How to prevent pressure ulcers on the buttocks?
The first article in this series identified what a pressure ulcer is and explained how pressure ulcers can form when pressure is applied to an area of the body over a long period of time. This pressure restricts the blood flow through the skin and tissue, starving the body’s cells of oxygen and causing them die and causing the skin and tissue around the area to break down.
The prevention and treatment of pressure ulcers is essential as they can range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle and they can be painful, debilitating and life threatening. (See: What are the stages of a pressure ulcer?)
People with mobility issues are at a higher risk
Most people do not get pressure ulcers because they are continuously moving and adjusting themselves so that no part of their body is under this kind of continuous pressure. It’s uncomfortable for us.
However, people with health or mobility conditions who may be restricted to a wheelchair, bed or day chair are at a higher risk of developing pressure ulcers.
For instance, a wheelchair user’s buttocks are under constant pressure throughout the day and people who are immobile or bed bound patients who are lying stationary for most of the day and night can have constant pressure being applied to the back of their head, shoulder, spine and heels.
Preventing pressure ulcers on the buttocks
As with pressure ulcers on any area of the body, prevention is as important as treatment, if not moreso. Here are a few general guidelines on how to prevent pressure ulcers from forming on the buttocks, as well as other areas of the body:
- Changing position
- Check skin regularly
- Use the most appropriate cushion
- Good nutrition
- Quit smoking
Wheelchair users, and medical professionals in particular, can find more information about finding the right wheelchair cushion to prevent or treat pressure ulcers in the 5th article in this series – Star Cushion Range: Effective prevention and treatment of pressure ulcers for wheelchair users.
Changing position
One of the most effective ways of preventing pressure ulcers on the buttocks and the rest of the body is making regular, frequent changes to your position.
As a general rule:
- Wheelchair users need to change their position at least once every 15-30 minutes.
- People confined to bed will need to change their position at least once every two hours.
If a pressure ulcer has already developed, a regular change of position will help to avoid putting further pressure on it, and give the wound a better chance of healing.
If you are unable to change position yourself, you will need a relative or care staff to assist you.
Check skin regularly
Performing a self-assessment on a regular basis is an important part of preventing pressure ulcers in general, as well as on the buttocks. Make sure that you check your skin on a daily basis for any signs of pressure ulcers, such as discoloured areas of skin. (see – How to tell if I have a pressure sore?)
For checking your buttocks, your can use a mirror or 2 mirrors depending on your mobility or you may need a relative or care staff to assist you if you are unable to check the area yourself. This is a particularly important step if you have known risk factors for pressure ulcers such as mobility issues, or an underlying condition such as nerve damage or diabetes, which may dampen or numb feelings of pain in certain parts of your body.
If you notice any skin damage, report it to your care team immediately or contact your GP or community nurse. If you are in hospital or a nursing home, inform one of your nurses or carers.
Use the most appropriate cushion
There are a range of specially designed pressure-relief cushions and that can relieve pressure on the buttocks and other vulnerable parts of the body, such as the Star Cushion range. Your care team will discuss the types of cushions that are most suitable for you. People with a grade three or four pressure ulcer will require more sophisticated cushions such as the Star Lock Cushion that can redistribute the pressure across the buttocks to relieve area that is under pressure while providing support for the rest of the buttocks.
Good nutrition
Having good nutrition and eating a healthy, balanced diet and that contains an adequate amount of protein and a good variety of vitamins and minerals plays an important role in preventing skin damage and speeding up the healing process.
This is important to note because people who are at risk of developing pressure sores may also have pre-existing health conditions that can cause them to have a reduced appetite. A dietician or nutritional therapist can create a dietary plan to help you to improve your diet and help prevent pressure ulcers.
For people who have a reduced appetite due to a pre-existing health condition, the advice listed from the HSE website may be useful:
- Smaller Meals
Try eating smaller meals throughout the day, rather than the usual two or three larger meals. - Plan Mealtimes
Set a timetable for when you should eat, rather than waiting until you feel hungry. - Avoid Excessive Drinking Before Meals
Avoid drinking large amounts just before you are about to eat as it can make you feel more full than you actually are. - Dysphagia
If you have dysphagia (difficulty swallowing), try drinking specially made nutritional drinks or pureed foods and soups. - Vegetarian High-Protein Alternatives
If you are a vegetarian, it is important to eat high-protein alternatives to meat such as cheese, yoghurt, peanut butter, and beans.
For more information, see HSE.ie.
Quit smoking
Giving up smoking can be an effective step towards helping prevent pressure ulcers. Smoking reduces the levels of oxygen in your blood and weakens your immune system, which increases your risk of developing pressure ulcers.
Treatment of pressure ulcers on the buttocks
Pressure ulcers are a complex health problem whether they are on the buttocks or another area of the body. They can arise as a result many interrelated factors and they can be painful, debilitating and life threatening. Care and treatment of pressure ulcers may be provided by a multidisciplinary team (MDT) made up of different disciplines of healthcare professionals.
This MDT may include:
- a tissue viability nurse (TVN), a specialist in wound care and prevention
- an occupational therapist
- a physical therapist
- a dietician
- experienced medical and surgical experts
The specific treatment of a pressure ulcer can depend on the stage a pressure ulcer has reached.
Changing position
As with prevention, it is important to avoid putting pressure on areas that are vulnerable to pressure ulcers or where pressure ulcers have already formed. Frequently changing your position helps to relieve the pressure on any Stage I or Stage II pressure ulcers that have developed.
If a pressure ulcer has developed, it is imperative that you consult with your local GP or a healthcare professional as soon as possible. Your care team will first perform a risk assessment. Once it is complete they will draw up a ‘repositioning timetable’. For some, this can be as often every 15 minutes. Others may need to be moved only once every two hours.
Mattresses and cushions
Again, the right pressure relieving cushion is important for anyone with a pressure ulcer on the buttocks.
People with pre-existing Stage I or Stage II pressure ulcers usually benefit from resting on a specially designed foam cushion and those with Stage III or Stage IV pressure ulcers can require more effective forms of pressure relieving cushions such as air-chamber cushions.
The Star Lock Cushion is one of the few available cushion capable of allowing for the treatment of a Stage IV pressure ulcer for a person in a wheelchair, while allowing them to remain in their chair. One of the alternatives to this is complete bed rest.
Dressings
There are also specially designed dressings and bandages as well as creams and ointments that can be used to protect pressure ulcers and speed up the healing process. Sometimes, it may not be possible for Stage III or IV pressure ulcers to heal and surgery may be required to seal the wound and prevent any further tissue damage.
Source: HSE: Treating Pressure Ulcers
This article is part 4 of a 5-part series on pressure care and pressure ulcers to help raise awareness of pressure ulcers as part of STOP Pressure Ulcers 2019.
Preventing and Treating Pressure Ulcers with the Star Lock Cushion
The Star Lock Cushion is one of the best pressure care cushions available for preventing and treating pressure ulcers of wheelchair users. It is clinically proven for the treatment Stage IV pressure ulcers.
Click here for more information.
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