06 March, 2026

If you're caring for a loved one who spends most of their time in bed or a wheelchair, there's a particular worry that tends to sit quietly in the back of your mind: the pressure sore. It begins as nothing more than a small patch of redness — barely a wound at all — but left unaddressed, it can develop within days into something deep, painful, and genuinely dangerous.

Pressure sores, also called bedsores or pressure ulcers, are among the most common complications in home caregiving, and yet they are largely preventable with the right approach. The difficulty is that once they take hold, treating them becomes urgent. This guide covers both sides of that equation — how to stop them from developing in the first place, and what to do carefully and correctly when they do.

What Actually Causes Pressure Sores and Who Is Most Vulnerable

The name tells you almost everything you need to know. A pressure sore is an injury caused by sustained, unrelieved pressure on the skin. That pressure restricts blood flow to the area, and when skin tissue is starved of oxygen-rich blood for long enough, it begins to break down and die.

Anyone can develop a pressure sore given the right circumstances, but several factors make the risk significantly higher. Limited mobility is the primary one — people who cannot shift their own weight in bed or a chair are in a constant battle against the pressure building under their bony prominences. Incontinence adds another layer of risk because moisture from urine or stool softens the skin, making it far easier for pressure and friction to cause damage. Poor nutrition matters more than most people realise — the body needs adequate protein and vitamins to keep skin resilient and capable of repairing itself. And conditions like diabetes or spinal cord injuries can eliminate the natural warning system that tells a person they need to move, removing the built-in protection that most of us take entirely for granted.

The Four Stages of Pressure Sores

Understanding how pressure sores progress is essential for catching them early, when they're still reversible.

Stage one is the warning stage. The skin is still intact, but a patch appears red on lighter skin tones or blue-purple on darker ones. The key test at this stage is simple: press the area gently with a finger. If the colour doesn't fade briefly to white when you apply pressure — if it stays red — that's the skin signalling that something is already wrong underneath.

Stage two is where the skin actually breaks. The outermost layer is lost, leaving behind a shallow, pinkish-red wound or sometimes a clear fluid-filled blister. At this point you're looking at a genuine open wound that needs proper dressing and careful management.

Stage three is significantly more serious. The wound deepens into the fatty tissue layer beneath the skin, often appearing as a small crater. You may notice yellowish material at the base of the wound — this is called slough, and it's dead tissue that the body hasn't yet cleared away.

Stage four is the deepest and most dangerous stage, where the damage reaches all the way down to muscle, tendon, or bone. Stages three and four are beyond what should be managed at home — they require professional medical involvement without delay.

What to Do the Moment You Notice a Stage One Sore

Spotting a stage one sore is not a reason to panic, but it absolutely is a reason to act immediately. At this stage, the damage is still entirely reversible — but only if you respond quickly and correctly.

The single most important step is removing all pressure from the affected area completely. If the redness is on the left hip, that person must not lie on their left side again until the redness has fully resolved. No exceptions, no compromises. Pressure is the cause, and removing it is the only way to allow recovery.

Keep the area clean and dry using a gentle pH-balanced cleanser. If incontinence is a factor, apply a barrier cream to protect the skin from ongoing moisture exposure. Covering the site with a transparent film dressing offers two benefits simultaneously — it protects the skin from the friction caused by bedsheets and clothing, while still allowing you to monitor the redness through the dressing without having to remove it and disturb the site.

One thing worth correcting here because it's a remarkably persistent myth: do not massage a pressure sore. The instinct to rub the area to encourage blood flow is understandable, but massaging fragile, already-compromised tissue causes further damage to the structures underneath rather than helping them recover.

How to Dress a Stage Two Pressure Sore at Home

Once the skin has broken, the approach shifts toward what wound care professionals call moist wound healing. The balance matters — a wound that's too dry forms a brittle scab that cracks and impedes healing, while one that's too wet causes the surrounding skin to break down. The goal is the middle ground.

Start by flushing the wound gently with sterile saline solution. Pat the skin immediately surrounding the wound dry with a lint-free gauze pad — not the wound itself, just the surrounding area.

For stage two sores, a hydrocolloid dressing is the most effective choice. These dressings absorb excess fluid from the wound and convert it into a soft gel, which maintains the ideal moisture environment for healing. They also provide a degree of cushioning against further pressure, which matters enormously for an area that will inevitably face continued contact. Perhaps most importantly, hydrocolloid dressings can remain in place for several days at a time. This matters because every dressing change draws warmth away from the wound bed and causes a temporary setback in the healing process — fewer changes means faster recovery overall.

