Decubitus Ulcers – More Than Just a Pain in the Butt

June 28, 2023

Older adult man sitting on sofa holding side due to back pain

Mr. Clarke lived alone in his one-bedroom apartment with his dog Buster. Recently, Mr. Clarke fell, broke his pelvis, and was transferred to skilled nursing for rehabilitation. After some rigorous physical therapy, Mr. Clarke was able to return home with some support from his neighbors.

Since his return home, Mr. Clarke’s neighbors have been visiting daily to make meals, pick up the house, and take Buster for a walk. During this time, they find Mr. Clarke in his recliner watching TV. He states that he is spending most of his day in his chair and even prefers to sleep in it.

Recently, Mr. Clarke’s son Charlie came to visit. He noticed his dad was disheveled and appeared in need of a shower. Reluctantly, Mr. Clarke agreed to let Charlie help him in the shower. When Charlie was helping his father undress, he found what appeared to be a wound on his father’s tailbone. Concerned, Charlie took his father to the doctor where he was diagnosed with a decubitus ulcer.

What is a decubitus ulcer?

A decubitus ulcer is a damaged area of skin caused by pressure to that area over a period of time, sometimes as short as a few hours. Pressure to an area of skin disrupts blood flow which can cause tissue damage or tissue death. Decubitus ulcers are known by many names such as pressure ulcers, pressure sores, pressure injuries, and bed sores.

Who can get a decubitus ulcer?

Anyone can get a decubitus ulcer, but it most often affects those with decreased mobility who lie in bed or sit in a chair for longer periods of time than not or are unable to change their position without the help of another.

Pressure is not the only thing that can cause this tissue damage. Friction and shear can cause this damage as well. Clothing or bedding can rub against the skin making fragile skin more susceptible to the problem. Also, think about somebody trying to assist another person in changing their position by pushing, sliding, or pulling them. They can easily cause two surfaces to move in opposite directions which is shear. This can frequently happen between skin and the bones it covers in various locations.

Where do decubitus ulcers occur?

When you think about bony areas of the body that are in contact with a bed or a wheelchair, you will recognize the areas that are more prone to prolonged pressure. These include the back of the head, shoulder blades, hips, lower back, tailbone, heels, and ankles.

Are there other risk factors that contribute to the development of decubitus ulcers?

Decreased mobility is not the only thing that can put a person at higher risk for pressure sores. Incontinence, or lack of voluntary control over one’s bowel or bladder, can weaken the skin from prolonged exposure to moisture. People with a lack of sensory perception may not feel the pain or discomfort that normally triggers people to change position. Poor nutrition and hydration can lead to a breakdown in tissue making bed sores more possible. Some medical conditions like diabetes or vascular disease affect blood flow to tissue as well.

What can I do to prevent decubitus ulcers?

There are several tips that can help prevent decubitus ulcers from occurring in the first place. This can include:

  • Shift your weight, lift off a surface to reposition rather than scoot or slide, and use pressure-relieving cushions or mattresses.
  • For caregivers who assist others with decreased mobility, ensure a proper amount of help is available to reposition someone appropriately without shear and reposition frequently, up to every hour.
  • Use a wheelchair that reclines to allow a sitting person a change of pressure points. A wheelchair cushion can also be helpful.
  • When someone is bed bound in an adjustable bed, be aware that keeping the head of the bed elevated leads to sliding down in the bed causing shear. Reposition frequently, up to every hour. This may include putting a pillow partially under the side of the individual’s body to reduce pressure. An hour or two later, changing the pillow to the other side. A pressure relieving mattress is also helpful.
  • If an individual is using depends, change frequently to ensure the skin stays clean and dry. Apply barrier cream.
  • For those who may have extra pressure on their heels, elevate the legs to redistribute the pressure from the susceptible area.

Decubitus ulcers can take months or even years to heal. They typically heal very slowly, require extensive treatment, and can reoccur. For those with limited mobility, take the time to inspect the skin daily, especially in high-pressure areas. If you notice an area that is discolored, swollen, tender, or warm to the touch, contact your doctor right away to begin treatment.

Sarelle is an RN Care Manager with Elder Options, Inc. Sarelle’s passion in the nursing field comes from her love of people and wanting to make a difference by showing a caring attitude and listening to what they have to say.

Categories: Caregiving, Healthy Living