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Pressure Sores and Multiple Sclerosis

Posted on March 08, 2021
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Emily Wagner, M.S.

People with advanced multiple sclerosis (MS) are at a higher risk of developing pressure sores due to mobility and sensory issues. One study found that pressure sores have a negative impact on the quality of life for people with MS and can lead to more mobility issues. Fortunately, there are ways to prevent and treat pressure sores if your MS puts you at risk.

What Are Pressure Sores?

Pressure sores (also known as decubitus ulcers, pressure ulcers, or bed sores) are areas of skin that become damaged from sitting or lying in one position for too long. Over time, the blood supply to the area is reduced from the body’s weight, causing the skin to die and form a sore.

Most often, lesions form in places where the bones are close to the skin (known as bony prominences). These include:

  • Elbows
  • Ankles
  • Back
  • Tailbone or buttocks
  • Heels
  • Hips
  • Back of the head
  • Shoulder blades

These are common areas where pressure sores can develop, but this is not an exhaustive list.

Types and Stages of Pressure Sores

Pressure sores develop gradually over time and are classified into four stages depending on the severity of symptoms. Stage 1 is the mildest, while stage 4 is the most severe.

Stage 1

Stage 1 classifies the first sign that a pressure sore may be forming. You may notice a small area of reddened and painful skin that does not turn white when you press on it.

Stage 2

During stage 2 of a pressure sore, the outer layer of the skin begins to break down and forms a blister or open sore. The skin surrounding the area is red, swollen, and irritated.

Stage 3

In stage 3, the tissue begins to die and forms an open, sunken hole (known as a crater) down into the deep layers of skin and fat tissue.

Stage 4

In stage 4, the most severe stage, the sore extends down into the muscle and bone, damaging the tissues, tendons, and joints. Infections may also develop and spread through the crater, worsening the sore.

Other Types of Pressure Sores

In addition to the four stages, two other types of pressure sores can develop: deep tissue injury and unstageable.

Deep tissue injuries can occur when pressure sores develop within the tissues beneath the skin. The skin may be maroon or dark purple, a color caused by a blood-filled blister underneath the skin. If left untreated, deep tissue injuries can quickly develop into a stage 3 or 4 pressure sore.

Unstageable sores do not fit any of the above criteria. These sores are covered in dead skin that is tan, green, yellow, or brown, which makes it difficult to gauge the depth of the sore.

Risk Factors for Developing Pressure Sores

People with MS may have more serious mobility issues as their disease progresses. This factor puts them at a high risk of developing pressure sores if they spend a lot of time sitting or in bed.

Other risk factors include:

  • Bladder or bowel incontinence
  • Older age
  • Decreased sensation in areas where sores may develop
  • Poor nutrition
  • Fragile skin
  • Cardiovascular disorders
  • Diabetes
  • Cognitive slowing, or conditions such as Alzheimer's disease

Preventing Pressure Sores

There are many precautions you can take to prevent pressure sores from forming. These precautions focus on relieving pressure to improve blood supply in the area.

It may help to change positions often and use tools that can reduce pressure. For example, if you are sitting or lying down in bed, it is best to move every two hours. If you are in a wheelchair, move every 15 minutes. Using special cushions, pillows, mattress pads, or booties filled with foam, air, or water may also help support the affected area without pressing down on underlying tissue.

These steps can also help prevent sores from developing:

  • Keep the areas of skin in contact with your bed or wheelchair clean and dry, and moisturize the skin as needed.
  • Check your skin for pressure sores every day. (If you cannot see an area, ask your caregiver to check for you.)
  • Lightly powder your sheets to keep your skin from rubbing on them, which can lead to friction and irritation.
  • To prevent friction, avoid sliding or slipping motions when you move.
  • Eat a healthy diet, which can give your tissues the nutrition they need.

Speak with your health care team or caregivers about what steps you can take to reduce your risk of pressure ulcers.

Treating Pressure Sores

Pressure sores can be easily treated in stages 1 or 2. Be sure to follow the proper wound care instructions given by your health care provider to minimize your risk of progression or infection.

For stage 1 sores, gently wash the affected area with mild soap and water. If necessary, moisturize the skin to protect the area. For a stage 2 sore, clean the affected area with a saline solution (saltwater) to remove loose, dead tissue. Stage 3 and 4 sores need to be treated by your provider, due to the severity of the wound and potential complications.

Your doctor will likely have recommendations for safe, gentle cleansers to use. Avoid using cleansers that contain iodine or hydrogen peroxide, which can damage the skin. After cleansing, cover the sore with a clean, specialized dressing that protects against infection. The right type of dressing depends on the size and stage of the sore but may include gauze, foam, and film.

In general, try to avoid positions that put weight or pressure on the sores, and get plenty of sleep and proper nutrition to help your body heal.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. More than 163,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you dealt with pressure sores with MS? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.

All updates must be accompanied by text or a picture.
Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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