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Bed Sores (Pressure Injuries)

Sores that form when skin is pressed against a bed or chair for too long, usually over bony spots such as the tailbone, hips and heels. They can become deep and dangerously infected, but most can be prevented with regular position changes, daily skin checks and good care.

Get medical help right away if a bed sore shows signs of infection:

Possible sepsis is an emergency. An infected sore can lead to sepsis (NHS inform), the body’s extreme, life-threatening reaction to an infection (CDC). Watch for confusion or disorientation, clammy or sweaty skin, extreme pain or discomfort, fever, shivering or feeling very cold, a high heart rate or weak pulse, and shortness of breath (CDC). Get medical care immediately (CDC, MedlinePlus). If the person is very confused, hard to wake or struggling to breathe, call 911.

What is a bed sore?

A bed sore is an area of damaged skin, and sometimes the tissue underneath, caused by staying in one position too long (MedlinePlus, NHS). You may also hear them called pressure injuries, pressure ulcers, pressure sores or decubitus ulcers (MedlinePlus, American Cancer Society). When something keeps pressing on the skin for too long, it cuts off the blood supply, and without blood the skin dies (MSKTC). Damage can develop within hours (NHS, American Cancer Society), and friction, moisture from sweat, urine or stool, and “shear” — skin being pulled as someone slides down in a bed or chair — all make it more likely (American Cancer Society).

They are common and can be serious: pressure sores can cause infections, some of them life-threatening (MedlinePlus), and up to 80% of people with a spinal cord injury will have one during their lifetime (MSKTC).

Where do they form?

Most often over bony areas close to the skin: the tailbone and buttocks, hips, heels, ankles, knees, elbows, the back and the back of the head (MedlinePlus, MSKTC, American Cancer Society). The ears are another common spot (American Cancer Society). Skin under casts or braces needs checking too (MSKTC), and pressure ulcers can even form on soft areas such as the nostrils, mouth or tongue (NHS inform).

Who is at risk?

Anyone who can’t easily change position: people who are bedridden, use a wheelchair, or can’t move on their own (MedlinePlus). Problems moving are the main reason people get them (NHS), and as we age the skin becomes thinner, drier and more fragile (MSKTC). Other things that raise the risk include:

The stages

Clinicians grade pressure injuries by how deep the damage goes. The National Pressure Injury Advisory Panel updated its definitions in 2016 and uses Stages 1 to 4 plus “unstageable” and “deep tissue” injuries (NPIAP, archived copy). In plain terms:

Deeper sores take the longest to heal — MSKTC estimates one to four months or more for Stage 3, and from three months to two years for Stage 4 — and carry a high risk of infection (MSKTC), which can include cellulitis, bone and joint infections and sepsis (NHS inform).

Why prevention matters

Healing can take weeks, months or longer (MSKTC), and the scar tissue left behind is more fragile than normal skin (MSKTC). The good news is that the basics — regular position changes, the right mattress or cushion, daily skin checks, clean and dry skin, and good food and fluids — are things families and care teams can do every day (NHS, NHS inform, MSKTC). The UK’s NICE guideline advises assessing the pressure-ulcer risk of adults admitted to hospital or a care home, using a validated scoring tool to support clinical judgement, offering a skin check by a trained professional to those at high risk, and building an individual care plan around it (NICE).

