in a while if possible, using specialty wheelchairs, avoiding sleeping in an elevated position, and maintaining your skin free of moisture. Dietary intake should also be improved along with a sufficient intake of water. It is always beneficial to hire a home nurse or a caregiver if you cannot move or reposition yourself. The caregiver must inspect the pressure areas regularly and notice any visible changes in skin color, temperature or texture at an early stage to avoid further complications.