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 , 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 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.
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 you 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: Prevention and Treatment.
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.
Treating pressure sores
General treatment for pressure sores is to keep the area dry and clean, eat well, and reduce pressure. All pressure sores need to be treated early. If a sore progresses to stage 3 or 4 , it is hard to treat and can lead to serious complications. Specific treatment depends on the stage of the pressure sore.
For more information on treatment, see the topic Pressure Sores: Prevention and Treatment.
Note: Pressure sores can trigger autonomic dysreflexia, which causes sudden very high blood pressure and headaches. If not treated promptly and correctly, it may lead to seizures, stroke, and even death. These complications are rare, but it is important to know the symptoms and watch for them.