Bed Sores: Causes, Stages And Using Pressure Cushions

Sally Madeley-Carr, OT
18 Aug 2020

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Pressure sores may develop if you sit down or lie in the same position for a sustained period of time.

Also called bed sores or pressure ulcers, they are localised areas of skin which deteriorate, causing inflammation and sometimes bleeding to body tissue.

Parts of the body where bones are close to the skin's surface are typically most at risk, like the tailbone, ankles, heels, elbows and in some cases the hips.

If you have lost weight, this may also lead to less fatty tissue, further increasing susceptibility.

People who are bedbound or whose condition means they are not able to use their usual range of motion, are the most vulnerable to bed sores.

Compressed blood vessels because of sustained pressure leads to restricted flow and a pressure sore develops.

There are several 'stages' of pressure sore, marking their degree of severity. Stage one is an inflamed area of skin, which does not become pale in colour when pressure is applied with the tip of the finger.

Stage two is an open sore or a blister, and the site of the lesion may cause irritation.

Stage three involves degradation through the whole depth of the skin through to the flat layer, creating a 'crater' in the surface of the skin.

Stage four sores are a depth of wound which reaches the underlying muscle, bone or tendon tissue.

General purpose of pressure relief cushions

The overriding goal of a pressure cushion is to reduce weight on a vulnerable site of the body. This is typically accomplished by spreading downward force over larger areas.

Cushions are also designed to cut friction which can occur when skin rubs against a surface and increase the likelihood of developing a sore.

Because they tend to be used for prolonged periods, most cushions for pressure sores are also 'breathable'. This means they allow some degree of air flow, reducing the chance of sweat build-up on the skin's surface, which may cause discomfort and worsen any lesions.

Risk levels

Dependent on their physical condition, there are also four levels of risk which someone might have of developing pressure ulcers: low risk, medium risk, high risk and very high risk. Essential Aids does a range of cushions designed for the various levels.

It is of vital importance that the level of risk for any individual is assessed by a doctor or other medical professional who has first-hand knowledge of the person concerned.

Generally speaking, cushions designed for low and medium risk individuals are made with foam, sometimes with gel or air filled pockets.

High and very high risk cushions may have cells powered by pumps, which move the precise location of weight, ensuring pressure is not maintained on a localised area of skin.

This type of cushion is sometimes called 'active', while the standard versions are 'static'.

Choosing a cushion

It is essential that you receive guidance from a qualified medical professional who will assess your particular risk level and advise on the type of cushion which is suitable.

They will consider your specific personal circumstances in combination with the seating or bed in which you'll be using the cushion.

Pressure relief cushions at Essential Aids

Essential Aids supplies a range of cushions, either for pressure relief or general wheelchair comfort. Here we'll run down some of the most popular and talk about where they might be practical.

Foam cushions

A simple foam option is the Visco Wave Cushion, designed to be comfortable while distributing weight evenly.

The special 'wave' surface of the high density foam allows the skin to breathe while still being supportive.

It is a popular choice for wheelchair use or for day-care centres, for people in the low or medium risk of pressure sores category.

Like many in the Essential Aids range, it features a removable cover which can be easily cleaned.

This is also the case with the Coccyx Wave cushion. This is similar to the standard Wave, but provides extra comfort in the tailbone area.

Many people experience sensitivity in this part of the body, sometimes exacerbated by having to sit down in the same position for long periods of time.

As well as the wave pattern of the foam surface, the cushion features a special form insert, providing softer feeling padding at the base of the spine. Again, this cushion is great for wheelchair users.

Also designed for special localised pain relief at the base of the spine is the 'Economy Coccyx Wedge'. Rather than having different foam for the tailbone area, this cushion has a cut-out so that it is able to 'float' without pressure or contact.

The wedge is designed to gently tilt the pelvis in a forward direction, assisting good spinal posture. Made from medium density polyurethane foam, it comes with a machine washable Velour cover and a carry handle.

A cost-effective and very popular option in this category is the 'Harley Pressure-Tex Cushion'. Suitable for those at medium risk of pressure sores it is made of soft foam with crossed grooves cut into the top surface.

Its design makes for a 'breathable' pad which does not get too hot when in use. Like many of the Harley cushions, it comes with a removable Dartex cover which can be easily washed.

The Harley cushions are all available in a range of sizes, so you will be able to find one suitable for your chair.

Gel cushions

The pressure relieving properties of gel inserts have a long-standing reputation for effectiveness.

One of the best sellers of this type of cushion is the 'Gel Cushion Plus'. It is constructed using a combination of high resilience foam, visco elastic foam and inserts of silicon gel.

It is suitable for people already experiencing pressure sores, as well as those in the high risk category of developing them. It is appropriate for use on wheelchairs seats, or other seating used for extended periods of time.

With a user-weight tolerance of up to 20 stone, the Gel Cushion Plus comes with a removable PU cover which features a zip opening. It also has a non-slip surface on the base, meaning it doesn't slide around once in place.

This feature is something to consider when buying a pressure relief cushion. Depending on the seat on which it is used, some may have the potential to slip out of place.

The problem of sliding off of one's seat is another issue faced by certain people because of their condition. We'll come on to a product designed to solve exactly this problem further down.

Haemorrhoid cushions

Haemorrhoids impact many people in the UK and can cause great discomfort and pain when sitting down. One long standing method to combat this is the use of a 'ring cushion'.

As the name suggests, these are circular cushions which have a central aperture where very little pressure is applied to the posterior and specifically the area of the haemorrhoids.

Essential Aids supplies a number of options to do precisely this job. The Dunlopillo Ring Cushion for example, has the classic round shape, with an aperture of around five inches in diameter.

Constructed from bacteria-static latex foam, it is supportive and comfortable to sit on. It is also available with a flame retardant cover.

The Harley Proform Cushion (Ringo) is another cost-effective model which has a cut out in the centre.

Made from very lightweight foam, it has a surface made up of small pyramids, promoting air-flow. This is aimed at keeping the user as cool as possible.

The weight of this cushion makes it easy to transport, and it comes with a cover made from faux suede, which is soft to the touch.

Pressure relief cushions for the severely overweight

Many standard pressure relief cushions have a user weight limit topping out at about 20 stone.

If you are overweight and in the bariatric category, you might need something more robust and specialist, especially if you are at high risk of pressure sores.

For those in this situation, the Harley Bari-Care Designer Sculpted Cushion might be the solution.

Suitable for individuals weighing up to 40 stone, it has a three-layer construction, each designed to work with the others to offer support and even weight distribution.

The contoured base of this wheelchair cushion is intended to keep the user in a good sitting posture and promote stability.

It is six inches deep, features welded seams, a two-way stretch vapour permeable cover and an anti slip coating on the base.

One-Way Seat Slide

Ideal for armchairs, wheelchairs or even in bed, the One-Way Seat Slide has an ingenious design which has an easy-slide surface.

This allows the sit to slide smoothly into position, but prevents the user slipping forward. While not a pressure relief cushion, it does have a removable foam pad, to improve comfort.

Using a leg rest

Some people find using a leg rest can considerably improve their comfort. These may be situated either in front of an armchair or sofa.

As well as the wide range of pressure relieving cushions Essential Aids supplies, there is an extensive range of leg and foot rests. We'll come on to the details of some of the items in a future blog post.