Pressure Ulcer: Bedsore Treatment for Stages 1 through 4

Pressure ulcers are staged—or named—based on symptoms and the extent of damage. This system provides a way of describing the type of pressure ulcer.

Prevention and early diagnosis are crucial to avoid severe problems. Without care, this type of wound can become infected. This can put you at risk of extreme outcomes like sepsis (a full-body response to an infection in your bloodstream).

This article describes pressure ulcer causes, staging, treatment, and ways to prevent this problem.

Illustration by Mira Norian for Verywell Health

A pressure ulcer forms on an area of the skin with prolonged pressure due to immobility. It can also form in areas that remain wet due to constant contact with body fluids like urine or sweat.

The continued pressure reduces blood flow and other fluids to the tissue in the affected area. This causes damage that leads to cell death, skin breakdown, and the eventual formation of an open wound.

The appearance of a pressure ulcer can happen quickly in a period as short as two hours, or it can occur over days. The wound is vulnerable to pain, disability, and infection.

Without correcting the circumstances causing the pressure, the skin damage is progressive. The deterioration eventually spreads to deeper tissue layers, affecting muscles, tendons, and bones.

Having one or more of the following internal and external risk factors for pressure ulcers can make you more susceptible to these wounds:

Internal risk factors for pressure ulcers include:

External risk factors for pressure ulcers include:

Among people with these risk factors, those with spinal cord injuries and those who live in nursing homes have the highest incidence of pressure ulcers.

The staging of pressure ulcer symptoms describes symptoms, the extent of tissue loss, and the anatomical features of each pressure ulcer stage. While there are different classification systems, the National Pressure Ulcer Advisory Panel (NPUAP) included the most recent research and clinical expertise regarding these conditions in its 2016 revision of its staging system to include the following criteria:

Stage 1 (the earliest stage of a pressure ulcer)

Stage 2

Stage 3

Stage 4

Unstageable pressure injury

Deep tissue pressure injury

Treatment of a pressure ulcer depends on the extent of the injury when it is diagnosed. Your healthcare provider and wound team will determine the seriousness of your pressure ulcer and the most appropriate treatment.

Treatment varies based on the site, stage, and potential pressure ulcer complications. Open or broken pressure ulcers often require longer and more complex treatment than closed pressure ulcers.

Treatments commonly used for pressure ulcers include the following:

Conservative treatment (usually adequate for stages 1 and 2 pressure ulcers) includes:

Surgical treatment (may be necessary for stages 3 and 4 pressure ulcers when conservative treatment is not adequate) includes:

Treatment of an infected pressure ulcer typically involves the use of antibiotics or antiseptics to kill or slow the growth of the source of the infection and help prevent the infection from worsening or spreading. Antibiotics may be administered systemically (orally, intravenously, or intramuscularly) or topical with an antibiotic or antiseptic.

Healing time for an infected pressure ulcer can vary based on the stage of the wound when treatment began and the extent of the infection.

Infected ulcers can take longer than uninfected pressure ulcers to heal. In some cases, an infection can develop into a chronic wound or it can spread throughout your body, leading to osteomyelitis (a type of bone infection) as the disease spreads a life-threatening problem like sepsis.

Pressure ulcer healing can vary greatly based on the location and extent of damage when treatment begins. Other factors, such as your general health and medical conditions, can also affect healing.

Healing times can range from days to years. General average pressure ulcer healing times by stage include the following:

Signs of pressure ulcer healing include the following changes:

During the healing process, a pressure ulcer can become infected. Contact your healthcare provider if any of the following occurs:

Your healthcare provider will advise an individualized routine for dressing your pressure ulcer to promote healing. A common routine includes the following procedures:

Taking the following precautions can help prevent pressure ulcers when caring for someone who is at risk for this condition:

If you or a loved one living at home is at risk for pressure ulcers, a healthcare provider and rehabilitation team can help you determine the type of home setup needed to reduce your individual pressure ulcer risk.

Support surfaces reduce the risk of pressure, especially in areas vulnerable to pressure ulcer development. Avoid recycling a previously used support surface until your healthcare provider approves it as being safe for your needs. Beware that your needs can change throughout your care.

Financial coverage (reimbursement) for specialty devices may be available for certain products. Check with your insurance carrier to determine whether these items are covered.

Some common items for a home setup include the following:

A pressure ulcer or pressure injury is an area of skin that breaks down as a result of constant pressure. This problem occurs most often among people who remain in bed or a wheelchair for long stretches.

Treatment varies by person based on the stage of a pressure ulcer when it is found. Other factors such as health problems can also affect treatment options. Stages 1 and 2 pressure ulcers can often improve with conservative treatment. Stages 3 and 4 pressure ulcers can involve severe deep tissue damage that requires surgery.

Preventing the onset of pressure ulcers is the best way to avoid the severe problems that can result. Frequent movement or change of position, proper bedding, cushions, and sound skin hygiene can reduce your risk of having this problem.

Department of Social Services, State of CA. Preventing pressure ulcers: a patient's guide.

American Academy of Physical Medicine and Rehabilitation (AAPM&R). Pressure ulcers and wounds/injury management.

American Academy of Family Physicians. Pressure sores.

Boyko TV, Longaker MT, Yang GP. Review of the current management of pressure ulcers. Advances in Wound Care. 2018;7(2):57-67. doi:10.1089/wound.2016.0697

Mount Sinai. How to care for pressure sores.

Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised National Pressure Ulcer Advisory Panel pressure injury staging system: Revised pressure injury staging system. J Wound Ostomy Continence Nurs. 2016;43(6):585–597. doi:10.1097/WON.0000000000000281

University of Rochester Medical Center. Pressure injuries.

Norman G, Shi C, Goh EL, Murphy EMA, Reid A, Chiverton L, Stankiewicz M, Dumville JC. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database of Systematic Reviews. 2022:4. Art. No.: CD009261. doi: 10.1002/14651858.CD009261.pub7

Norman G, Dumville JC, Moore ZE, Tanner J, Christie J, Goto S. Antibiotics and antiseptics for pressure ulcers. Cochrane Database Syst Rev. 2016;2016(4):CD011586. doi:10.1002/14651858.CD011586.pub2

Model Systems Knowledge Translation Center (MSKTC). Recognizing and treating pressure sores.

University of Washington Rehabilitation Medicine. Taking care of pressure sores.

Consortium for Spinal Cord Medicine. A guide for people with spinal cord injury.

By Anna GiorgiAnna Zernone Giorgi is a writer who specializes in health and lifestyle topics. Her experience includes over 25 years of writing on health and wellness-related subjects for consumers and medical professionals, in addition to holding positions in healthcare communications.