What it is
A bed sore, also called a pressure ulcer or pressure injury, is damage to the skin and sometimes the tissue beneath it. It usually develops when pressure, or pressure combined with friction or shear, reduces blood flow to an area for a long time. Common spots are bony areas such as the tailbone, hips, heels and elbows.
Clinicians commonly describe pressure injuries in stages. Stage 1 is usually described as intact skin with a patch of redness that does not fade when pressed, and it may feel warmer, cooler, firmer or tender. Stage 2 involves partial loss of skin thickness and may look like a shallow open area or a blister. Stage 3 involves deeper loss of skin, where fatty tissue may be visible. Stage 4 is the deepest, where muscle, tendon, ligament or bone may be exposed.
Some wounds are described as unstageable, meaning the base is covered by dead tissue so the depth cannot be seen, or as deep tissue injury, which can look like a purple or maroon area of discolored but intact skin. Skin tone can change how redness and discoloration look, so photos online may not match what you see. This is one reason pictures alone are not a reliable way to judge a wound.
How it’s traditionally been approached
Traditionally, pressure injuries have been approached through prevention and careful assessment. Caregivers and nurses often check at-risk skin regularly, and staging systems give clinicians a shared language for describing depth and severity.
Care has commonly focused on relieving pressure on the area, using special mattresses or cushions, changing position, keeping skin clean and protected, and supporting nutrition and hydration. Wound dressings are chosen by clinicians based on the wound's appearance, drainage and location.
For deeper or slower-healing wounds, clinicians have also used approaches such as removing dead tissue (debridement), negative pressure wound therapy, and sometimes surgical care. Which of these is appropriate depends entirely on an individual evaluation by a licensed clinician.
How the right wound care specialist may help
The right wound care specialist may help by examining the wound in person, identifying the likely cause, and determining its stage. They may also look at the bigger picture, such as mobility, circulation, nutrition, moisture, other health conditions and the surfaces someone sits or lies on.
A visit generally includes questions about when the area first appeared, how it has changed, pain, drainage, and the person's daily routine. The specialist may measure the wound, check the surrounding skin, and sometimes take photos for the record so changes can be tracked over time.
Questions worth asking a licensed provider: What is causing this wound, and what stage is it? What treatment options exist and why? How long might healing take? What can be done to reduce pressure at home or in a care facility? What signs should prompt a call? And what does my insurance cover? Some advanced options, such as skin substitutes or amniotic grafts, vary in FDA status and coverage, so it is reasonable to ask about that too. For further reading on amniotic products specifically, amnioticdoctors.com is an independent resource.
The whole-person view
Body, mind and stress affect each other. Pain, limited mobility, long recoveries and dependence on others can be exhausting and emotionally heavy, and stress and poor sleep can in turn make daily routines like repositioning, eating well and keeping appointments harder.
Some people find that body-based support, such as the approaches listed through Somatic Experiences, helps them reconnect with their bodies during a long recovery. Others find talk therapy through Therapists.plus useful for coping with worry, frustration or caregiver strain. These are complements to medical care, not replacements for it.
Somatic Experiences: trauma and emotional healing →Somatic Experiences: embodiment and movement →Therapists.plus: mind body connection →
Keep in mind
- Pictures online cannot diagnose or stage a wound; only a licensed clinician can do that after an evaluation.
- Seek medical care promptly for spreading redness, red streaking, increasing warmth or pain, pus, foul odor, fever or chills, or a wound that is getting worse quickly.
- Call 911 or go to the ER for heavy bleeding, exposed bone or tendon, signs of sepsis such as confusion, rapid heartbeat or fever with chills, or a deep or severely contaminated wound.
- If you are overwhelmed or in crisis, call or text 988. Licensed professionals should guide all wound care decisions.
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Frequently asked questions
What are the 4 stages of bed sores?
The four commonly described stages are Stage 1 (non-fading redness on intact skin), Stage 2 (partial-thickness skin loss, like a shallow open area or blister), Stage 3 (deeper loss with fatty tissue possibly visible) and Stage 4 (very deep, with muscle, tendon or bone possibly exposed). Some wounds are called unstageable or deep tissue injury. A licensed clinician must determine the actual stage.
What does a Stage 1 bed sore look like?
A Stage 1 bed sore is usually described as a patch of intact skin that looks red and does not turn pale when pressed. On darker skin it may look purple, bluish or slightly different in tone from nearby skin, and it may feel warm, firm or tender. Because it can be subtle, ask a provider to check any area you are unsure about.
Can I tell the stage of a bed sore from pictures?
No, pictures are not a reliable way to stage a wound. Lighting, skin tone and depth are hard to judge in a photo, and some wounds hide their true depth under dead tissue. A wound care specialist or other licensed clinician can examine it in person and stage it properly.
When should I see a wound care specialist for a bed sore?
Consider seeing a licensed provider whenever skin stays red after pressure is relieved, a blister or open area appears, or a wound is not improving. Seek care promptly for signs of infection such as spreading redness, pus, foul odor, increasing pain or warmth, fever or chills. Call 911 or go to the ER for heavy bleeding, exposed bone or tendon, or signs of sepsis.
How might a wound care specialist help with bed sores?
A wound care specialist may evaluate the wound's cause and stage, discuss treatment options, and look at factors like pressure, moisture, nutrition and circulation. They may also coordinate with other providers or caregivers. What is appropriate depends on your individual evaluation, so ask about treatment options, expected healing time and insurance coverage.
Are skin substitutes or amniotic grafts approved for bed sores?
It varies. Most skin substitutes and amniotic or placental grafts are regulated as minimally manipulated tissue rather than FDA-approved drugs, and coverage differs by product and payer. Only a licensed clinician can say whether any option is appropriate for a specific wound, so ask a provider about regulatory status and coverage.
Educational resource. WoundKare shares general information and connects people with independent wound care specialists. It is not medical advice, diagnosis or treatment. Talk with a licensed professional about your health.