Pressure Injuries & Bed Sores: A Wound Care Guide to Stages and Treatment

A bed sore is an injury to the skin and the tissue under it, usually over a bony area such as the tailbone, hips, heels, or shoulder blades. It develops when pressure, or pressure combined with friction or shearing, reduces blood flow to the area for too long. Clinicians now commonly use the term pressure injury, and you will also see pressure ulcer or decubitus ulcer.

People who spend long periods in a bed or chair, have limited mobility, or have reduced sensation are often more at risk. Moisture, poor nutrition, certain medical conditions, and age can also affect how vulnerable skin is. A pressure ulcer on the tailbone is one of the most common locations because the area bears weight when someone lies on their back or sits.

Pressure injuries are typically described in stages, from stage 1 (intact skin that stays red) through stage 4 (deep tissue loss that may reach muscle or bone). There are also categories for injuries that cannot be staged because the base is covered, and for suspected deep tissue injury. Staging is done by a trained clinician, and pictures online can help you understand the terms but cannot confirm what a specific wound is.

Prevention has long been the foundation of pressure injury care. Approaches commonly discussed include changing position regularly, using specialized mattresses or cushions, protecting heels and bony areas, keeping skin clean and dry, and attending to nutrition and hydration. How to prevent bed sores in a particular person depends on their health, mobility, and setting, so caregivers are usually guided by a clinician.

Once an injury exists, care has traditionally focused on relieving pressure on the area, cleaning the wound, and choosing dressings suited to its depth and moisture level. Earlier-stage injuries with intact or shallow skin loss are often managed differently from deeper ones. In general terms, stage 2 pressure ulcer treatment tends to focus on protecting the shallow wound and offloading pressure, while stage 3 and stage 4 pressure ulcer treatment may involve more extensive wound assessment and care.

For deeper wounds, clinicians may remove non-viable tissue (debridement), manage infection, address nutrition, and consider advanced options. These can include negative pressure wound therapy, which is well established, and in some cases surgical closure. Skin substitutes and amniotic or placental grafts are also used in some wound settings; their FDA status varies by product (most are regulated as minimally manipulated tissue rather than FDA-approved drugs) and coverage differs by product and payer. For further reading specifically on amniotic products, see amnioticdoctors.com, which is an independent site and not affiliated with WoundKare.

The right wound care specialist may help by identifying the likely cause of the wound, determining its stage, and looking at the factors that affect healing, such as circulation, nutrition, moisture, and mobility. A visit generally includes a history, a hands-on look at the wound and surrounding skin, and a discussion of the supports and surfaces used in bed or in a chair. Only a licensed clinician can decide what is appropriate after an evaluation.

Specialists often work with a wider team, which may include nurses, physicians, surgeons, dietitians, and physical or occupational therapists. This team approach may help address both the wound and the reasons it developed. Whether any particular therapy, such as negative pressure wound therapy or a graft product, is suitable is a decision for the treating provider.

Questions worth bringing to a visit: What caused this wound and what stage is it? What are my treatment options and why? How long might healing take, and what could slow it? What signs should prompt me to call you? What will insurance cover, including any dressings, devices, or advanced products? Ask about regulatory status if a medical product is suggested.