In a nursing home that takes part in Medicare or Medicaid, preventing and treating pressure ulcers is a legal duty (42 CFR 483.1): federal rules say residents must get care to prevent them and must not develop them unless their medical condition made it unavoidable (42 CFR 483.25). See Wellness coaching below for how to speak up if you are worried about someone’s care.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Taking pressure off (regular repositioning, pressure-relieving mattresses and cushions), cleaning and dressing the wound, removing dead tissue (debridement), antibiotics for infection, a nutrition check, and surgery for some deep sores — often with a wound-care nurse or specialist. Medicare Part B can help pay for pressure-reducing mattresses and overlays used at home (some types need prior approval); after the Part B deductible you pay 20% of the Medicare-approved amount. If you qualify for Medicare home health care, skilled nursing including wound care for pressure sores costs nothing. Other wound-care costs: estimate being researched. An early sore may clear in days if all pressure is kept off it; deeper sores often need special wound care and can take months to heal. Scar tissue stays fragile, so prevention carries on.
Chiropractic Being researched — coming soon.
Acupuncture Being researched — coming soon.
Herbal medicine Medical-grade honey dressings, used by a clinician; and making sure the person gets enough calories, protein and fluids, with supplements only if a dietitian finds a shortfall. Cost estimate being researched. Honey has only very-low-quality evidence for pressure sores (one small trial). Supplements may slightly help sores heal but the evidence is uncertain, and they may make little or no difference to preventing them. Never put kitchen honey or other home remedies on an open wound.
Massage therapy Not a treatment for bed sores. Never massage or rub reddened skin, bony areas, or skin on or near a sore. Not applicable. We found no evidence that it prevents or heals bed sores. Guidelines advise against massage or rubbing to prevent pressure sores, and hospital advice is not to rub or massage red, purple or tender areas. Ask the care team before any massage for someone at risk.
MBHA Wellness Coach A daily caregiver routine: skin checks, a turning schedule, wheelchair pressure reliefs, clean and dry skin, incontinence care, food and fluids, safe moving — plus help speaking up in a hospital or nursing home and reaching the Long-Term Care Ombudsman. Long-Term Care Ombudsman services are free and confidential. MBHA coaching cost estimate being researched. Steady daily habits are the heart of prevention, and a spinal-cord-injury resource center says most pressure sores are preventable. Coaching works alongside the care team, never instead of it.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on how severe the sore is (NHS). An early (Stage 1) area can clear if all pressure is kept off it, but a provider should see it if it hasn’t gone in 2 to 3 days; an open sore needs a provider right away, and deeper sores often need special wound care (MSKTC). See a doctor if you think you or someone you care for has a pressure sore (NHS).

1. Take the pressure off

Nothing heals while the pressure continues. Changing position regularly relieves pressure and helps prevent new sores (NHS). MedlinePlus suggests changing position every two hours (MedlinePlus), and the American Cancer Society suggests shifting at least every 2 hours in bed and every 15 minutes in a chair (American Cancer Society). Keep weight off the sore itself (MSKTC, Vanderbilt University Medical Center). The right schedule depends on the person, so ask the care team to set one (MSKTC).

2. Clean and dress the wound

  • Keep an early (Stage 1) area clean and dry (MSKTC). An open sore is cleaned the way the nurse or doctor recommends — ask them what to clean it with (NHS, American Cancer Society).
  • Dressings protect the sore and help it heal (NHS). There are many kinds, such as foam, alginate and hydrocolloid dressings (Cochrane review). NICE suggests a dressing that keeps the wound warm and moist for Stage 2 to 4 sores, advises against plain gauze, and says the choice should be talked through with the person and family, taking into account pain, where the sore is, how much it leaks and how often the dressing needs changing (NICE).
  • Don’t put antiseptics on the sore unless a provider tells you to — NICE advises that topical antiseptics or antimicrobials should not be used routinely to treat pressure ulcers (NICE).
  • Which dressing works best? A large 2017 Cochrane review couldn’t tell: the studies were small and mostly low or very low certainty, so clinicians choose based on the wound, their experience, the patient’s wishes and cost (Cochrane review).

3. Remove dead tissue (debridement)

Dead tissue slows healing. A clinician may use a special dressing that helps the body break dead tissue down on its own, or cut it away if that would be faster (NICE, American Cancer Society). This is a job for a trained professional, not something to try at home.

4. Treat infection

Antibiotics are used when a sore is infected (NHS). NICE advises antibiotics by mouth or vein for signs of spreading infection such as sepsis, spreading cellulitis or bone infection (osteomyelitis), but not simply to make a sore heal, and not just because a wound swab grows bacteria when there are no signs of infection (NICE).

5. Nutrition

How quickly a sore heals depends partly on nutrition (NHS inform). NICE recommends that adults with a pressure ulcer get a nutrition assessment from a dietitian or other trained professional, and supplements if they have a nutritional shortfall (NICE) — see Herbal medicine below for what the research shows.

