Pressure sores, also called bedsores or pressure ulcers, are wounds that form when constant pressure cuts off blood flow to the skin. They most often affect people who spend long periods in bed or in a wheelchair. Without early treatment, pressure sores can become deep, painful, and very difficult to heal. Understanding what causes them — and how to prevent them — can make a real difference in someone’s quality of life.
What Are Pressure Sores?
Pressure sores are injuries to the skin and the tissue underneath it. When one area of skin is pressed against a surface for too long, blood cannot reach that tissue. As a result, cells begin to die, and the skin breaks down into an open wound or ulcer.
These wounds appear most often in people who are bedridden or have limited mobility. However, anyone who cannot change positions regularly may be at risk. In Canada, pressure sores are a common concern in hospitals, long-term care homes, and for people recovering at home after surgery.
What Causes Pressure Sores?
The main cause is prolonged pressure on the skin, especially over bony areas where there is little padding between bone and skin. However, other factors also play a role.
Friction is another cause. This happens when skin rubs against rough surfaces like bed sheets or clothing. In addition, sliding down in a bed or chair can create skin folds that pinch blood vessels and reduce circulation.
Poor nutrition and dehydration also contribute. When the body does not get enough protein and fluids, skin becomes thinner, drier, and less elastic. This makes it much easier for pressure sores to develop and much harder for wounds to heal once they form.
Common Risk Factors
Some people are more likely to develop pressure sores than others. You or a loved one may be at higher risk if any of the following apply:
Limited mobility: People confined to a bed or wheelchair, especially after a spinal cord injury, face significant risk.
Inability to move without help: This includes people with paralysis, those in a coma, or those recovering from surgery.
Bladder or bowel incontinence: Moisture from urine or stool irritates the skin and makes it more vulnerable.
Poor diet: A diet low in protein leads to slower healing and weaker skin.
Altered consciousness: Certain medications, anaesthesia, or health conditions can reduce awareness of pain or discomfort.
Older age: As we age, skin becomes thinner and less flexible, making it harder to handle pressure evenly.
Smoking: Nicotine dries out the skin and reduces blood flow to the surface.
Fever: A higher body temperature increases stress on already vulnerable skin.
Chronic conditions: Diabetes and kidney disease can slow healing and increase the risk of complications.
Where Do Pressure Sores Develop?
Pressure sores form most often over bony areas where skin and bone are close together with little cushioning in between. About 95% of pressure sores develop in the lower body.
The most common locations include the lower back, the tailbone area (sacrum), the hips, the buttocks, and the heels. Furthermore, pressure sores can also appear on the back of the head, behind the ears, on the backs of the shoulders, the elbows, between the knees, and above the ankles.
The Four Stages of Pressure Sores
Pressure sores develop in four stages. Catching them early — at stage one or two — gives the best chance of healing without serious complications. According to the Mayo Clinic’s overview of bedsores, early intervention is key to preventing severe tissue damage.
Stage One
At this stage, the skin is not broken. However, the affected area may look red or darker than the surrounding skin, similar in appearance to a bruise. The area may feel tender, warm, or painful to the touch. Stage one pressure sores can often be reversed with prompt care.
Stage Two
In stage two, the skin breaks open and forms a shallow wound or blister. The sore is painful and sensitive. It extends into the deeper layers of skin. Some cells may already be damaged beyond repair at this point.
Stage Three
By stage three, the wound has deepened into a small crater. It reaches the tissue beneath the skin. Pain may decrease at this stage — not because healing is happening, but because extensive tissue damage has occurred. The risk of infection becomes very high.
Stage Four
This is the most severe stage. The ulcer is very deep and may extend into muscle, bone, tendons, or joints. Pain is often absent due to widespread cell death. At this stage, serious complications can develop. These include osteomyelitis (bone infection) and sepsis (a life-threatening blood infection). Healthline’s guide to pressure ulcer stages provides helpful visuals and further detail on each stage.
How Are Pressure Sores Diagnosed?
A doctor can usually diagnose pressure sores through a straightforward physical examination. In most cases, the wound’s appearance clearly indicates what stage has been reached.
However, in some situations, further tests may be needed. These can include wound or skin cultures to identify any bacteria that may be causing infection. A skin biopsy may also be recommended if the diagnosis is uncertain or if skin cancer needs to be ruled out.
Conditions That Can Look Similar
Not every wound is a pressure sore. Other conditions can cause similar-looking skin damage. These include gangrene (tissue death from infection), venous insufficiency, peripheral arterial disease, and skin cancer. A proper diagnosis from a healthcare provider is essential before starting any treatment.
Treatment Options for Pressure Sores
Treatment depends on the stage of the pressure sore. The primary goals are to relieve pressure, keep the wound clean, remove damaged tissue, and prevent or treat infection.
General Treatment Approaches
Relieving pressure is the most important first step. This means changing the person’s position frequently — at least every two hours if bedridden. Special mattresses, foam cushions, and positioning aids can help distribute weight more evenly and reduce stress on vulnerable skin.