For sores in awkward locations like the tailbone or sacrum, securing the edges of the dressing with micropore medical tape keeps everything properly in place without the aggressive adhesive that would tear at already fragile skin on removal. For more guidance on choosing the right dressings and tapes for sensitive skin, our How to Care for a Wound on Thin or Fragile Elderly Skin guide covers this in detail.

The Two-Hour Rule and the Importance of Repositioning

No dressing in the world can compensate for insufficient repositioning. If the pressure isn't being regularly relieved, the wound cannot heal it's as straightforward as that.

In clinical settings, the standard practice is to reposition a bedbound patient every two hours. For a lone caregiver at home, maintaining that schedule around the clock is genuinely exhausting, but it remains the most important single factor in both prevention and recovery. In bed, rotate between lying on the back, the left side, and the right side in a regular cycle. Use pillows to lift the heels completely off the mattress — heels are one of the most common sites for pressure sores and one of the most overlooked.

For someone in a wheelchair, weight shifting should happen every fifteen to thirty minutes. Even small movements help redistribute pressure enough to make a meaningful difference.

When positioning someone on their side, avoid placing them directly on the hip bone. Instead, use what's called the thirty-degree tilt — angle the person slightly and support their back with a long body pillow so their weight rests on the fleshy, padded part of the buttock rather than directly on the bone.

Building a Daily Skin Care Routine Around Prevention

Prevention is most effective when it's woven into the daily care routine rather than treated as a separate task.

Every morning and evening, check the bony prominences the tailbone, heels, hips, elbows, and the back of the head. These are the points where bone sits closest to the skin surface and where pressure does its damage first. Getting into the habit of a quick visual and tactile check at these sites means nothing develops unnoticed.

Moisturising dry skin is important because dry skin cracks and becomes vulnerable, but overdoing it creates its own problems overly moist or waterlogged skin tears more easily than healthy skin. Apply a good quality moisturiser to dry areas and make sure it's fully absorbed before clothing goes back on.

If your loved one uses incontinence pads, alcohol-free barrier wipes used at each change create a thin protective layer between the skin and moisture. This small step significantly reduces the skin softening and breakdown that moisture causes over time. For more on managing incontinence-related skin care challenges, our Caring for an Elderly Parent with Incontinence guide goes into this in depth.

Recognising the Signs That a Pressure Sore Has Become Infected

Pressure sores involve damaged and sometimes dead tissue, which makes them highly susceptible to bacterial infection. Because of this, knowing the infection warning signs is essential for every caregiver managing these wounds at home.

Contact a GP or call 111 promptly if you notice a foul or unusual smell coming from the wound, thick yellow or green drainage, redness that is visibly spreading outward from the wound's edges, or signs that your loved one is developing a fever or becoming confused. That last combination fever and confusion can indicate that the infection has entered the bloodstream, a life-threatening condition called sepsis that requires emergency medical attention. Our Wound Infection Signs guide covers each of these warning signs in detail and explains clearly when home management is no longer appropriate.

Questions Caregivers Ask About Pressure Sores

How long does healing actually take? A stage one sore can resolve completely within two to three days once pressure is fully removed. A stage two sore typically takes two to four weeks to close. Stages three and four can take months or, in serious cases, considerably longer which is precisely why catching things at stage one matters so much.

Can pressure sores be reversed? In the early stages one and two yes. However, the skin that forms in place of a healed sore is always slightly less resilient than the original tissue, which means prevention has to remain a permanent priority even after a sore has healed.

Should I use a donut-shaped cushion? Despite their intuitive appeal, ring-shaped cushions are actually counterproductive. Research has consistently shown that they reduce blood flow to the tissue sitting in the centre of the ring, which worsens rather than relieves the pressure injury. A flat high-density foam or gel cushion distributes weight far more effectively.

What to Keep Ready at Home

Having the right supplies on hand before a sore develops means you can respond at the earliest stage rather than scrambling to find what you need. A basic prevention and treatment kit should include hydrocolloid dressings for stage two healing and cushioning, transparent film dressings for stage one protection and monitoring, silicone border dressings for high-friction areas like heels and the sacrum, micropore medical tape for securing dressings against sensitive skin, and alcohol-free barrier wipes for protecting skin from incontinence-related breakdown.

Related Guides for Caregivers

Caring for an Elderly Parent with Incontinence: An Honest Guide Wound Infection Signs: How to Tell If Your Cut or Surgical Site Is Infected How to Care for a Wound on Thin or Fragile Elderly Skin: A Practical Guide Post-Surgery Wound Care at Home: What Your Hospital Didn't Tell You