Hesperian Health Guides

Pressure sores

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HealthWiki > A Health Handbook for Women with Disabilities > Chapter 5: Taking care of your body > Pressure sores


Pressure sores are especially common for women who use wheelchairs or lie in bed and do not move their bodies regularly. Pressure sores start when the skin over the bony parts of the body is pressed against a chair or bed. The blood vessels get squeezed shut, so that not enough blood can get to the skin. Eventually, a dark or red patch will appear on the skin. If the pressure continues, an open sore can develop and work its way deeper into the body. Or the sore can start inside the body, near the bone, and gradually grow toward the surface. If a pressure sore is not treated, the infection can spread through the body and kill the person.

Because her bones are less cushioned, a very thin woman is more likely to get pressure sores. You are also more likely to get a pressure sore if:
  • you use a wheelchair, or sit or lie in bed most of the time.
  • you have urine leaking (incontinence).
  • you get muscle spasms that cause your body to rub against sheets or clothes.
Signs
  • hot, red, or dark skin that does not get lighter in color when you press it
  • a swelling or an open wound on the skin


When you notice the first signs of a pressure sore

  • change your position at least once an hour.
  • use extra padding to protect the area from pressure.
  • keep watching the area to see if it gets better or worse.
a woman using a mirror to look at her back.
Examine your skin every day.

If you have a pressure sore:

  • Keep all pressure off the sore area. Do not sit or lie on the sore at any time.
  • Gently wash the sore and the surrounding skin twice a day, with clean or boiled and cooled water. Wash around the edge of the sore first. Then use a new piece of clean cloth or gauze to wash from the center out to the edges.
  • After cleaning, spread some ointment on a clean cloth or piece of gauze, and cover the sore lightly. You can use any mild ointment, such as antibiotic cream or petroleum jelly (Vaseline). This will prevent the skin from becoming dry and will also protect the sore from dust, dirt, flies and other insects.
  • Be careful not to rub or massage the skin around the pressure sore. This can weaken the skin or tear it and make the sore worse.
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open
sore
Dead flesh may be gray, black, greenish, or yellowish and may have a bad smell if infected.

If the sore is deep and has a lot of dead flesh:

  • The sore needs to be cleaned 3 times a day.
  • The sore is often bigger than it looks. It can go deep under the edges of the skin. When the sore is cleaned, be careful to take out more of the dead flesh. Little by little, the dead flesh must be removed until the healthy red flesh or bone is visible.
  • Wash the sore with soap and water every time dead flesh is cleaned away. Use liquid surgical soap if it is available. Afterward, rinse the sore with clean or boiled
    and cooled water.

If a pressure sore gets infected

If the pressure sore has a bad smell and is swollen, red, and hot, or if you have fevers and chills, the sore has become infected. It is best to go to a health worker who can find out what germs are causing the infection and what medicine will work best. If that is not possible, you can use an antibiotic, such as doxycycline, erythromycin, or dicloxacillin.
  • Pressure sores heal from the inside out, so you will notice the sore gradually start to fill in. This will not happen quickly, so try to be patient.
  • If necessary, take paracetamol for pain.

If you have lost feeling in part of your body, it is important for you, and your family and caregivers, to learn as much as possible about pressure sores and how to treat and prevent them. Pressure sores are very common in persons with spinal cord injury. Often the sores start in hospitals shortly after the injury, because the injured person does not get moved enough from one position to another to relieve pressure. With proper attention, no one should get pressure sores.

Preventing pressure sores

Even if you cannot make big movements, try to move or shift your weight at least every 2 hours. If you lie down all the time, have someone help you change position if you cannot easily move yourself.

Try putting a pillow or soft blanket roll where your skin rubs together, such as between your knees or between your head and your arms. You can also lie or sit on something soft that reduces pressure on bony areas. A cushion or sleeping pad that has hollowed-out areas around the bony parts will help. You can make a simple cushion or sleeping pad from a plastic bag filled with uncooked beans or rice. It must be refilled with new rice or beans once a month. If you use a wheelchair, try to make sure you always sit on a good cushion.

a woman lying on her side with dark patches on her back.

Examine your whole body carefully every day. You can use a mirror to look at your back. If you notice a dark or red place, try to avoid any pressure on this area until your skin returns to normal.

Try to wash every day with mild soap and clean water. Pat your skin dry, but do not rub it. To prevent dry skin, which can crack and tear more easily, gently apply a little lotion once a day. Never use alcohol on your skin. Alcohol can dry out the skin and make it weak.

Eat plenty of fruits, vegetables, and foods rich in protein and iron—such as lentils, beans, peas (especially when they are sprouted), meat (especially liver, heart, and kidney), fish, or chicken. This will make your skin and muscles healthy and strong, which will help to prevent pressure sores.