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Causes and prevention of pressure sores

Pressure sores are wounds that develop when constant pressure or friction on one area of the body damages the skin. Constant pressure on an area of skin stops blood flowing normally, so the cells die and the skin breaks down.

Other names for pressure sores are bedsores, pressure ulcers and decubitus ulcers.

Causes of pressure sores

Pressure sores happen if you can’t move around and so stay in one position for a long time. We normally move about constantly, even in our sleep. This stops pressure sores developing.

People who are unable to move around tend to put pressure on the same areas of the body for a long time. If you are ill, bedridden or in a wheelchair, you are at risk of getting pressure sores.

A number of things can increase your risk of pressure sores, including:

  • being unable to move around easily due to old age or illness
  • weight loss - you may have less padding over bony areas
  • sliding down in a bed or chair - pressure on the skin cuts off blood supply because the skin is being pulled in different directions (called shearing)
  • friction or rubbing of the skin, for example against sheets
  • a poor diet
  • lack of fluid (dehydration)
  • moist skin - for example, due to sweating or incontinence
  • other medical conditions, such as diabetes
  • having a previous pressure ulcer

Preventing pressure sores

It is much better to prevent pressure sores than to treat them. The National Institute for Health and Care Excellence (NICE), Healthcare Improvement Scotland and the European Pressure Ulcer Advisory Panel (EPUAP) have guidelines on pressure sores.

They all recommend that a member of the health care team looking after you should assess your risk of developing pressure sores and create a plan to prevent them. 

The areas of skin most at risk of getting sore depends on whether you are lying down or sitting. The following diagrams show the areas most at risk:

Diagram showing the areas of the body at risk of pressure sores when sitting
Diagram showing the areas of the body at risk of pressure sores when lying down

Tips to prevent pressure sores

The following tips can help to prevent pressure sores:

Relieving direct pressure

  • change position and keep moving as much as possible
  • stand up to relieve pressure if you can
  • ask your carer to reposition you regularly if you can't move
  • change position at least every 2 hours
  • use special pressure relieving mattresses and cushions
  • don't drag your heels or elbows when moving in your bed or chair

Skincare

  • keep your skin clean and dry
  • avoid scented soaps as they can be more drying
  • moisturise your skin thoroughly after washing
  • avoid using talcum powder as this dries the skins natural oils
  • keep your skin well moisturised

General tips

  • make sure the bedsheets are smooth and not wrinkled when you are lying in bed
  • sheets should be cotton or silk like fabric
  • eat a well balanced diet
  • have at least 2 litres of fluid a day
  • tell your doctor or nurse if you notice any skin changes or discomfort as soon as possible
Last reviewed: 
21 Feb 2019
  • Oxford textbook of palliative medicine (3rd Edition)
    D Doyle and others
    Oxford University Press
    ISBN 0 19 856698 0

  • Support surfaces for pressure ulcer prevention
    E McInnes and others.
    Cochrane Database for Systematic Reviews (2011) Issue 4, Art. No.: CD001735. DOI: 10.1002/14651858.CD001735.pub4

  • Pressure ulcers
    National Institute for Health and Care Excellence (NICE), 2015

  • Prevention and management of pressure ulcers. Best Practice Statement
    Healthcare Improvement Scotland, 2009

  • Pressure ulcers prevention and treatment
    European Pressure Ulcer Advisory Panel (EPUAP), 2014

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