Table of contents
- What Are Bed Sores?
- Bed Sores Causes: Why Do Pressure Injuries Develop?
- Common High-Risk Areas for Pressure Injuries
- Early Signs and Symptoms of Bed Sores
- Bedsores Treatment: How Pressure Injuries Are Managed
- How to Prevent Bed Sores
- The Role of Pressure Care Mattress and Cushions
- Pressure Injury Prevention Equipment
- Key Takeaways
Pressure injuries commonly known as bed sores or pressure ulcers are a significant concern for individuals with limited mobility. As Occupational Therapists, we frequently work with clients who spend extended periods sitting in a chair, using a wheelchair, or lying in bed. Understanding bed sores causes, prevention strategies, and the role of assistive equipment is essential to protecting skin health and maintaining independence.
This guide explains how pressure injuries develop, who is most at risk, and the practical strategies and equipment such as Pressure Care mattress systems, cushions, and other Pressure Injury prevention equipment and assistive technology that can help reduce risk.
What Are Bed Sores?
When skin is compressed between a bony prominence and a surface such as a chair or mattress, circulation to that area decreases. Without adequate blood flow, skin cells cannot receive oxygen and nutrients. Over time, the tissue begins to break down, resulting in a pressure injury.
Pressure injuries may initially appear as:
- Red or darkened areas of skin
- Shiny or discoloured patches
- Skin that feels warm, firm, or tender
- Areas that do not return to normal colour when pressure is applied
If untreated, these areas can develop into open wounds that may become infected.
Bed Sores Causes: Why Do Pressure Injuries Develop?
Understanding bed sores causes is essential for prevention. The primary cause is prolonged pressure on the skin, especially over bony areas.
According to clinical guidance, pressure injuries occur when pressure reduces or cuts off blood flow to the skin, which damages the tissue and leads to ulcer formation.
Key Contributing Factors
- Prolonged pressure
- Sitting or lying in one position for long periods
- Being unable to reposition independently
- Reduced mobility
- Wheelchair use
- Bed rest
- Paralysis or muscle weakness
- Friction and shear
- Sliding down in a chair or bed can stretch the skin and underlying tissues.
- Moisture
- Sweat, urine, or stool can weaken the skin barrier.
- Reduced sensation
- People with nerve damage may not feel discomfort that normally prompts movement.
- Poor nutrition
- Inadequate protein and nutrients can slow skin repair.
- Underlying medical conditions
- Diabetes
- Circulatory conditions
- Heart disease
- Kidney disease
From an Occupational Therapy perspective, many of these risk factors are connected to difficulty moving, changing position without help, and managing daily self-care routines independently.
Common High-Risk Areas for Pressure Injuries
Pressure injuries typically develop where bones are close to the skin, because these areas experience the greatest compression against surfaces.
Common high-risk areas include:
- Buttocks
- Tailbone (sacrum)
- Hips
- Heels
- Ankles
- Elbows
- Back of the head
- Shoulders
For individuals who sit for long periods, the ischial tuberosities (sitting bones) and sacrum are particularly vulnerable.
When someone sits without shifting weight, these bones press the skin against the seat surface. Over time, the skin becomes “squashed” between the bone and the chair, which restricts blood flow and increases the risk of tissue damage.
Early Signs and Symptoms of Bed Sores
Early detection is critical. Pressure injuries can progress quickly if not addressed.
Common warning signs include:
- Persistent redness or discoloration
- Warm or cool skin compared to surrounding areas
- Swelling
- Pain or tenderness
- Changes in skin texture
- Blisters or open wounds
In more severe cases, infection may occur. Symptoms of infection can include fever, foul-smelling wounds, redness, swelling, or drainage.
Regular skin checks, especially over high-risk areas are an essential prevention strategy.
Bedsores Treatment: How Pressure Injuries Are Managed
Effective bedsores treatment focuses on relieving pressure, promoting wound healing, and reducing the risk of infection. Care is often provided by a multidisciplinary team, which may include doctors, nurses, Occupational Therapists, physiotherapists, dietitians, and wound care specialists, with each professional contributing to different aspects of recovery and prevention.
Key Treatment Approaches
1. Pressure relief
Reducing pressure on the affected area is the most important step. This may involve repositioning or using support surfaces.
Regular repositioning helps restore blood flow to compressed tissue and limits further skin damage. Support surfaces such as pressure-redistributing mattresses, cushions, and heel-protection devices can help spread body weight more evenly, but they work best when used together with a repositioning schedule.
2. Wound care
Depending on the stage of the wound, treatment may include:
- Cleaning the wound with saline
- Applying specialised dressings
- Maintaining a moist wound environment
Wound cleansing helps remove debris and lower the risk of infection, while dressings are selected based on the wound’s depth, drainage, and condition of the surrounding skin. A moist wound environment is commonly recommended because it supports healing and helps protect new tissue as it forms.
3. Removing damaged tissue
In some cases, clinicians may remove dead tissue through a process called debridement.