6. Surgery

If a sore is severe or other treatments haven’t worked, surgery may be needed to clean and close the wound (NHS, NHS inform).

Who to see

Start with the person’s doctor or nurse. Deeper sores often need special wound care (MSKTC). It helps to bring questions to the appointment — which areas to check, which dressings and mattresses to use, how often to turn, and which signs mean the sore is getting worse. NICE says people at high risk and their families should get tailored information about the causes and early signs of pressure ulcers and how to prevent them, and be shown the techniques and equipment used (NICE).

What it costs

  • Pressure-reducing mattresses and overlays (Medicare): Part B covers durable medical equipment that a provider orders for use at home, from a Medicare-enrolled supplier (Medicare.gov). Certain powered air mattresses, air-flotation beds and advanced overlays need prior authorization: the supplier and provider send the paperwork to Medicare first, and a denial can be appealed (Medicare fact sheet). After the Part B deductible you pay 20% of the Medicare-approved amount if the supplier accepts assignment (Medicare.gov).
  • Home health wound care (Medicare): if a doctor certifies that the person is homebound and needs part-time skilled care, Medicare home health covers skilled nursing, including wound care for pressure sores, and you pay nothing for the covered home health services (Medicare.gov).
  • Wound-clinic visits, private-pay supplies and surgery: MBHA cost estimate being researched.

How well it works — what to expect

A Stage 1 area can clear in about three days if all pressure is kept off it; Stage 2 sores take from three days to three weeks, and deeper sores take months, sometimes up to two years (MSKTC). Because scar tissue is more fragile than normal skin and a past sore raises the risk of another, the prevention routine carries on after the sore closes (MSKTC, NHS).

Find a medical doctor in our directory

Approach 4 of 6

Herbal medicine

There is no herb that heals a bed sore. Two topics come up often, though: honey dressings and nutrition supplements.

Medical-grade honey dressings

Honey has been used on wounds since ancient times (Cochrane review). Here is what the evidence shows:

  • The 2015 Cochrane review of honey for wounds found only one small trial in pressure ulcers (40 people), where honey healed sores faster than saline soaks — but the evidence was rated very low quality. Overall, the reviewers found it hard to draw conclusions about honey for most wounds (Cochrane review).
  • Memorial Sloan Kettering notes that small studies suggest manuka honey may help wound healing, but some trials found it no better than standard treatment, and it advises patients not to treat themselves with honey products (Memorial Sloan Kettering).
  • Medical-grade honey is sterilized and meets safety standards for medical use, while ordinary commercial honey has weaker antibacterial activity (review, JAR Life, 2024 — note that two of its authors work for a company that makes honey wound dressings).

Safety. Don’t put kitchen honey, sugar, oils or other home remedies on an open wound. If honey is an option, it should be a medical-grade dressing chosen and checked by the person’s nurse or doctor (Memorial Sloan Kettering). People allergic to honey should avoid it, and the sugar in manuka honey may raise blood sugar in people with diabetes (Memorial Sloan Kettering).

Protein, zinc, vitamin C and other supplements

A balanced diet with enough protein, and enough water each day, helps keep skin healthy (MSKTC, American Cancer Society), and poor nutrition is a known risk factor (NICE, American Cancer Society). But do special supplements help? The 2024 Cochrane review of 33 trials found:

  • Prevention: energy, protein and micronutrient supplements, or protein supplements alone, may make little or no difference to whether a person develops a pressure ulcer (low-certainty evidence) (Cochrane review).
  • Healing: energy, protein and micronutrient supplements may slightly increase the number of sores that heal (low-certainty evidence). Collagen supplements probably helped sores shrink in one study. The evidence for vitamin C, zinc and several other supplements on their own was very uncertain (Cochrane review).
  • Overall, the reviewers concluded that the benefits are uncertain and there may be little or no difference compared with a standard diet (Cochrane review).

