What is a pressure ulcer?

A pressure ulcer is damage that occurs on the skin and underlying tissue. Pressure ulcers are caused by three main things:

  • Pressure - the weight of the body pressing down on the skin
  • Shear - the layers of the skin are forced to slide over one another or over deeper tissues for example when you slide down or are pulled up, a bed chair or when you are transferring to and from your wheelchair.
  • Friction - rubbing the skin

The most common places for pressure ulcers to develop are over bony prominences (bones close to the skin). Some of the most common sites are shown below:

Body lying flat on back

Body lying on side                                            Person sitting up in bed

Illustration kindly used with permission of Family and Elderly Health Services, Department of Health, Hong Kong.


Pressure ulcers can develop from external medical devices too such as oxygen masks, casts, catheter tubes, splints, footwear and glasses.

What are the signs to look for?

The first sign that a pressure ulcer may be forming is usually discoloured skin, which may get progressively worse and eventually lead to an open wound.

  • On light - skinned people, red patches of skin that do not go away.
  • On dark - skinned people, bluish/purplish patches that do not go away
  • Blisters, or damage to the skin
  • Patches of hot skin
  • Swelling
  • Patches of hard skin
  • Patches of cool skin

Who is at risk?

Anyone can get a pressure ulcer, but some people are more likely to develop one than others. People with a pressure ulcer are also at risk of developing another elsewhere on their body.

    You are more at risk of getting a pressure ulcer if you:

  • Have problems moving and cannot change position by yourself without help
  • Cannot feel pain over a part or all of your body
  • Are incontinent
  • Are seriously ill or undergoing surgery
  • Have had pressure ulcers in the past
  • Have a poor diet and don't drink enough water
  • Are very old or very young
  • Have damaged your spinal cord and can neither move nor feel your bottom and legs
  • Have heart problems or poor circulation

How to prevent pressure ulcers developing

Pressure ulcers can develop very quickly in some people if the person is unable to move for even a very short time – sometimes within an hour.

Keep Moving

One of the best ways of preventing a pressure ulcer is to reduce or relieve pressure on areas that are vulnerable to damage (see diagrams on page 2). This is done by moving around and changing position as much as possible.

If possible change your position at least every two hours; alternate between your back and sides. If you already have a pressure ulcer, lying or sitting on the ulcer should be avoided as it will make the ulcer worse. People with limited mobility may need to have assistance to change their position by a healthcare professional or a carer.

Use pillows to lift your heels off the bed, or to stop your ankles and knees touching each other especially when you are lying on your side. Image shown is of a lower leg elevated on a pillow to suspend the heel and relieve pressure. The pillow is placed lengthways and extends from the back of the knee to the back of the ankle.

Shared with permission from The Dudley Group Foundation Trust

You may need a special mattress, or seat cushion. Your healthcare professional can advise you on what will be suitable for your needs.

Skin Assessment

Your skin should be assessed regularly to check for signs of pressure ulcer development. How often your skin is checked depends on your level of risk and your general health. You or your carer should inspect your own skin for signs of pressure damage – you may need help to look at awkward areas such as your bottom or heels.

A good diet

Eating well and drinking enough water is very important. It is particularly important for people at risk of developing a pressure ulcer or those with a pressure ulcer. If you already have an ulcer your body will require extra calories to heal. Eating foods high in calories and protein – such as cheese, fish, meat and eggs – can help.

If you do have a pressure ulcer, your healthcare professional may refer you to a dietician for specialist advice.


Urine, faeces and sweat can cause skin damage. It is essential to keep skin clean and dry. Ensure you follow these principles:

Frequent toileting

If you require a continence product, ensure they are fitted by a health care professional

Wash your skin with non perfumed soap, preferably pH balanced, pat skin dry. You may require a barrier product to protect your skin.

Avoid oil based creams such as Sudocrem, Metanium or Conotrane if you wear continence products as they can affect absorbency of the product

Who do you contact for advice / help?

If you or your carers notice possible signs of damage you should tell a healthcare professional immediately.

There are examples of patient’s stories and their experience under the resources section

Further information is available through:

Pressure Ulcer Research Service User Network (PURSUN)

PURSUN UK was set up to improve the quality of Patient and Public Involvement in pressure ulcer research. We are a network of service users, patients and carers who work to ensure that pressure ulcer research is relevant to the public and is carried out in an ethical and respectful way.

Click on this link:

Your Turn

The Your Turn Campaign aims to prevent pressure ulcers through education. We help people understand who is at risk, and what they can do to avoid getting a pressure ulcer.

Click on this link: