Who is at risk
- People confined to bed after a stroke, hip fracture, spinal injury or long illness
- Elderly people who are thin or weak
- People with diabetes, poor circulation or numbness
- People who are incontinent (skin stays wet)
- Anyone who cannot move themselves, including patients in ICU
Sores can start within a few hours of unrelieved pressure. Families caring at home after a hospital stay are often the first to notice them.
Where they form
The skin breaks down where bone is closest to it:
- Lying on the back: lower back and tailbone (sacrum), heels, back of the head, shoulder blades, elbows
- Lying on the side: hips, side of the knee, ankle bones, ear
- Sitting: the sitting bones (ischium) and tailbone
Prevention: the daily routine
- Turn every 2 hours. Back, then left side, then right side. On the side, tilt the person about 30 degrees with a pillow behind the back, not fully onto the hip bone.
- Float the heels. Put a pillow under the calves so the heels hang free of the bed.
- Keep the head of the bed low, no more than 30 degrees, except during meals and for an hour after. Raising it more makes the body slide down and drags the skin over the tailbone.
- Lift, don't drag. Use a draw sheet with two people to move the person up the bed.
- Use a pressure-relieving mattress. An alternating air mattress or a high-density foam mattress.
- Keep the skin clean and dry. Change wet nappies or sheets promptly, wash with mild soap, pat dry and apply a barrier cream.
- Check the skin every day, especially the tailbone, hips and heels. Use a mirror or ask for help.
- Feed protein and water. Dal, eggs, paneer, curd, milk, fish or chicken at every meal, and enough water. Ask the doctor about supplements if the person eats little.
- Control sugar in people with diabetes.
Things that do harm
- Ring or donut cushions: they press on the skin around the sore and cut off blood supply.
- Massaging red skin over a bone: it damages the tissue further.
- Talcum powder, haldi, oils or home pastes on an open sore: they hide infection and delay healing.
- Hot water bottles on numb skin, which can cause burns.
The four stages
| Stage | What you see | What to do |
|---|---|---|
| 1 | Red patch that does not fade when pressed; may be warm or firm. On dark skin it may look purple or darker | Remove all pressure from the area; check every turn |
| 2 | Shallow open sore or blister | Keep pressure off; clean, moist dressing; see a doctor if not better in 1–2 weeks |
| 3 | Deep crater into the fat | Medical treatment needed |
| 4 | Muscle, tendon or bone visible | Hospital treatment, often surgery |
| Unstageable | Covered with yellow or black dead tissue | Needs a doctor to remove the dead tissue and assess depth |
Warning signs: see a doctor the same day
- Black or yellow tissue in the sore
- Pus, a bad smell or spreading redness
- Fever, confusion or the person becoming drowsy
- A sore that keeps getting bigger or deeper
- Bone visible at the base
Infection from a deep sore can spread to the bone (osteomyelitis) or the blood, which can be life-threatening in an elderly or weak person.
Hospital treatment
Treatment follows the same steps as other chronic wounds described on the diabetic foot and wound care page:
- Pressure relief and nutrition, without which nothing else works.
- Debridement: dead tissue is removed in the operating theatre.
- Infection control, with antibiotics chosen from tissue culture, and bone tests if bone is exposed.
- Dressings or VAC therapy to clean and shrink the wound. See VAC therapy for diabetic foot ulcers, which works the same way for pressure sores.
- Flap surgery for deep stage 3–4 sores. Healthy skin, fat and sometimes muscle are moved with their own blood supply to cover and pad the bone. The same flap methods are used after accidents, described on the trauma and microsurgery page.
Flap surgery is planned only when the cause can be controlled: the person can be kept off the area after surgery, incontinence is managed and nutrition is adequate. Otherwise the sore tends to come back.
Help in Ranchi
Dr. Vikrant Ranjan, MCh plastic surgeon, treats bed sores, diabetic foot ulcers and other non-healing wounds at Jharkhand Charitable Hospital, Kanke, Ranchi. Wound care is priced on assessment, with VAC charged per dressing cycle; see the price list. If the person also has diabetes, the diabetic foot daily checklist covers foot checks. Call 090656 39577.
Common questions
How often should a bedridden patient be turned?
At least every 2 hours in bed, day and night, unless the doctor advises otherwise. On a good pressure-relieving mattress the gap can sometimes be longer, but check the skin at every turn. A person sitting in a chair or wheelchair should shift their weight every 15–30 minutes.
Is an air mattress enough to prevent bed sores?
No. An alternating air mattress lowers pressure and helps a lot, but the person still needs turning, skin checks, dry skin and good nutrition. Check that the mattress is inflated: if you can feel the bed frame under the person's hip, it is not working.
Can bed sores heal at home?
Early sores (red skin or a shallow blister) usually heal at home once pressure is taken off completely and the skin is kept clean. Deep sores with yellow or black tissue, a bad smell or bone showing need hospital treatment.
Last reviewed: 2026-10-11
This page is general information, not a diagnosis or a treatment plan. Results and recovery differ between patients. Prices are starting prices and are confirmed after examination.