What Are the Stages of Pressure Sores?

You may know pressure sores by their more common name: bed sores. They happen when you lie or sit in one position too long and the weight of your body against the surface of the bed or chair cuts off blood supply. You might get them if you’re on bed rest or in a wheelchair.

Your doctor may talk about the “stage” of your pressure sores. The stages are based on how deep the sores are, which can affect their treatment.

If found early, there's a good chance these sores will heal in a few days, with little fuss or pain. Without treatment, they can get worse.

You'll know they’re better when the sore gets smaller and pink tissue shows up along the sides.

Stage 1

This is the mildest stage. These pressure sores only affect the upper layer of your skin

Symptoms: Pain, burning, or itching are common symptoms. The spot may also feel different from the surrounding skin: firmer or softer, warmer or cooler.

You may notice a red area on your skin. If you have darker skin, the discolored area may be harder to see. The spot doesn’t get lighter when you press on it, or even 10 to 30 minutes after you stop pressing. This means less blood is getting to the area.

What to do: The first and most important thing to do with any pressure sore is to stop the pressure. Change your position or use foam pads, pillows, or mattresses.

If you spend a lot of time in bed, try to move at least once every 2 hours. If you’re sitting, move every 15 minutes. You may need someone to help you.

Wash the sore with mild soap and water and dry it gently.

It may help to eat a diet high in protein, vitamins A and C, and the minerals iron and zinc. These are all good for your skin. Also, drink plenty of water.

Recovery time: A Stage 1 pressure sore may go away in as little as 2 or 3 days. If it hasn't, call your doctor.

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Stage 2

This happens when the sore digs deeper below the surface of your skin.

Symptoms: Your skin is broken, leaves an open wound, or looks like a pus-filled blister.

The area is swollen, warm, and/or red. The sore may ooze clear fluid or pus. And it’s painful.

What to do: Follow the same steps for Stage 1. You should also clean the wound with water or a salt-water solution and dry it gently. This may hurt, so ask your doctor if you should take a pain reliever 30 to 60 minutes before cleaning.

Keep the sore covered with a see-through dressing or moist gauze. If you see signs of an infection (such as pus, fever, or redness), tell your doctor.

Recovery time: A Stage 2 pressure sore should get better in 3 days to 3 weeks.

Stage 3

These sores have gone through the second layer of skin into the fat tissue.

Symptoms: The sore looks like a crater and may have a bad odor. It may show signs of infection: red edges, pus, odor, heat, and/or drainage. The tissue in or around the sore is black if it has died.

What to do: Stage 3 sores will need more care. Talk to your doctor. She may remove any dead tissue and prescribe antibiotics to fight infection. You may also be able to get a special bed or mattress through your insurance.

Recovery time: A Stage 3 pressure sore will take at least one month, and up to 4 months, to heal.

Stage 4

These sores are the most serious. Some may even affect your muscles and ligaments.

Symptoms: The sore is deep and big. Skin has turned black and shows signs of infection -- red edges, pus, odor, heat, and/or drainage. You may be able to see tendons, muscles, and bone.

What to do: Tell your doctor right away. These wounds need immediate attention, and you may need surgery.

Recovery time: A Stage 4 pressure sore could take anywhere from 3 months or much longer, even years, to heal.

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Other Stages

In addition to the 4 main stages for bed sores, there are 2 others:

"Unstageable" is when you can’t see the bottom of the sore, so you don’t know how deep it is. Your doctor can only stage it once it’s cleaned out.

"Suspected Deep Tissue Injury" (SDTI). This is when the surface of the skin looks like a Stage 1 or 2 sore, but underneath the surface it’s a Stage 3 or 4.

WebMD Medical Reference Reviewed by Carol DerSarkissian on September 14, 2016

Sources

SOURCES:

American Academy of Family Physicians: "Pressure Sores."

University of Washington Rehabilitation Center: "Taking Care of Pressure Sores."

Harvard Medical School: "Bedsores (Decubitus Ulcers)."

CDC National Center for Health Statistics: "Pressure Ulcers Among Nursing Home Residents: United States, 2004."

Deutsches Arzteblatt International, “Decubitus Ulcers: Pathophysiology and Primary Prevention.”

The Permanente Journal: “Pressure Ulcers: What Clinicians Need To Know.”

National Database of Nursing Quality Indicators: "Pressure Ulcers and Staging."

Centers for Medicare & Medicaid Services: "Pressure Ulcer Staging."

National Pressure Ulcer Advisory Panel: NPUAP Pressure Ulcer Stages/Categories."

Model Systems Knowledge Translation Center: "Skin Care & Pressure Sores -- Recognizing and Treating Pressure Sores."

Uptodate.com: "Clinical staging and management of pressure-induced injury."

National Multiple Sclerosis Society: "Pressure Sores."

FamilyDoctor.org: “Pressure Sores.”

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