Healing a bedsore depends on how deep it is, but every stage requires the same core approach: relieve the pressure that caused it, keep the wound clean and moist, and give your body the fuel it needs to rebuild tissue. Stage 1 and 2 bedsores typically heal with consistent home care, while stage 3 and 4 wounds often need professional medical intervention and can take weeks to months to close.
Know What Stage You’re Dealing With
Bedsores (also called pressure injuries) progress through stages based on how deep the tissue damage goes. The stage determines everything about your treatment approach.
A stage 1 bedsore looks like a red or discolored patch of skin that doesn’t turn white when you press on it. The skin is still intact. At stage 2, the skin has broken open or formed a shallow blister, exposing a pinkish wound bed. These two stages respond well to conservative care at home.
Stage 3 means the wound extends through the full thickness of skin into the fat layer beneath, often appearing as a crater. Stage 4 is the most severe: the wound reaches down to muscle, tendon, or bone. Both of these stages may require surgical intervention, including procedures to remove dead tissue. If you see black or dark leathery tissue covering the wound, it can’t be staged until that dead tissue is removed, because no one can tell how deep the damage goes underneath.
Relieve the Pressure First
Nothing else you do matters much if pressure is still compressing the wound. For someone in bed, repositioning every two hours is the standard guideline. Studies in long-term care, aged care, and intensive care settings consistently show lower rates of bedsore development and better healing with two-hour intervals compared to longer gaps. Repositioning every four, five, or six hours is not considered safe.
For someone in a wheelchair, weight shifts should happen every 15 to 30 minutes. When repositioning, avoid dragging the person across sheets, which creates friction that tears fragile skin. Use a draw sheet or a lifting device to move them.
The mattress or cushion matters too. Several types of pressure redistribution surfaces can help. High-specification foam mattresses work well for people who can reposition themselves or who receive regular repositioning. Alternating pressure air mattresses cycle air through chambers to shift pressure automatically, though some people find them uncomfortable. Reactive (static) air mattresses spread body weight across a larger surface to reduce pressure at bony areas like the tailbone, heels, and hips. One study of 308 nursing home residents found that a reactive air surface actually outperformed an alternating air mattress: only 5.2% of residents on the static surface developed deeper wounds, compared to 11.7% on the alternating air surface. There’s no single best mattress type, so the choice depends on comfort, the person’s ability to move, and the wound’s severity.
Never use ring-shaped cushions or “donut” pillows. They concentrate pressure around the edges and make things worse.
How to Clean the Wound
Clean the bedsore gently each time you change the dressing. Use a non-toxic wound cleanser or saline solution. Products containing hypochlorous acid are commonly recommended for wounds that are expected to heal. Avoid harsh antiseptics like betadine on healing wounds. These kill the new tissue your body is trying to grow. They’re only appropriate for wounds that aren’t expected to heal, such as those with poor blood supply and dry, hard dead tissue that’s being left in place intentionally.
If there’s dead tissue in or around the wound, it needs to come off. This process, called debridement, can happen several ways. Surgical debridement, where a clinician cuts away dead tissue, is the fastest and most effective method when the surrounding skin is healthy. For wounds with only small amounts of dead tissue, applying a specialized occlusive dressing and changing it weekly encourages the body to break down the dead tissue naturally. Enzyme-based gels placed under an occlusive dressing can also help dissolve dead tissue more actively. Your care team will choose the method based on how much dead tissue is present and whether the wound can tolerate a more aggressive approach.
Choosing the Right Dressing
The goal of any dressing is to keep the wound moist enough to heal but not so wet that the surrounding skin breaks down. The amount of fluid draining from the wound is the main factor in choosing a dressing type.
- Dry wounds: Hydrogel dressings add moisture to a wound that isn’t producing much fluid on its own. These are gel-based and keep the wound bed from drying out.
- Moderate to heavy drainage: Foam dressings, hydrocolloid dressings, and alginate dressings all absorb fluid well. Alginates are made from seaweed-derived fibers that turn into a gel when they contact wound fluid, making them especially effective for heavily draining wounds. They need a secondary dressing on top.
- Light drainage or protective covering: Transparent film dressings let air through while keeping bacteria out, but they don’t absorb much. They’re often used to cover another dressing or to protect a stage 1 bedsore.
Change dressings on the schedule your care provider recommends, or sooner if the dressing becomes saturated, shifts out of place, or starts to smell. Each dressing change is a chance to check the wound for signs of improvement or trouble.
Feed the Wound From the Inside
Your body can’t rebuild tissue without adequate calories, protein, and hydration. Bedsores dramatically increase your nutritional demands. For someone with a stage 2 or higher bedsore who is malnourished or at risk for malnutrition, clinical guidelines recommend 30 to 35 calories per kilogram of body weight per day and at least 1.25 to 1.5 grams of protein per kilogram per day. For a 150-pound person, that translates to roughly 2,000 to 2,400 calories and 85 to 100 grams of protein daily. Fluid intake should be around 30 milliliters per kilogram, or about eight to ten cups of water per day for most adults.
Good protein sources include eggs, chicken, fish, Greek yogurt, beans, and protein shakes if solid food is difficult. Vitamins C and A, along with zinc, support tissue repair and immune function. Many people with bedsores are already undernourished, which is part of why the wound developed in the first place. Correcting that deficit is one of the most impactful things you can do to speed healing.
Recognizing Infection Early
Bedsores are open wounds, and any open wound can become infected. Watch for increasing redness spreading outward from the wound edges, warmth and swelling around the site, worsening pain, a foul smell, or pus-like drainage that changes color. A fever combined with any of these signs suggests the infection may be spreading beyond the wound.
The most dangerous complication is infection reaching the bone underneath, a condition called osteomyelitis. This is a real risk with deep stage 3 and 4 wounds, particularly over the tailbone and hips where bone sits close to the surface. Signs include persistent pain near the wound, fatigue, fever, and swelling that doesn’t improve. Osteomyelitis can block blood flow within the bone and cause permanent bone damage if untreated. It can also lead to joint infection in nearby areas. Older adults and people with weakened immune systems sometimes develop bone infection with very few obvious symptoms, so any wound that stalls in healing or gets worse despite good care warrants medical evaluation.
When Advanced Treatment Is Needed
If a bedsore isn’t improving with consistent repositioning, proper dressings, and good nutrition, more aggressive options exist. Negative pressure wound therapy uses a sealed dressing connected to a gentle vacuum that pulls excess fluid from the wound and promotes blood flow to the area. It’s particularly useful for wounds with heavy drainage or fluid pooling. The device stays on continuously and is changed every few days by a care provider.
Deep stage 3 and 4 wounds sometimes require surgery to close. This can involve cleaning the wound surgically, removing damaged bone if osteomyelitis is present, and using a flap of healthy tissue to cover the defect. Surgical repair is typically considered after the wound has been cleaned, infection is controlled, and nutritional status has been optimized.
Realistic Healing Timelines
Stage 1 bedsores can resolve within a few days to a couple of weeks once pressure is completely relieved. Stage 2 wounds with intact treatment plans typically take several weeks. Stage 3 and 4 bedsores often take months, and some require ongoing management for much longer, especially in people with limited mobility, poor nutrition, or chronic health conditions that slow healing.
Progress isn’t always linear. A wound might shrink steadily for weeks and then plateau. Measuring the wound’s width, depth, and drainage at each dressing change helps you track whether things are genuinely improving. A wound that’s getting smaller, producing less drainage, and developing pink or red tissue at the base is heading in the right direction. A wound that’s growing, smelling worse, or developing dark tissue is going backward and needs a change in approach.