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What are pressure ulcers?

Pressure ulcers are areas of damage to the skin and the tissue underneath it. They are also known as pressure sores or bed sores.  

They often develop over bony areas of the body where the pressure reduces blood flow to the skin.  

Pressure ulcers may cause pain or lead to a longer stay in hospital. They can become infected, leading to blood poisoning or bone infection. In extreme cases they can be life-threatening. 

Where on the body can pressure ulcers occur?

The most common areas are: 

• heels and hips 
• elbows 
• tailbone (the base of your spine) 
• areas in contact with medical devices (like oxygen tubing or neck collars). 

Pressure ulcers are caused by:  

• Pressure: from body weight pressing against a hard surface. This damages the blood supply to that area.  
• Shearing: this may happen if you slide down, or are dragged up, the bed or chair. This may damage the deeper layers of the skin.  
• Friction: poor moving and handling can remove the top layers of the skin.  

What are the signs and symptoms of a pressure ulcer?

• Discoloured patches of skin that do not change colour when pressed. 
• Red on lighter skin tones. 
• Purple or blue on dark skin tones. 
• Skin that feels warm, spongy, or hard. 
• Pain, tenderness, burning, or itchiness in the area. 
• Swelling. 
• Blisters. 
• Shiny areas. 
• Dry patches, cracks or calluses. 

If you have any of these symptoms, tell someone on the healthcare team looking after you straight away. 

How long does it take for pressure ulcers to develop?

Pressure ulcers usually develop gradually, but in some cases, they can form in a few hours.

What happens if pressure ulcers are not treated?

If not treated, they can get worse. They can turn into blisters or open wounds. They could extend into deeper layers of skin, muscle, or even bone.  

Who is at risk of getting pressure ulcers?

Pressure ulcers can develop in people of any age. Certain factors increase the risk.  

You are more likely to be at risk if you have:  

• Limited mobility: difficulty moving or changing position without help 
• Reduced sensation: less feeling in parts of the body due to nerve damage or other conditions 
• Incontinence: limited bladder or bowel control (being able to control peeing or pooing), leading to skin moisture and irritation 
• Prolonged surgery: long periods spent in one position during operations 
• Previous pressure ulcers: a history of pressure sores makes it more likely that you will get them again. 
• Poor nutrition and hydration (not eating or drinking in a healthy way): including weight loss or obesity.  
• Chronic medical conditions such as diabetes, heart disease, or rheumatoid arthritis.  
• Impaired (poor) circulation which reduces oxygen and nutrient supply to tissues.  
• Pain or breathlessness which limits movement or how easy it is to lie in comfortable positions. 

What can I or the people looking after me do to help prevent pressure ulcers?

Look out for: 

• purple or bluish patches on darker skin 
• red areas on lighter skin that do not turn white when pressed 
• swelling or puffiness 
• blisters 
• shiny, tight-looking skin. 

Report any of these changes to the healthcare team immediately. 

• If you are able, shift your position frequently (for example, every 1 to 2 hours). 
• If you need help, ask the staff to help you in turning or adjusting your position. 
• Make sure bedding is smooth and crease-free, and not too tight. 
• Avoid tight clothing, zips, or buttons that may press on the skin. 
• Check that shoes, slippers, and socks fit comfortably and do not restrict circulation. 

Can I have special equipment to help prevent pressure ulcers?

Yes. You can have specialist equipment such as pressure-relieving mattresses and cushions. These help reduce pressure on vulnerable areas of your body. 

We want to make sure that specialist equipment is available to all patients who need it. Your care should always be delivered with your comfort, dignity, needs and choices in mind.   

It is important that you, your carer, and the healthcare team work together to make sure that: 

• your personal choices and comfort are thought about when selecting equipment 
• the equipment provided is suitable for your needs and condition 
• you receive support and help about how to use it correctly. 