Debridement helps by clearing away necrotic tissue that can delay healing and make it harder to assess the true size and depth of the wound. Depending on the wound, this may be done using dressings, topical agents, or surgical/sharp techniques chosen by the treating clinician.
4. Pain management and infection control
Pain control is important because discomfort can limit movement, interfere with sleep, and make repositioning harder. Antibiotics are generally used when there is evidence of infection rather than for every pressure injury, and advanced wounds may need surgery such as flap closure or other reconstructive repair when conservative treatment is not enough.
Severe pressure injuries may require surgical repair.
How to Prevent Bed Sores
As an Occupational Therapist in Cas Health, when I work with clients who are at risk of pressure injuries, I always prioritise prevention first. In practice, this means building simple and realistic strategies into everyday routines, such as regular repositioning, daily skin checks, appropriate equipment, and practical habits that the person and their carers can follow consistently.
For people with mobility challenges, pressure injuries often begin with small warning signs such as lingering redness, discomfort during sitting, or spending longer in one position because moving has become harder.
Practical Prevention Strategies
| Change positions regularly | Regular repositioning helps relieve pressure before it reduces blood flow enough to damage the skin. MedlinePlus advises changing position about every 15 minutes in a wheelchair and about every 2 hours in bed, while exact timing should still be tailored to the person’s skin condition, comfort, and overall risk. |
| Shift weight frequently | For people who can complete independent pressure-relief movements, strategies such as leaning forward, shifting side to side, or briefly pushing up through the chair arms can help reduce pressure on the sitting bones and sacrum. |
| Maintain skin hygiene | Keeping skin clean and dry is important because moisture from sweat, urine, or stool can weaken the skin barrier and make breakdown more likely. NHS guidance recommends prompt skin care, continence management where needed, and avoiding prolonged exposure to damp clothing or bedding. |
| Check skin daily | Early changes in colour or texture should be monitored. |
| Eat a balanced diet | Good nutrition and hydration support skin integrity and tissue repair, which is especially important for people who are unwell, losing weight, or eating poorly |
| Stay physically active | As much safe movement as possible helps improve circulation, reduce the time spent under constant pressure, and support general health. Even small amounts of activity such as standing, short walks, bed mobility, or guided exercises, can be useful when matched to the person’s abilities. |
The Role of Pressure Care Mattress and Cushions
Support surfaces play a critical role in Pressure sore prevention products.
Pressure Care Mattress
A Pressure Care mattress is designed to redistribute body weight and reduce pressure on vulnerable areas while lying in bed.
These mattresses may use:
- Foam layers
- Air cells
- Alternating pressure systems
They are particularly helpful for individuals who spend extended periods in bed.
Pressure Cushions for Sitting
Pressure cushions are commonly prescribed by Occupational Therapists for people who sit for long periods.
These cushions:
- Create a protective layer between the body and the seat surface
- Redistribute pressure across a larger area
- Reduce pressure on bony prominences such as the ischial tuberosities
- Improve comfort during prolonged sitting
Many cushions use materials such as:
- Foam
- Gel
- Air cells
- Fluid or hybrid designs
However, it is important to remember that a cushion does not replace movement. Even with the best cushion, individuals should still perform pressure relief or stand regularly to restore blood flow to the skin.
Pressure Injury Prevention Equipment
Several types of Pressure Injury prevention equipment can support skin health and comfort.
Common examples include:
- Pressure-relieving wheelchair cushions
- Pressure Care mattress systems
- Heel protectors
- Positioning wedges and pillows
- Adjustable hospital beds
- Sheepskin overlays
Occupational Therapists assess each individual’s mobility, posture, weight distribution, and risk level to recommend the most appropriate equipment.
Different cushions and mattresses are available for low, medium, and high risk users, ensuring that support matches the individual’s needs.
Assistive Technology for Self-Care
Assistive technology plays an important role in helping individuals maintain independence while protecting their skin.
Examples include:
- Electric adjustable beds
- Tilt-in-space wheelchairs
- Standing frames
- Transfer aids
- Smart seating systems that prompt repositioning
These tools help people reposition safely, reduce prolonged pressure, and continue participating in daily activities.
From an Occupational Therapy perspective, the goal is not only pressure injury prevention, but also supporting independence, comfort, and quality of life.
Key Takeaways
From years of Occupational Therapy practice, one of the most important lessons is that pressure injuries are often preventable. When risks are identified early and simple routines are put in place. Understanding bed sores causes, noticing early skin changes, encouraging regular repositioning, and using the right support equipment such as pressure cushions, a Pressure Care mattress, and other pressure relief aids. These Assistive technology can make a real difference in protecting skin integrity, comfort, and independence for people with limited mobility.
reference:
https://my.clevelandclinic.org/health/diseases/17823-bedsores-pressure-injuries
https://www.merckmanuals.com/home/skin-disorders/pressure-sores/pressure-sores
https://familydoctor.org/condition/pressure-sores/
https://www.merckmanuals.com/home/skin-disorders/pressure-sores/pressure-sores
https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes
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