Bedsores

WHEN TO SEE YOUR DOCTOR

* You have a red, irritated bedsore that doesn't heal after two weeks of self-care.

* The skin around a bedsore ruptures or cracks.

* Your bedsores or the areas around them show signs of infection: swelling, soreness, discharge or heat.

* You also have a fever.

What Your Symptom Is Telling You

Bedsores aren't so much a problem of skin against bed. They're a problem of bone against skin. When you lie in the same spot without moving for a long period of time, areas of the body where bone is close to skin can get red and start feeling sore. That's because the tender skin gets "squeezed" between bone and bed.

"Bedsores usually crop up in areas of the body where there is underlying bone that is fairly close to the surface of the skin," says Rebekah Wang-Cheng, M.D., associate professor of general internal medicine at the Medical College of Wisconsin in Milwaukee. "The pressure causes the skin to become irritated and inflamed."

Bedsores are actually a misnomer; they don't happen only to those who are bedridden. "People who are in wheelchairs also have problems because there is even more pressure on certain points, like the buttocks, when you're sitting up."

In its early stages, a bedsore—more accurately called a pressure ulcer or pressure sore—may look like a red patch that doesn't go away. If left untreated, these sores can grow. Eventually, the skin will crack and an open wound and infection will develop. In very severe cases, the tissue can even erode to the point of exposing bone or muscle.

Obviously, bedsores are common among the bedridden. Anyone who spends a few weeks in the hospital and even a few days in bed with the flu can develop sore, red skin. "Pressure sores can begin after just an hour of pressure on the skin," Dr. Wang-Cheng says. And they can be aggravated by anything that creates friction on the skin, such as poor hygiene, wetness from incontinence, poor blood circulation, chafing caused by efforts to move about in bed—all common problems for those who are seriously ill. Bedsores most commonly develop on the back, tailbone and buttocks. But they also can form on the knees, ankles, heels and back of the head.

Bedsores are also more common among older people, because they are usually less active and their skin is thinner and less able to withstand pressure.

Symptom Relief

The best time to treat a bedsore is before a blister forms, Dr. Wang-Cheng says. "Once there is a blister, you're in for a long wait. These sores heal very slowly," she explains. "You're going to be measuring your recovery in terms of weeks, not days."

The best thing to do is to stop them before they start. Constantly check the skin of a bedridden person for irritation. If you find bedsores developing, here's what to do.

Take a load off. Relieving pressure on the sore spot is the most important thing you can do, Dr. Wang-Cheng says. For example, move the bedridden person from side to side if the sores are on the back. If a person confined to a wheelchair is getting sores on the buttocks, get him off his bottom and into bed and on his side or stomach until the sore heals.

Keep moving. Change body positions frequently. If the person is capable of moving, be sure he shifts his weight every 15 minutes, says Dr. Wang-Cheng. If the person you're caring for is immobile, move him into a new position at least once an hour (if he's in a wheelchair) or once every two hours (if he's bedridden).

Float on air. "A lot of people try using egg crate or sheepskin mattress coverings. But those two things don't reduce the pressure on the skin enough to prevent bedsores," Dr. Wang-Cheng says. An air mattress with a bedside pump that alternately inflates and deflates the mattress is a much better way to reduce pressure on the sores. These mattresses are available at many medical supply stores.

Keep it under wraps. Clean the bedsore with saline solution. Then cover it with a transparent film bandage that seals itself around the wound and can be left in place for up to four days. "The body is producing growth factors that help heal the wound. But if you're changing that bandage every day, those growth factors are whisked off the skin before they have a chance to work," says Kevin Welch, M.D., assistant professor of dermatology at the University of Arizona Health Sciences Center in Tucson. "An airtight dressing will help keep the growth factors in contact with the wound and promote healing." These bandages, called occlusive dressings, are available at most medical supply stores.

Be gentle. "Because of the irritating effects of stool and urine on the skin, people who are incontinent and immobile are four times more likely to develop pressure sores than those who aren't," says Katherine Jeter, Ed.D., an enterostomal therapist in Spartanburg, South Carolina, and executive director of Help for Incontinent People. "These people need intensive skin care. Use products such as spray washes and moisture barriers that are specifically made for incontinence." Most of these products are available at medical supply stores.

Eat, drink and keep your skin healthy. "Malnutrition is one of the first things we look for in people who have bedsores," Dr. Jeter says. "The skin is the body's largest organ, and just like any other organ of the body, it will suffer severe damage when it doesn't get a sufficient amount of nutrients." To keep skin nourished, drink at least eight glasses of water a day and eat a balanced diet including plenty of protein. Protein is the body's repairman and is vital for maintaining healthy skin.

Take vitamin C. "Studies suggest that taking 500 milligrams of vitamin C supplements twice a day helps reduce the size of some bedsores by as much as 84 percent," Dr. Wang-Cheng says. Before taking vitamin C therapy, however, get your doctor's approval.