loader image

Bedsores 101: Pressure Ulcer Stages, Signs, Treatment & Prevention

Mar 12, 2022

A study shows there is an increasing trend of chronic wounds in Singapore and bed sores, along with diabetic wounds, are the most common. Out of 100,000 people, 183 reported having pressure ulcers or bedsores.

Chronic wounds are common in the elderly, particularly those who are aged 80 and above. It can reduce the quality of life for patients and caregivers alike. It is also a common source of pain, depression, embarrassment and anxiety.

Pressure injuries are common with Singaporeans who are bedridden or spend prolonged periods sitting due to limited mobility. However, despite its detrimental effects, it is largely underreported and misdiagnosed. Raising awareness regarding this condition can go a long way in recognizing and treating pressure ulcers.


Development of MOH Prediction and Prevention of Pressure Ulcers in Adults Guidelines

Understanding this as a health concern, the Ministry of Health released guidelines for nurses, healthcare personnel as well as caregivers who are providing treatment and care for patients who are at risk for developing pressure ulcers. The guidelines aim to do the following:

–       Identify patients at risk of pressure ulcer development;

–       Specify nursing interventions that promote tissue tolerance to pressure;

–       Specify interventions that protect patients against external pressure, shear and frictional forces and;

–       Improve patient outcomes through educational programmes for practitioners and carers.


More details regarding these guidelines can be found on the MOH website.

What is a Bed sore?

Bedsores (or pressure ulcers or decubitus ulcers) is a skin injury common in bony areas, such as the tailbone, hips, ankles and heels, that occur due to prolonged pressure. Some are more susceptible to developing bedsores and may form sores in a matter of hours. Some sores heal while others do not heal completely.

Bed sores are most common for people who are bedridden or spend prolonged periods sitting on a chair, have limited mobility or have lost sensation to sense pain due to an injury or a medical condition.


3 Causes of Pressure Ulcers

Pressure Ulcers develop because the blood supply to the affected area and skin tissues is not enough. Immobility or lack of movement affects blood circulation which in turn disrupts the supply of oxygen and essential nutrients that keeps the skin healthy. This can lead to tissue damage and chronic wounds such as bedsores.

Factors such as pressure, friction and shearing contribute to the development of bedsores.



Constant pressure can affect blood flow to the skin. Blood circulates oxygen and nutrients to the skin and other tissues. Poor circulation can lead to tissue damage and cell death. This is more common in areas of the body that receive significant pressure such as the back of the head, shoulder blades, tailbone, elbows and heels.  


Friction occurs when skin rubs on clothes and bedsheets. Moist areas, in particular, may become more vulnerable to damage.


Shearing happens when the bones and skin are pulled in opposite directions. A bedridden patient, whose head is raised, would be pulled down by gravity but his skin is remained attached to the bed due to friction. This position compresses the blood vessels between bones and skin and interrupts the blood flow.


Training for Pressure Ulcer Prevention

Proper measures and checks should be taken to prevent bed sores. Care facilities ensure staff are trained in pressure ulcer prevention. Here are some tips that are taught in training:

Repositioning. It allows for a weight shift and will relieve pressure which allows blood flow properly. Capable patients may do this themselves but those who lack the strength or the capability should be assisted by a care provider.

Keep the skin clean and dry. Ensuring cleanliness protects the skin from irritations such as unchanged linens and buttons on clothes. Moisture makes skin more fragile so it is important to keep it dry. Regular inspection of vulnerable areas will also help prevent pressure sores from developing.

Avoid Shearing. Maintain a head elevation of a 30-degree angle

Use equipment the relieve pressure. Equipment such as a pressure-relieving mattress, foam pad and wheelchair can help with bed sores prevention.

Practice Proper Skincare. Skincare can help reduce the risk of developing pressure sores. Barrier creams could be described to protect the skin from moisture, urine or faeces.