Daily cleaning of the wound with a saline (salt water) solution helps keep infection at bay. The healthy skin around the sore should be kept clean and dry. Damaged or dead tissue must be carefully removed to help the wound heal. Medicated creams and ointments can reduce the risk of infection and support recovery.
For wounds that are slow to heal, additional therapies may be used. These include ultraviolet light therapy and ultrasound therapy, both of which can encourage tissue repair.
When Infection Occurs
If a pressure sore becomes infected, antibiotic treatment will be necessary. Your doctor or nurse practitioner will determine the right antibiotic based on the type of bacteria present. It is important to complete the full course of antibiotics as directed.
Surgical Treatment
Severe pressure sores — particularly those at stage three or four — may require surgery. Surgical options can include cleaning out the wound, removing dead tissue, and sometimes using skin or muscle flaps to cover large areas of damage. Many people with advanced pressure sores also have other health conditions, such as diabetes, kidney disease, or heart disease, which can affect healing and must be managed at the same time.
According to Health Canada, wound care and pressure injury prevention are important parts of quality care for older adults and people with chronic illness across Canadian provinces and territories.
Preventing Pressure Sores
Prevention is always better than treatment. For caregivers and patients alike, a few consistent habits can stop pressure sores from ever forming.
Reposition regularly: Change the person’s position at least every two hours in bed, or every hour in a wheelchair.
Use support surfaces: Pressure-relieving mattresses and cushions are widely available and make a significant difference.
Maintain good nutrition: A diet rich in protein, vitamins, and fibre supports skin health and wound healing.
Stay hydrated: Proper fluid intake keeps skin supple and resilient.
Keep skin clean and dry: Address incontinence promptly and use barrier creams where needed.
Inspect the skin daily: Check bony areas regularly for early signs of redness or skin changes.
Avoid smoking: Quitting smoking improves blood flow to the skin and reduces risk significantly.
When to See a Doctor
If you notice any redness, skin discolouration, or soreness on a bony area — especially in someone with limited mobility — do not wait. Contact your family doctor or visit a walk-in clinic as soon as possible. Early-stage pressure sores can often be treated at home with proper guidance. However, deeper wounds or signs of infection require prompt medical attention.
If the person has a fever, the wound has an unpleasant smell, or you notice pus or increased redness spreading around the wound, seek care right away. In Canada, you can also call your provincial health line (such as 811 in most provinces) for guidance on next steps. Your family doctor can refer you to a wound care specialist or a home care programme if needed.
As always, speak with your healthcare provider before starting any new treatment plan. Every person’s situation is different, and a professional assessment ensures the safest and most effective care.
Frequently Asked Questions About Pressure Sores
How long does it take for pressure sores to heal?
Healing time depends on the stage of the pressure sore. Stage one and two pressure sores can heal within days to a few weeks with proper care. However, stage three and four wounds may take months or may never fully heal without surgical intervention.
Can pressure sores be life-threatening?
Yes, advanced pressure sores can become life-threatening. If a pressure sore becomes severely infected, it can lead to sepsis — a dangerous infection of the blood — or osteomyelitis, which is a serious bone infection. These complications require urgent hospital care.
What is the best way to prevent pressure sores at home?
The most effective way to prevent pressure sores at home is to reposition the person regularly — at least every two hours. Using a pressure-relieving mattress, maintaining good nutrition, keeping skin clean and dry, and checking the skin daily for early warning signs are all essential steps.
Are pressure sores covered under provincial health plans in Canada?
Treatment for pressure sores, including wound care and doctor visits, is generally covered under provincial health plans across Canada. However, specialised equipment like pressure-relief mattresses may require prior approval or private coverage. Contact your provincial health authority or family doctor for details specific to your province.
Who is most at risk of developing pressure sores?
Older adults, people with limited mobility, and those who are bedridden or use a wheelchair are most at risk of developing pressure sores. People with diabetes, poor nutrition, incontinence, or altered consciousness also face a higher risk. Regular skin checks are especially important for these groups.
What does a stage one pressure sore look like?
A stage one pressure sore looks like a patch of reddened or discoloured skin that does not fade when you press on it. The area may feel warm, tender, or slightly swollen. At this early stage, the skin is still intact, and prompt treatment can often prevent the wound from getting worse.
Key Takeaways
Pressure sores form when prolonged pressure cuts off blood supply to the skin, causing tissue damage and open wounds.
They most commonly affect people who are bedridden, use a wheelchair, or have limited mobility.
There are four stages of pressure sores — from mild redness to deep wounds involving muscle and bone.
Early detection is critical. Stage one and two sores are far easier to treat than advanced wounds.
Treatment focuses on relieving pressure, keeping wounds clean, removing dead tissue, and preventing infection.
Prevention through regular repositioning, good nutrition, hydration, and daily skin checks is the most effective strategy.
If you notice early signs of a pressure sore, contact your family doctor or a walk-in clinic promptly. Your provincial health line (811) can also offer guidance.
Always consult a healthcare professional for a proper diagnosis and personalised care plan.