Let the nursing staff know if: 

• the equipment is not working properly 
• it feels uncomfortable or unsuitable 
• you use any pressure-relieving equipment at home or in your usual care setting. 

What if I have limited bowel or bladder control?

If you have limited bladder or bowel control, taking steps to protect your skin is really important to help prevent pressure ulcers. 

Good skin hygiene (keeping your skin clean and healthy) every day helps to reduce the risk of pressure ulcers and improve overall comfort. 

Is eating and drinking properly (good nutrition) important to prevent pressure ulcers?

Yes. Eating a balanced diet and drinking enough fluids is very important for healthy skin. It also supports your body to prevent and heal pressure ulcers. 

Why nutrition matters: 

• Good nutrition provides the building blocks your body needs to repair damaged skin and tissues. 
• It supports your immune system, helping to prevent infection. 
• Proper hydration (drinking enough fluid) helps keep the skin supple, resilient, and less prone to breakdown. 

How can I make sure that what I eat and drink gives me the best chance of preventing pressure ulcers?

1. Include protein-rich foods 

Protein is essential for tissue repair and keeping your skin healthy and strong.

Try to include high-protein foods at each meal. 

• Lean meats, poultry, and fish. 
• Eggs. 
• Dairy products such as milk, cheese, and yogurt. 
• Beans, lentils, and legumes. 
• Tofu or meat substitutes. 
• Nutritional supplements, if recommended. 

2. Eat calorie-dense foods if you are at risk of weight loss. 

People with pressure ulcers or at risk of developing them often need more energy.  

If you have a reduced appetite or are losing weight: 

• choose small, frequent meals and snacks 
• include healthy fats such as avocados, nuts, seeds, olive oil, and full-fat dairy 
• add extra calories to meals using ingredients like cheese, cream, or nut butters 
• use prescribed oral nutritional supplements if advised by your team. 

3. Eat foods with lots of vitamins and minerals. 

Certain nutrients are especially important for skin and wound healing: 

• Vitamin C: supports skin health (like oranges, peppers, broccoli). 
• Zinc: helps with tissue repair (like meat, wholegrains, dairy, seeds). 
• Iron: supports oxygen transport (oxygen moving around your body) and immune function (like red meat, leafy greens, fortified cereals).

4. Stay hydrated (drink enough). 

Dehydration (not drinking enough) can make the skin more fragile and prone to damage. 

Aim to: 

• drink fluids regularly throughout the day (unless you have been advised to restrict fluid intake) 
• include water, milk, soups, and juice if tolerated. 

5. Work with your care team. 

• Speak to a dietitian or nurse if you are not sure about eating and drinking to meet your nutritional needs. 
• Let your team know if you are struggling with eating, swallowing, or appetite. 
• You can get support with your diet that meets your individual health needs, preferences, and medical conditions. 

What will happen if I get a pressure ulcer while I am in hospital?

University Hospitals Sussex NHS Trust is committed to reducing the number of pressure ulcers that happen while people are in our hospitals. Our staff follow evidence-based practices to help prevent pressure ulcers and protect your skin. 

Sometimes, even with proper care, serious or complex medical conditions can still cause pressure ulcers in a few cases. 

If you get a pressure ulcer: 

• you will receive care and support to prevent further skin damage 
• the clinical team will create and follow a wound care and dressing plan created for you 
• the Trust’s Harm Free Care Specialist may carry out an investigation to make sure all the right measures were in place and to learn from the event. 

Support on discharge (when you leave the hospital): 

• If needed, you may be given specialist pressure-relieving equipment to use at home. 
• The Community Nursing Team may be involved in your ongoing care and wound management after discharge. 

Who should I contact for further information and advice?

If you would like further information about pressure ulcer prevention or treatment: 

• Please speak to the nursing staff on your ward. 
• You may also ask for a visit from the Tissue Viability Team. They are specialists in skin and wound care. 

Additional Resources

Please scan these QR codes to see further information from the NHS National Wound.