This matches NICE, which recommends a nutrition assessment for anyone with a pressure ulcer and supplements for people with a nutritional shortfall — but not supplements for people who are already eating well (NICE). Ask the care team or a dietitian before starting any supplement, especially if the person takes other medicines. We don’t list doses here.

Approach 5 of 6

Massage therapy

Don’t massage or rub reddened skin, bony areas, or skin on or near a sore. Vanderbilt University Medical Center’s patient advice is not to rub or massage over red, purple or tender areas (Vanderbilt University Medical Center), and the UK’s NICE guideline says not to offer skin massage or rubbing to prevent pressure ulcers in adults or children (NICE).

It can be tempting to rub a red spot, but current guidance says not to (see above). The helpful thing to do with a red or discolored area is to keep weight off it until it returns to normal (MSKTC) and tell the care team if it isn’t getting better after repositioning (American Cancer Society).

We found no evidence that massage prevents or heals bed sores. If someone who spends a lot of time in bed or a chair would like massage of other areas for comfort, be careful: older people have a higher risk of injury from massage, and rare serious problems such as blood clots, nerve injury or broken bones have been reported, more often with vigorous techniques such as deep tissue massage (NCCIH). Discuss it with the person’s health care provider first, and don’t use massage to put off seeing a provider about a medical problem (NCCIH). Any therapist should be told which areas are at risk so they can stay well away from them.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Most of the work of preventing bed sores happens at home and at the bedside, day after day, and it often falls to family members. The Model Systems Knowledge Translation Center, a spinal-cord-injury resource, says most pressure sores are preventable (MSKTC). An MBHA Wellness Coach can help caregivers set up a routine that sticks, keep track of it, and know when and how to speak up.

A daily skin check

Turning and positioning in bed

Wheelchair users

Clean, dry skin and incontinence care

Food and fluids

Help the person eat a balanced diet with enough protein and drink enough water each day (MSKTC, American Cancer Society). Poor nutrition keeps tissue from rebuilding and fighting infection (MSKTC). If appetite is poor, ask for a dietitian. Not smoking helps too (NHS).

Working with the care team

Ask for a pressure-sore risk assessment so the care team can make a prevention plan (NHS), and ask them to explain the early signs and show you the techniques and equipment they use (NICE). If the person is going home from the hospital, ask whether they qualify for Medicare home health care, which can include wound care for pressure sores (Medicare.gov), and whether a pressure-reducing mattress or cushion should be ordered (Medicare fact sheet).

If your loved one is in a nursing home

Nursing homes that take part in Medicare or Medicaid (42 CFR 483.1) must give residents care, in line with professional standards, to prevent pressure ulcers, and must give residents who have them the treatment needed to heal them, prevent infection and stop new ones forming (42 CFR 483.25). It is fair to ask staff how often your loved one is being turned, what mattress they are on, and when their skin was last checked.

If you are worried, you can:

  • Raise it with the care team first — the nurse in charge, the director of nursing or the administrator — and write down dates, names and what you saw.
  • Contact the Long-Term Care Ombudsman. Every state has an ombudsman program that advocates for residents of nursing homes, assisted living and board-and-care homes, and investigates and resolves complaints about quality of care. Anyone can contact it, it follows the resident’s wishes, and its services are free and confidential (National Long-Term Care Ombudsman Resource Center). In California, every long-term care facility must post the local ombudsman’s number and the statewide Ombudsman Hotline, 1-800-231-4024, which takes calls 24 hours a day; you can also find your county’s office on the California Department of Aging website (California Department of Aging).
  • File a complaint with your State Survey Agency, the state office that inspects nursing homes. Call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) to get its contact details (Medicare.gov). In California this is the Department of Public Health’s Licensing and Certification Program: you can file online through its Cal Health Find database, or by phone, fax or letter to the district office, which will tell you the results in writing (California Department of Public Health).
  • For a quality-of-care concern with any Medicare provider, you can also contact the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) (Medicare.gov).

If you think someone is in immediate danger, call 911. A coach can help you prepare notes and make these calls, but a coach is never a substitute for the person’s doctors and nurses.

Still being researched: Chiropractic, Acupuncture. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating Bed Sores (Pressure Injuries)? Tell us.

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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