Early symptoms of bedsores

The early symptoms of bedsores (pressure ulcers) fall within the first stage of this condition, as defined by the National Pressure Ulcer Advisory Panel. As the condition progresses through each of the four stages, so do the symptoms.

Bedsores symptoms



I (early)

·         The skin is not broken.

·         Skin redness in people with lighter skin color.

·         Skin discoloration in people with darker skin.

·         The skin does not briefly blanch when touched.

·         The site may be tender, itchy, painful, spongy, firm, soft, warm, or cool when compared with the skin around it.


·         Damage or loss of the outer layer of the skin.

·         Injured skin blisters or develops an open sore or abrasion.

·         Wound may be shallow and pinkish or red.

·         Wound may appear like a fluid-filled or ruptured blister.

·         There may be a surrounding area of red or purple discoloration, mild swelling and some oozing.


·         The sore becomes a crater-like deep wound.

·         Loss of skin exposes some fat.

·         There may be some yellowish, dead tissue at the bottom of the wound.

·         Damage may reach beyond the primary wound below healthy layers of skin.


·         Large-scale tissue loss.

·         Muscle, bones, or tendons may be exposed through the wound.

·         Tissue necrosis at the bottom of the wound.

·         Damage often extends beyond the primary wound below healthy skin layers.


Additionally, a bedsore is deemed unstageable if yellow, brown, black or dead tissue covers the surface, not allowing to see how deep the wound is. Pressure ulcers occur when the skin is subjected to pressure, friction, humidity, temperature, continence, medication, and shearing. All of these causes are commonly experienced by people who are bedridden or wheelchair-bound because of poor health or weakness, paralysis, injury, recovery following surgery, sedation, or coma. The location of bedsores is directly related to the position in which the person spends most of his or her time.

Common sites of bedsores


On the back

·         Back of the head.

·         Shoulder.

·         Elbow.

·         Tailbone.

·         Heel.

On the side

·         Ear.

·         Shoulder.

·         Hip.

·         Knee.

·         Ankle.



·         Shoulder blade.

·         Spine.

·         Back of the arms.

·         Back of the legs.

·         Buttocks.

·         Heels.

·         Ball of the foot.



In addition to being confined to a wheelchair or bed, other risk factors include the following:

·         Old age.

·         Loss of sensory perception.

·         Decreased movement.

·         Loss of weight.

·         Poor nutrition.

·         Dehydration.

·         Wetness from perspiration, urine or feces.

·         Bladder and/or bowel incontinence.

·         Conditions that cause poor circulation.

·         Smoking.

·         Limited alertness.

·         Muscle spasms.

·         Residing in a nursing home.

If treated when the early symptoms of bedsores first appear, pressure ulcers easy to treat. Conversely, latter-stage bedsores are not only more difficult to manage but also more dangerous. Bacteria can enter the bloodstream through broken skin, potentially causing an infection that can in turn to the rest of the body (sepsis) including bones and joints. Realistically speaking, an untreated bedsore could be deadly to the patient. Other complications are cellulitis and cancer.

Treatment for bedsores

Medical care team

·         Primary care physician.

·         Wound care specialist.

·         Nurse.

·         Social worker.

·         Physical therapist.

·         Dietitian.

·         Neurosurgeon.

Reducing pressure

·         Repositioning* at least every 2 hours.

·         Wheelchair cushions.

Wound care

·         Cleaning.

·         Dressings.

Removal of damaged tissue

·         Surgical debridement.

·         Mechanical debridement.

·         Autolytic debridement.

·         Enzymatic debridement.


·         Pain management.

·         Antibiotics.

·         Healthy diet.

·         Simple exercises.

·         Incontinence management.

·         Relief of muscle spasms.

·         Negative pressure therapy.

·         Hydrotherapy.

·         Maggot therapy.


·         Inspecting skin daily.

·         Cleaning affected skin.

·         Protecting skin.

·         Reducing shear and friction.


Related: Positioning and Seating with Wheelchair Cushions