Many factors can influence the patient’s outcome, including the bedsores stages and any underlying health conditions. Chronic deep ulcers are among the most difficult to treat. So, bedsores are usually categorized into four stages based on the extent of the tissue involved or the depth of the ulcer.

INTRO: Pressure ulcers, also known as bedsores, pressure sores, or decubitus ulcers, are areas of damaged skin and underlying tissues, caused by prolonged pressure on the skin. This pressure leads to the cutting off of blood flow to the body parts and causes the skin to become damaged.

Bedsores can occur at many spots on the body, but they are most commonly found in the hips, back, ankles, and buttocks. This type of wound usually occurs on the skin covering bony areas as it is an open wound on the skin.

However, it is unclear why Pressure Ulcers develop, but those who are confined to a bed, chair, or wheelchair for an extended period, including those who are paralyzed or ill, old or frail, are more likely to develop the condition. Apart from such, people incapable of making small movements may also develop pressure ulcers.


Early Bedsores Stages (Stage 1 & 2)

It is possible to categorize pressure ulcers into four stages based on the extent of the tissue involved or the depth of the ulcer. Tissue layers are classified as follows:

  • Skin’s outermost layer (Epidermis)
  • Skin’s second layer (Dermis)
  • Hypodermis (the fat and connective tissue layer below the epidermis)

Stage One

In stage 1 bedsores, intact skin appears reddened but does not blanch. There is likely a warm sensation to the touch, and the skin may feel firmer or softer than the surrounding skin. Darker skin types may experience visible discoloration.

Most of the time, studies suggest that stage one pressure ulcers may be accompanied by edema (swelling of the tissues) and induration (hardening of the tissues). When pressure is not removed from the ulcer at stage one, it may progress to stage two.

stage1 of bedsores picture

Stage Two

You can identify a second-stage ulcer by removing intact skin layers with sudden pressure. This exposes the epidermis and sometimes the dermis as well. Most of the time, there is only a superficial lesion on the skin, such as an abrasion, blister, or shallow crater on the skin. The symptoms of stage two bedsores include several symptoms, including the appearance of redness and warmth, among others.

There may be a clear fluid present in the broken skin as well. For the patient to avoid progressing to stage three and want stage 2 bedsores treatment, it is necessary that their sores should be cushioned, and that their bodies should be positioned frequently so as not to cause a secondary infection.

stage2 of bedsores picture

Late Stages (stage 3 and stage 4): When to see a doctor?

Stage Three

Stage 3 bedsores occur when the lesion penetrates the dermis and extends from the dermis into the hypodermis. In this stage of the process, a small crater will be formed. In an open sore, some fat will probably be present, but no muscles, tendons, or bones will be visible. In some cases, pus may be visible, and an unpleasant odor may be present. It is essential to know that this type of ulcer puts the body at risk for infection and can result in serious complications, including osteomyelitis (infection of the bones) and sepsis (infection of the blood).

stage3 of bedsores picture

Stage Four

During stage 4 bedsores, muscle and bone beneath the hypodermis become exposed due to a breach between the fascia and the hypodermis. A pressure ulcer is one of the most severe and most difficult to treat of the several types of pressure ulcers. Severe cases are usually accompanied by copious amounts of pus and drainage, which cause damage to deep tissues, tendons, nerves, and joints.

A pressure ulcer that has reached stage four should receive aggressive treatment to prevent systemic infection and other potentially life-threatening complications. According to a study, almost 60 percent of elderly patients suffering from pressure ulcers at stage four are more likely to perish within one year.

stage4 of bedsores picture

Treatment For Bed Sores

You should change your position regularly if you are looking for a stage 1 and stage 2 bedsores treatment, use special mattresses to relieve pressure, and apply dressings to aid in the healing process. Sometimes it may be necessary to undergo surgery.

– Changing positions regularly

Pressure ulcers can be relieved by moving regularly and changing positions. This method will also prevent the development of pressure ulcers.

The following training and advice may also be provided to you –

  • Squatting and lying positions
  • Adjusting the position in which you sit and lie
  • How to relieve heel pressure by supporting your feet
  • Equipment needed and how to use it

– Using cushions and mattresses

Low-pressure mattresses are designed specifically for people with low blood pressure and can help prevent pressure ulcers. If you have a minor ulcer or are at risk for one, you should sleep on a static foam mattress or dynamic mattress.

When the ulcer is more serious, it would be better to have a better mattress or bed system that allows continuous airflow to the mattress. For example, this is a mattress connected to a pump that continuously airflows to your mattress.

A variety of foam and pressure-distribution cushions are also available for patients. Please consult with your caregiver if you are unclear about what type of care you should receive. The National Institute for Health and Care Excellence (NICE) has identified a limited number of pressure-redistributing devices as the most effective in preventing and relieving pressure ulcers.

– Dressing

It is possible to accelerate the healing process of pressure ulcers by using specially designed dressings.

Some of these include –

  • An alginate dressing – Products made from seaweed contain sodium and calcium, which are known to speed up the healing process.
  • A hydrocolloid dressing – It stimulates ulcer growth by keeping the healthy skin surrounding the ulcer dry with a gel that prevents new skin cells from forming on the ulcer surface.
  • Dressings of other types: There are also many antimicrobial products, such as dressings, foams, films, gels, and hydrofibers. The dressing your care provider uses to treat your pressure ulcer should be discussed. The use of gauze dressings as a preventative measure or as a treatment for pressure ulcers is not recommended.

– Applying creams or ointments

In general, antibiotic-containing creams, ointments, and antiseptic or antimicrobial creams are not recommended to treat pressure ulcers. It is possible, however, that incontinence may damage or irritate the skin, requiring a barrier cream.

– Antibiotics

Antibiotics may be prescribed if a patient is suffering from an infection that is serious, such as an ulcer or a bloodstream infection.

  • Sepsis (blood poisoning)
  • Bacterial infection under the skin (cellulitis)
  • Osteomyelitis (bone infection)


– Wholesome nutrition and diet

The consumption of a nutritious, balanced diet rich in proteins, vitamins, and minerals, can speed up healing. A dietitian can assist you if you have a poor diet, and you can have them prepare a dietary plan for you. Drinking plenty of fluids is not the only important thing, as dehydration can also slow down the healing process.

– Debridement (removal of damaged tissue)

Occasionally, pressure ulcers require the removal of dead tissue to promote healing. The process is called Debridement. A special dressing can be used to remove small amounts of dead tissue. You may use the following methods if you need to remove a large amount of dead tissue –

  • A high-pressure water jet
  • Sonotherapy
  • Surgery tools like scalpels and forceps
  • Local anesthetic should be applied to the ulcer area before Debridement without a dressing.

When you reposition your body on the bed, you reduce the stress on your skin, reducing the risk of bedsores. You can also prevent bed sores by eating a healthy diet and ignoring the symptoms of bed sores. Moreover, you should consult your doctor if you experience rashes, burns, or changes in the color of your skin.

Disclaimer: Content provided on this website is for information purposes only, and should not be treated as professional medical advice. In case of any health concerns, you should get in touch with a registered medical practitioner.