Risk Factors for Bedsores

There are risk factors that make patients more susceptible to bedsores. Knowing the risk factors help identify care recipients who are more vulnerable to developing sores.

– Immobility. This may happen due to poor health, spinal cord injury or paralysis after a stroke.

– Impaired ability to feel or respond to pain – pain and discomfort act as warning signals to change positions. Loss of sensation due to spinal cord injuries and neurological disorders can lead to sores.

– Incontinence  – skin that is exposed to urine and stool is most likely to develop sores.

Problems in circulation – lack of movement, muscle weakness, and medical conditions like vascular disease can affect blood flow.

– Malnutrition – Poor nutrition leads to tissue damage and cell death. Healthy skin requires proper hydration, nutrients and vitamins to prevent tissue death.

– Smoking– Smoking reduces blood flow to the skin which only make smokers who already have limited mobility, more susceptible to pressure sores. Smoking also impedes healing.


4 Stages of Pressure Ulcers

Stage 1

The affected skin is unbroken yet discoloured or has turned red. It does not lighten or turn white when pressed. 


Stage 2

Skin is broken. A shallow open sore has appeared on the skin’s surface. It may or may not leak pus or fluid.


Stage 3

Deep wound two layers deep into the skin. There may be signs of infection which are redness surrounding the sore, pus, odour or fever. Black and dead tissue is an indication of necrosis.


Stage 4

The wound is deep enough to reach muscle or even bone. This is a deep tissue injury. Dead tissue and drainage are present with a high possibility of infection.


Treatment and Care for Pressure Sores

Keep in mind the following steps to treat pressure sores:

  • Search and remove the cause of pressure sore.

  • Stay off the pressure sore and keep the area clean and dry. Inspect the area at least twice a day to check for more skin damage or infections.

  • Mild soap or gentle cleanser may be used to clean the wound and covering open sores with antimicrobial dressing can prevent infection.

  • A diet of high protein, proper nutrition and hydration will help the pressure sore heal.

  • Vitamins such as A and C as well as iron and zinc can help promote healing and collagen growth.

For mild cases of pressure sores, they may disappear after a few days. If it doesn’t, it is best to call for a health care provider.

  • For Stage 1, call a health care provider if it does not abate after 2-3 days.

  • For more severe stages, see a doctor right away. Surgery is often required for Stage 4 pressure sores.

It takes some time for pressure sores to heal. Mild cases may take up 2-3 days while the most severe stage can take up months or even years before healing. Some do not heal completely.


Pressure Ulcer Care Services in Singapore

Bedsores are chronic wounds that require attention and treatment to heal. Seeking professional help and looking through senior care options will speed up your loved one’s recovery.

A primary care physician such as Geriatrician Singapore, who received additional training to treat older adults, can help diagnose and recommend the proper treatment.

In times that surgery may be required (such as Stage 4) in treating pressure sores, an orthopaedic surgeon can remove dead tissue as well as pad the open wound with tissue or muscle. Nurses who specialize in wound care are also available to provide post-surgery care. They can treat infections as well as clean and dress open wounds.

Physical therapy can also help, particularly in preventing pressure sores from developing. Occupational therapists and physiotherapist Singapore can help exercise mobility and strengthen muscles that not only reduce chances of developing pressure-induced injury but also help your loved one regain their independence.

For chronic wounds, healing may take a long time. As such, it is important to look into long term care options such as live in caregivers and nursing homes to ensure your loved one has the attention and medical care they need to recover properly.

For loved ones who prefer to recover in a familiar environment, comfortable home care with a full time caregiver for elderly in Singapore is a good option. Caregivers are trained to assist those who have difficulty with activities of daily living such as moving, eating and bathing.

On the other hand, Nursing Homes are also available for those who require medical attention. Nursing agency Singapore provide 24/7 nursing care to aid in your loved one’s healing and recovery.

Join Waitlist We will inform you when the product arrives in stock. Please leave your valid email address below.