Bed sores, also referred to as pressure sores, are injuries to your skin and underlying tissue—caused by prolonged pressure on the skin. These sores can be painful, and range in severity. More severe sores can cause tissue damage and infection, which can extend into your muscle and bone.
There are four stages of a bed sore—the later stages being more severe. Identifying which stage your bed sore is will be important for caring and treating the sore. Here’s an overview of the four stages of bed sores.
Stage 1
In the first stage, sores aren’t open wounds yet. You may feel pain around the affected area, but the skin isn’t broken or torn. Although your skin appears red, it doesn’t blanch—this means it doesn’t lose color when you press your finger on it. Your skin temperature may be warmer or cooler, and the sore can feel either firmer or softer than the surrounding area.
Stage 2
In the second stage, your skin breaks open and wears away or forms an ulcer. The ulcer will be sensitive and painful. The sore extends deeper into the skin and can look like a scrape, blister, or shallow crater. Some skin may be permanently damaged or die at this stage.
Stage 3
In the third stage, the bed sore worsens and continues to go deeper into the tissue beneath the skin, forming a larger—but still relatively small—crater. Fat may show in the sore, but not tendon, bone, or muscle.
Stage 4
In the fourth stage, the sore is very deep. It reaches into the muscle and bone, causing extreme damage. In addition to damage to muscle and bone, deeper tissues, tendons, and joints can become damaged as well.
In the later stages of a bed sore (stages 3 and 4), you may experience little to no pain. The absence of pain is due to extensive tissue damage. If the sore progresses, serious complications including an infection of the bone, called osteomyelitis, or blood, called sepsis, can occur.
Unusual Bed Sores
There are situations when a bed sore doesn’t fit into any of the four traditional stages:
- Deep tissue injury: A bedsore may be suspected but unable to be confirmed. This occurs when there’s not an open wound, but the tissues beneath the surface have been damaged. In this case, the sore is referred to as a deep tissue injury (DTI). A DTI can appear purple or dark red and a blood-filled blister may develop. If a bedsore is suspected, then it’s treated as one.
- Unstageable bed sore: An “unstageable” sore means that the stage isn’t identifiable. This happens when the base of the sore is covered by a thick layer of other tissue and pus — appearing yellow, gray, green, brown, or black. Because it’s covered, the doctor can’t see the base of the sore to identify the stage. In this situation, serious skin and tissue damage is present and is oftentimes untreatable.
