Decubitus Ulcer Definition, Reason, Symptoms, Treatment & Prevention

Decubitus Ulcer Definition, Reason, Symptoms, Treatment & Prevention


Decubitus ulcers, also known as  bedsores  or  pressure ulcers  , are sores (ulcers) on the skin and tissues under the skin due to excessive pressure on the skin. 

This condition most often occurs on the skin covering bony areas of the body, such as the heels, ankles, hips, and buttocks.

People who are most at risk of developing decubitus ulcers are those who have limitations changing their body position due to certain medical conditions.

Those who spend most of their time in bed or in a chair with limited movement are also at risk.

Most wounds can indeed improve with proper treatment. However, some others cannot disappear completely.

Various steps can be taken to prevent decubitus ulcers and support the healing process.

Decubitus Ulcer Symptoms 

In those who use a wheelchair, decubitus ulcers most often develop on the skin around the buttocks, back, spine, or the backs of the arms and legs where they are attached to the chair.

In those who spend most of their time in bed, the most common locations for decubitus ulcers are on the back or side of the head, back, hips, lower back, buttocks, heels, ankles, and the back of the knees.

Some of the signs and symptoms of decubitus ulcers that can appear include:

  • Unusual changes in skin color or texture
  • Swelling
  • There is a liquid that resembles pus
  • Areas of skin that feel colder or warmer than other areas
  • There is tenderness in certain parts of the body

Decubitus ulcers can be categorized based on the degree of severity, which depends on the depth, size, and other characteristics of the wound.

The degree of skin and tissue damage also varies, from skin that looks reddish to deep wounds involving muscles and bones.

Based on  the Pressure Ulcer Advisory Panel  (NPUAP), decubitus ulcers are classified into six degrees, namely:

  • Degree 1:  the skin in the protruding bone area looks reddish, feels pain, until there is a change in temperature to become colder or warmer than the surrounding tissue
  • Grade 2:  part of the dermis skin begins to disappear and causes open shallow ulcers characterized by redness at the base of the wound without any ulcers or  slough
  • Degree 3:  the skin is disappearing so that the fat under the skin begins to appear. At this stage, no bones, tendons, or muscles are visible
  • Grade 4:  bones, tendons and muscles are visible. At the base of the wound will appear  slough  and/or eschar (dead skin tissue that covers the wound)
  • Unspecified depth:  in this degree, the wound bed cannot be seen due to  slough  and/or eschar
  • Deep pressure injury / deep pressure sores:  pressure sores with suspected deep tissue damage to intact skin, which is characterized by the appearance of a dark red or purple discoloration

Decubitus Ulcer Reason

Here are some causes of decubitus ulcers: 

1. Pressure

The main factor in the occurrence of decubitus ulcer disease is constant pressure on certain parts of the body. That pressure ultimately impedes blood flow to the body’s tissues in the area. 

In fact, blood flow is important for delivering oxygen and other nutrients to a tissue. Without these essential nutrients, the skin and tissues there can be damaged.

In people with limited mobility, this pressure generally occurs in areas that do not have a solid layer of muscle or fat, such as the spine, coccyx, back, hips, heels and elbows.

2. Friction

Same with pressure, friction or friction can occur when the skin is in constant contact with clothes or sheets. 

This can make the skin more susceptible to damage, especially when the skin is damp.

3. Exfoliation

This one cause can occur when two surfaces move in opposite directions. For example, when the bed is raised at the head, a person may fall down. 

When the coccyx moves down, the skin can remain attached to the mattress, which causes the skin to peel. 

Risk Factors 

Decubitus ulcers can occur if a person has risk factors, such as:

1. Immobility

This condition can be caused by poor health, spinal injuries, and other causes.

2. Reduced Sensory Perception

Neurological disorders, spinal injuries, or other conditions can trigger loss of sensation.

Difficulty feeling pain or discomfort can occur due to a person not being aware of the danger signs of a decubitus ulcer and the importance of changing positions.

3. Poor Nutrition and Hydration Status

Everyone needs sufficient fluids, calories, protein, vitamins and minerals in their daily diet, including those who are sick. 

This is useful for maintaining skin condition and preventing tissue damage.

4. Medical Conditions Affecting Blood Flow

Health problems that affect blood flow, such as diabetes and vascular disease, can increase the risk of tissue damage.

