Stages of Pressure Ulcers

Stages I - IV of Skin Breakdown and Bed Sores

Elderly woman in a hospital bed.
Your PT can help you prevent pressure ulcers if you are on bed rest. David Sacks / Getty Images

If you are ill of have been injured, you may need to spend a significant amount of time in the hospital or on bed rest. If you are having difficulty with bed mobility due to weakness or loss of range of motion, you may benefit from physical therapy to help improve the way you can move around. One of the goals of physical therapy if you have limited strength is to keep you moving to prevent pressure ulcers, also known as decubitus ulcers.

Pressure ulcers are cause by pressure against your skin for a long period of time. This pressure causes decreased circulation and skin breakdown. Your physical therapist can work with your nursing team to help prevent pressure ulcers from forming. Methods of pressure ulcer prevention may include:

  • Frequent position changing
  • Using pressure-relieving pads over bony prominences
  • Education for nurses, doctors and family members about the importance of frequent movement to prevent skin breakdown.

Once a pressure ulcer forms, it can be difficult to treat. Understanding the different stages of pressure ulcer formation can help determine the best treatment for you.

Pressure ulcers are categorized into four stages depending on the level of tissue involvement, or depth of the sore. The tissue being referred to includes the skin and underlying dermis, fat, muscle, bone, and joint. Knowing the appropriate stage assists in the prognosis and management of the ulcer.

Stage I Pressure Ulcer

Stage one pressure ulcers are characterized by non-blanchable erythema of intact skin. The skin may appear red and feel warm to touch. In individuals with darker skin, discoloration, warmth, edema, induration, or hardness may be indicators of a stage 1 pressure ulcer formation.

Stage II Pressure Ulcers

Stage 2 pressure ulcers involve partial thickness skin loss involving epidermis, dermis, or both. The lesion is superficial and presents clinically as an abrasion, blister, or shallow center. It may be warm to touch.

Stage III Pressure Ulcers

Stage 3 decubitus ulcers are full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The sore presents clinically as a deep crater with or without undermining of adjacent tissue. The area surrounding the sore may be red and hard, and warmth may be palpated throughout.

Stage IV Pressure Ulcers

The stage 4 pressure ulcer presents as full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures. This is the most sever of pressure ulcer formation and is most difficult to treat. These ulcers require strict adherence to a pressure relieving schedule and a wound care team to fully manage the lesions.

A Word from Verywell

If you or a loved one is hospitalized and is having difficulty moving around, you need to be aware of and watch out for pressure ulcer formation. By understanding pressure ulcers and their formation, you can be sure to lookout for any problems with skin breakdown while in the hospital.