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Living With a Spinal Cord Injury - Pressure Sores

When you have a spinal cord injury, the nerves that normally signal discomfort and alert you to relieve pressure by changing position may no longer work. This can cause pressure sores, which are injuries to the skin and the tissue under the skin. They often develop on skin that covers bony areas camera.gif, such as the hips, heels, or tailbone. Pressure sores can also occur in places where the skin folds over on itself. They are described in four stages camera.gif that range from mild reddening of the skin to severe complications, such as infection of the bone or blood. They can be hard to treat and slow to heal.

Pressure sores may be caused by:

  • Constant pressure on the skin, which reduces blood supply to the skin and to the tissues under the skin.
  • Friction, which is the rubbing that occurs when a person is pulled across bed sheets or other surfaces.
  • Shear, which is movement (such as sliding down a chair) that causes the skin to fold over itself, cutting off the blood supply.
  • Irritation of the skin from things such as sweat, urine, or feces.

Pressure sores are usually diagnosed with a physical exam. A skin and wound culture or a skin biopsy may be done if your doctor thinks you may have an infection.

Preventing pressure sores

You or your caregiver can help prevent pressure sores. These steps can help keep skin healthy:

  • Prevent constant pressure on any part of the body.
    • Change positions and turn often to help reduce constant pressure on the skin. Learn the proper way to move yourself or to move a person you are caring for so that you avoid folding and twisting skin layers.
    • Spread body weight. Use pressure-relieving supports and devices, especially if your are confined to a bed or chair for any length of time, to help prevent pressure sores. Pad the metal parts of a wheelchair to help reduce pressure and friction.
  • Avoid sliding, slipping, or slumping, or being in positions that put pressure directly on an existing pressure sore. Try to keep the head of a bed, a recliner chair, or a reclining wheelchair raised no more than 30 degrees.
  • Eat a balanced diet that includes plenty of protein.
  • Keep the skin clean and free of body fluids or feces.
  • Use skin lotions to keep the skin from drying out and cracking, which makes the skin more likely to get pressure sores. Barrier lotions or creams have ingredients that can act as a shield to help protect the skin from moisture or irritation.

For more information on prevention, see the topic Pressure Sores.

Signs to look for

Watch for early signs of a pressure sore. These can include:

  • A new area of redness that doesn't go away within a few minutes of taking pressure off the area.
  • An area of skin that is warmer or cooler than the surrounding skin.
  • An area of skin that is firmer or softer than the skin around it.

Contact your doctor if you:

  • Think a pressure sore is starting and you aren't able to adjust your activities and positioning to protect the area.
  • Notice an increase in the size or drainage of the sore.
  • Notice increased redness around the sore or black areas starting to form.
  • Notice that the sore begins to smell bad and/or the drainage becomes a greenish color.
  • Have a fever.
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