Early Signs of a Pressure Sore

A pressure sore, also known as a bed sore or pressure ulcer, is an area of skin that breaks down due to constant pressure and friction. This breakdown can expose the underlying tissues, including bone.

Pressure sores are common in people who can't get out of bed or who use a wheelchair full time. According to research, they may affect as many as 55% of elderly people with a hip fracture and nearly a quarter of quadriplegics.

If a sore develops, it can be extremely difficult to treat and may require debridement (the removal of dead tissue) and surgery to repair the damage.

Pressure sores need to be spotted early, before the skin ruptures (which is also known as a stage 2 ulceration). By acting fast, you can preserve the skin while preventing complications that, in some people, may become life-threatening.

When checking for signs of a developing pressure sore, pay attention to the bony parts of the body where tissues are most likely to be stressed. These include:

• Hip bone
• Ischium (the curved bone forming the base of each half of the pelvis)
• Sacrum (tailbone)
• Heel
• Scalp

Compare the flesh in the bony areas to the surrounding skin, and look for changes in the skin color. Among some of the visual clues, the skin of the affected area:

• May appear reddened
• May not turn white (blanch) when pressed
• May be bruised or have a bluish or purplish hue

Temperature changes may also indicate the early development of a pressure sore. Compared to the skin around the sore, an early pressure ulcer may feel either abnormally warm or abnormally cool to the touch.

Changes in sensation may also accompany the other symptoms. Take note if your loved one complains about pain, tingling, or itching on any part of the body, even if it's minor.

If you notice any of these early warning signs, alert your healthcare provider immediately. If caught early, there are steps you can take to avert a sore before it develops. Among them:

• Turn your loved one every couple of hours. Doing so alleviates the pressure and friction while restoring circulation to the areas of developing damage. In some cases, you will need pillows or bolsters to keep the person comfortably in place. However, don't wake your loved one in the middle of the night to do so. Rest is important, so wait until he or she is fully awake.
• Keep the skin dry and clean. The drier the skin is, the less likely it will become boggy and vulnerable to damage. By keeping the skin clean, bacteria are less likely to infiltrate compromised skin. Use a mild soap and soft cloth to wash the skin, ensuring that you don't miss the hard-to-reach spots (such as under the breasts, in the groin, or between the buttocks). To avoid irritation, pat the skin rather than rubbing it dry.
• Cushion the body with pillows. To reduce moisture and abrasion, place pillows between parts of the body that press against each other. If lying on the back, place pillows under the tailbone, shoulders, heels, and elbows. (Do not place pillows under the knees as it places pressure on the heels). If you are lying on the side, use pillows to separate the knees and ankles.
• Treat the skin gently. Use moisturizing creams and skin protectants every day to keep the skin supple and prevent flaking or cracking. Avoid talc powders that can be harsh and daily showers or baths that can dry the skin. Ensure the skin is fully clean after a bowel movement or urination, using a squirt bottle to wash the anus, penis, or vagina if needed.
• Dress your loved one in soft clothes. Avoid clothes that are tight or have thick seams, buttons, or zippers that press against the skin. Make sure the clothes don't bunch up or wrinkle on parts of the body where any pressure is placed on the skin.

You can buy a number of tools that help prevent pressure sores. These include egg-crate mattresses or chair pads that distribute pressure more evenly on the skin. 

Fluidized air mattresses can also reduce the risk of pressure sores. These specialized mattresses are filled with glass beads that liquefy when the air is pumped into them. Although effective, the mattresses are typically reserved for bed-bound patients since moving people in and out of them can be difficult.

There are other types of cushions that work to varying degrees. These include:

• Gel pads
• Natural sheepskin
• Memory foam
• Air cell foam
• Alternating pressure pads that use an electronic air pump to constantly redistribute pressure on a mattress or cushion

Talk to an orthopedic specialist to determine the best option for your loved one.

If you're still not sure how to spot the early signs that a pressure sore or prevent one from forming, don't hesitate to consult a healthcare professional. They often have pamphlets, illustrations, or other materials that can help you to better identify them before they become a problem.