5. Incontinence

When someone who is on bed rest has  incontinence problems  or is unable to hold urination and/or bowel movements so that he often wets the bed or unknowingly defecates, his skin will unknowingly come into continuous contact with urine and feces.

If this condition occurs frequently, the skin is prone to developing decubitus ulcers.


In diagnosing decubitus ulcers, the doctor will conduct a detailed medical interview to ask about signs and symptoms of decubitus ulcers that you are experiencing, what risk factors you have, and what diseases or treatments you are currently undergoing. 

After the medical interview, the doctor will carry out a physical examination in the form of observing the skin to see the signs and severity of the decubitus ulcer.

The degree of severity needs to be known to help determine the next treatment for decubitus ulcers. 

Other investigations, such as a blood test can be considered to determine the patient’s condition, as well as to see if there is an infection that extends from the decubitus ulcer. 

Decubitus Ulcer Treatment 

Treatment of decubitus ulcers mainly involves reducing pressure on the involved body parts, treating wounds, managing pain, preventing infection, and maintaining good nutrition.

Approaches from various aspects of wound care require a multidisciplinary team in its management. 

Considering that everyone’s condition can be different, you should consult with a surgeon to plan which action is appropriate.

In general, here are some ways to treat decubitus ulcers, namely:

1. Lowering the Pressure

The first step in dealing with decubitus ulcers is to reduce pressure and friction on the body parts involved. 

Some strategies that can be followed are to change positions at least every hour while sitting and every two hours while lying in bed. 

In addition, bearings can also be used to reduce pressure on certain body parts.

2. Cleaning and Caring for Wounds

Handling decubitus ulcers depends on the depth of the wound experienced. In general, cleaning and caring for a wound involves treating it with saline and applying a bandage.

3. Lifting Damaged or Dead Networks

To aid the healing process, tissue that has turned into a scab or died usually has to be removed. This aims to help the growth of new, healthier skin. 

In removing dead skin tissue, the surgeon will perform a small operation known as  debridement . 

4. Drugs 

Several types of drug therapy can be given to people with decubitus ulcers to reduce pain or treat infection. 

For example, painkillers belonging to the NSAIDs class such as  ibuprofen  or  diclofenac . Antibiotic drugs in the form of oral medications or ointments can be used to help treat existing infections. 

5. Surgery

Decubitus ulcers that are large and cannot be treated with other methods of treatment may require a surgical procedure.

Not only cleaning dead tissue, the surgeon will help close the open wound using healthy tissue from the patient’s skin. 

6. Fulfillment of nutrition

Apart from the methods above, to speed up the recovery process for decubitus ulcers, you are advised to fulfill your daily nutritional needs.

Adequate nutrition every day, especially protein and vitamins such as vitamins A and C, can help accelerate the growth of new skin.  


Decubitus ulcers can be prevented in several ways, such as:

  • Change positions frequently to avoid excessive and persistent pressure on certain body parts
  • Consider a few things about changing positions, namely trying to change positions at least every hour while sitting in a wheelchair. Also try to find a wheelchair that is flexible and can tilt
  • Also choose anti-decubitus mattresses, pillows or sheets that help reduce pressure on certain body parts
  • Do also raise the back of the bed in the area of ​​​​the head of about 30 degrees
  • In addition, it is advisable to keep the skin clean and dry, use lotion and check the skin regularly for signs of decubitus ulcers.
  • Implement adequate nutritional and fluid intake, avoid smoking, control stress well


Decubitus ulcers that are not treated immediately can cause complications, including:

1. Cellulitis

Cellulitis  is an infection of the skin and soft tissue characterized by inflammation, swelling, and feeling warm in the infected area. 

2. Bone and joint infections

Infection in decubitus ulcers can spread to the surrounding bones and joints, as a result the function of the surrounding bones and joints can be disrupted.

3. Sepsis

Although rare, decubitus ulcers can be a source of infection that can spread to the blood and be fatal.

4. Cancer

As a result of a wound that does not heal for a long time (marjolin ulcer) it can change to squamous cell carcinoma. 

When to See a Doctor?

Immediately go to the doctor if you find the signs and symptoms of decubitus ulcer above.

Especially if the sufferer has risk factors, for example bed rest for too long and signs of infection such as fever, sores emitting pus, and also swelling.

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