Pressure Ulcer Staging

Pressure ulcer staging is critical when determining appropriate treatment. Pressure ulcers develop as a result of limited body movement.

Most of those affected by pressure ulcers have mobility issues like staying in one position for a long time. Prolonged pressure on certain parts of the skin creates bedsores. Most of them heal without treatment. However, there are cases where treatment is paramount.

What are Pressure Ulcers?

Pressure ulcers are also referred to as bedsores. They appear in various forms from closed to open wounds. They form after lying or sitting for a long time in one position and can affect anybody. They are prevalent in people with paralysis, frailty, severe illness, or old age.

These ulcers develop when there is friction or unrelieved pressure on one body part. Mobility reduces and in some cases cuts off blood supply to various body parts damaging surrounding tissues. Common areas where bedsores develop include ankles, back of the head, heels, shoulders, hips, back, butt, and elbows. They form predominantly on the skin covering the body’s bony areas.

If you develop these ulcers, you will realize that they develop in four stages based on the depth of the sores. Some cases are severe. Based on severity, non-stage sores and suspected deep pressure injury are the two types of pressure ulcers that cannot be categorized in any of the four development stages.

Pressure ulcer staging

Staging of bedsores is based on the extent of tissue damage. These stages enable doctors to implement the best course of treatment to guarantee a quick recovery. If diagnosed in the early stages and treated correctly, these sores can be healed within a few days.

Stage 1

This stage is the mildest. It causes the upper layer of the skin to discolor into a reddish appearance. Although the wound is yet to open, the condition extends more in-depth beyond the skin’s surface. The affected parts get sore with no surface tears or breaks. Mild itching or burning sensation is a common occurrence.

When the affected area is pressed firmly, it never turns pale signifying blood flow interruption. Temperature and texture of the developing sore are different from that of the surrounding tissues.


Treatment starts with removing pressure from the affected area. This ease of pressure prevents ulcers from breaking through the skin surface. Position adjustment using pillows, extra padding and blankets can be done. Furthermore, the affected area can be cleaned and dried to avoid tissue damage. Diet should contain more protein, calcium, and iron. It’s prudent to remain hydrated to enhance your skin health.

Developing ulcers in this stage can be healed in three days when diagnosed on time.

Stage 2

This stage features some pain in the ulcer. The sore part breaks through the top skin layer and below. The breakage forms shallow, open wounds that may or may not produce a discharge. The ulcer appears as a serum-filled blister that may have burst. The surrounding skin gets sore, swollen, or red indicating tissue damage or death.


Treatment starts by removing pressure from the wound and seeking medical attention. Keep the affected area dry and clean. Clean the sore with mild, sterile saltwater solution to ensure the wound is dry. Once the ulcer is clean and dry, your doctor properly bandages the wound.

Monitor the ulcer for any infection signs like red skin, worsening pain, fever, and pus. The healing process from this stage takes three days to three weeks.

Stage 3

At this stage, the ulcers have wholly broken through the top two skin layers and have entrenched into the fatty tissue below. The third stage bedsores resemble a crater and may smell bad. Look for infection signs that include discolored drainage, foul odor, redness, and pus.


Seek immediate medical attention since these sores require special attention. Your doctor may remove any dead tissue and prescribe antibiotic therapy. Therapy promotes healing and prevents or treats infections. Doctors recommend a special bed or mattress if you are immobilized to relieve pressure from all the affected areas. Bedsores in stage three require between one and four months to heal.

Stage 4

This stage is the most severe. Ulcers break below the subcutaneous fat layer to affect deep tissues like tendons, muscle, and ligaments. In some cases, they extend to the cartilage or bone. Ulcers are extremely painful, and the risk of infection is quite high. Expect to see exposed muscles, dead skin tissue, drainage, and sometimes bone.

The skin turns black and a dark, hard substance, eschar, develops in the ulcer.


At this stage, patients need to get to hospital immediately. Doctors may recommend surgery to repair the affected tissues. Recovery takes three months to two years to ensure that bedsores heal completely.

Additional types

Unstageable pressure ulcers and suspected deep tissue injury are the types of bedsores. Ulcers that arise from suspected deep tissue injury are challenging to diagnose. It resembles a stage one or two sore on the surface. It may also be as deep as stage three or stage four wounds below the discolored skin surface. They can be covered with eschar or may resemble a blood blister.

The Unstageable pressure ulcers are also challenging to diagnose. The bottom of these sores is covered by eschar or slough. The depth of the wound is determined after it is thoroughly cleaned. These ulcers are green, yellow, brown, or black from the slough. Surgery is required to remove extensively damaged tissues.

Nonetheless, if the covering is stable and dry, it’s advisable not to touch it depending on its location on the body. Dry eschar is a natural layer of protection developed by the body.

Symptoms of Pressure Ulcers

Based on depth, severity, and other characteristics, bedsores are categorized in several stages. Their primary symptoms include:

  • Tender areas
  • Unusual skin texture or color changes
  • Pus-like draining
  • A skin area that feels warmer or cooler to the touch than surrounding areas
  • Swelling

Causes of Pressure Ulcers

Bedsores are caused by constant pressure on the skin that prevents normal blood circulation to various body parts. The primary factors that cause these sores are:

  • Friction: It arises when the skin rubs against bedding or clothing. It makes skin vulnerable to injury, especially in the cases where the skin is moist.
  • Pressure: Constant pressure lessens blood flow to various body parts. Inconsistent blood circulation causes nearby skin and tissues to be damaged and in some cases die. People with limited immobility tend to develop these sores.
  • Shear: This arises when two surfaces move in opposite directions. For example, sliding down a bed that is elevated at the head causes shearing.

Risk Factors of Pressure Ulcers

Immobility while seated or in bed caused by poor health and old age increases the risk of developing pressure sores. Other risk factors include:

  • Poor nutrition
  • Lack of sensory perception
  • Poor hydration
  • Medical conditions affecting blood flow.

How to Prevent Pressure Ulcers

Frequent re-positioning to avert stress on the skin is one strategy of preventing bedsores. Other methods include managing stress, taking good care of your skin, exercising daily, quitting smoking, and maintenance of good fluid and nutrition intake.

When to Call a Doctor

If you discover a suspicious area of blistering or redness on a patient, contact the doctor promptly. Call your doctor in the cases of excessive pain and whenever there are signs of infection. Simple bedside treatments get rid of stage one and two sores. Nonetheless, stage three and four sores can require reconstructive surgery to repair the damaged areas.

Bedsores can get fatal if left unattended. However, with the implementation of the preventive measures, you are assured to avert the risks of developing pressure ulcers significantly.

Last Reviewed:
June 23, 2018
Last Updated:
June 24, 2018