Pressure sores, which are also called pressure ulcers, decubitus ulcers, or bedsores, happen when certain parts of the skin or the tissues beneath it, such as muscles and bones, get hurt because they don’t receive enough blood flow. These sores are quite frequent among people who have spinal cord injuries (SCIs), affecting around 23-30% of them every year.
Pressure ulcers have various names. So, when you come across terms like pressure sores, bedsores, or decubitus ulcers, it’s important to understand that they all describe the same medical condition.
Causes and Risks of pressure ulcers in people living with spinal cord injury
The primary cause behind the development of pressure ulcers in individuals with spinal cord injuries is impaired sensation. Before their injury, people typically experience a natural urge to shift or change positions after sitting or lying down for an extended period.
However, when a spinal cord injury occurs, it interrupts the communication between the brain and the body. Consequently, the brain doesn’t receive sensory signals indicating prolonged pressure on a specific body part. As a result, individuals who have lost sensation due to a spinal cord injury no longer feel the discomfort or restlessness that prompts them to change positions when sitting or lying down for an extended period. Consequently, they remain in the same position, leading to the accumulation of pressure.
When pressure builds up for an extended duration, it disrupts the blood flow to that area of the body, depriving the tissues of oxygen. This condition renders the skin vulnerable to breakdown, a condition known as pressure sores.
Additionally, individuals with higher-level spinal cord injuries are generally at a higher risk of developing pressure ulcers because they have more areas of their bodies susceptible to motor impairments and loss of sensation.
How can I avoid getting a pressure sore?
To prevent pressure sores, a combination of approaches is necessary.Perform routine pressure reliefs, often referred to as weight shifting, pressure redistribution, and pressure reduction.
Pressure relief means taking the weight off certain areas of your body that have been under pressure because you’ve been sitting or lying in one position for a while. This helps improve blood circulation.
When you’re sitting in a wheelchair, it’s a good idea to do pressure reliefs every 15 to 30 minutes, and each relief should last at least 30 to 90 seconds. You should also do these reliefs when you’re sitting in a car or on different surfaces like sports equipment. If you need guidance on how to do pressure reliefs, you can refer to the ” Pressure Reliefs techniques
If you’re unable to do pressure reliefs on your own, you can ask the person who assists you with your daily care, like a family member or caregiver, to regularly move you and reduce pressure on areas at risk of developing pressure sores.
Before leaving the hospital, your therapist will teach you the specific methods and timing of pressure reliefs based on your injury and skin sensitivity. Remember that everyone’s skin is different, so some people may need to do pressure reliefs more frequently than others. It’s essential to build up your skin’s tolerance gradually, For nighttime pressure relief, “Padding, Positioning, and Turning in Bed” . This involves turning regularly while in bed, using pillows and foam pads to protect bony areas, and avoiding elevating the head of your bed unless advised by your doctor. In some cases, individuals at high risk for pressure sores may be prescribed special mattresses or beds for long-term use.
In addition to pressure relief, it’s important to inspect your skin regularly. Check for any changes in color, blisters, bruises, dryness, or areas that feel hard, swollen, or warm. Pay special attention to high-risk areas like the lower back, tailbone, heels, buttocks, hips, elbows, knees, ankles, toes, bony foot areas, and the back of the head. Use a mirror or ask someone to help you inspect hard-to-see areas, and be mindful of your fingernails and toenails to prevent any potential issues.
If you notice any skin damage or suspect a pressure sore, seek advice and treatment from a professional .
To keep your skin healthy and prevent issues, here are some simple tips:
- Keep Your Skin Clean and Dry: Take a daily bath with mild soap and warm water. Pay extra attention to keeping areas like your groin and skin folds clean and dry. If there’s any leakage of stool or urine, clean and change your clothing immediately. Avoid using harsh soaps, alcohol-based skin products, or antibacterial soaps. Instead, use a moisturizer like vaseline or nivea.
- Proper Seating and Wheelchair: Ensure you have the right cushion for your wheelchair and your comfort. Your wheelchair should be specifically measured for you and match your mobility needs and activities. Try to get a wheelchair that fits you not too small .
- Positioning and Transferring: Sit as upright as possible in your wheelchair to avoid damaging your skin. Be careful when transferring in and out of your wheelchair; don’t drag or scrape your bottom. If you need assistance with transfers, make sure the helper is well-trained.
- Clothing and Shoes: Wear well-fitted clothing without thick seams, rivets, or bulky pockets. Check for folds and wrinkles in your clothes. Shoes should be 1-2 sizes larger and wider than your pre-injury size to account for foot swelling during the day. Opt for shoes with sturdy toe protection to prevent injuries.
- Hydration (Fluid Intake): Drink enough water daily to stay hydrated, but consult your healthcare provider for guidance based on your bladder management routine. Avoid caffeinated drinks as they can dehydrate you and trigger bladder spasms.
- Nutrition: Eat a balanced diet with sufficient protein, fruits, and vegetables (preferably fresh). Good nutrition helps your body tissues stay healthy, rebuild, and fight infections. If you’re unsure about your nutritional status, consider asking your doctor for blood tests or consulting a dietitian, especially if you have conditions like diabetes or hypertension.
- Sun Protection: Be cautious about sun exposure to avoid sunburn, especially if you’re taking medications that make your skin more sensitive. Use sunscreen, limit your time in the sun, or seek shade.
- Equipment Maintenance: Use the equipment prescribed for you, such as seat cushions, mattresses, and pillows, to protect your skin while seated or lying down. Check your wheelchair, mattress, cushions, and transfer boards daily for issues and follow the manufacturer’s maintenance recommendations.
- Temperature Control: Be aware that you’re more vulnerable to cold weather and heat during hot Weather due to changes in circulation and lack of sensation. Avoid hot objects and take precautions in extreme temperatures.
- Circulation: If you smoke, quit smoking. Stay as active as possible to maintain good circulation.
By following these straightforward tips, you can help keep your skin healthy and reduce the risk of skin-related problems.