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How Pressure Ulcers Form

Even a healthy person can begin to develop pressure ulcers in less than a day if left in one position. It helps to know where how pressure ulcers develop and what you can do to prevent them.

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Unrelieved Pressure

People who can’t move for long periods of time are at risk for pressure ulcers because oxygen and other nutrients can’t easily reach their cells. An immobile person with skin made fragile by age or disease is at even greater risk. This skin heals more slowly.

Shear and Friction

Two forces contribute to pressure ulcers. Opposite, but parallel, sliding motions (shear)—like bone moving down and skin up—compress blood vessels. Surfaces rubbing (friction) can also cause skin to break down.

Moisture Buildup

Skin overfilled with fluid is fragile. And certain kinds of fluid—sweat, urine, or feces—can provide a medium for bacteria growth, delaying healing. Too much moisture carries another risk: it can increase friction.

Poor Nutrition

Cells reproduce slowly if they are poorly nourished. They reproduce even more slowly in a person with an illness or tissue injury. Loss of body weight from poor nutrition makes tissue thin and fragile.

Publication Source: Clark AM, The Osler Medical Handbook, 2nd ed., Management of chronic wounds, Chapter 24, 2006, pp 282-290
Publication Source: Goldman L, Cecil medicine, 23rd ed., 2007, pp 110
Publication Source: Rehm CR, Siebens H, Essentials of Physical Medicine and Rehabilitation, 1st ed., Pressure ulcers, Chapter 130, 2002, pp 699-704
Online Medical Reviewer: Oken, Emily MD
Date Last Reviewed: 9/17/2004
Date Last Modified: 7/9/2002