An ulcer is a sore that forms when a break in a bodily membrane erodes the surface layers of skin or tissue, exposing the underlying layers. This can occur on the skin or on mucous membranes lining internal organs. Ulcers develop from an imbalance between factors that protect tissues and those that cause damage, leading to tissue breakdown.
Underlying Causes of Ulceration
The formation of an ulcer stems from conditions that damage tissue and overwhelm its natural repair mechanisms. One cause is impaired blood circulation. When blood flow is insufficient, tissues are deprived of the oxygen and nutrients needed for cell health, leading to cell death. This can happen when veins struggle to return blood to the heart or when arteries fail to deliver enough blood.
Prolonged, unrelieved pressure on the skin is another cause, particularly over bony areas of the body. This constant pressure compresses small blood vessels, obstructing blood flow and leading to tissue death.
Infection and inflammation are also central to ulcer development. Certain bacteria can cause chronic inflammation that damages protective mucosal layers, allowing acid to injure underlying tissue. Finally, chemical or physical irritation can directly erode tissue surfaces, such as when long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) inhibits substances that protect the stomach lining.
Common Types of Ulcers
Ulcers are categorized based on their location and underlying cause.
Peptic Ulcers
Peptic ulcers are open sores that develop on the inside lining of the digestive tract. Gastric ulcers form specifically in the lining of the stomach, while duodenal ulcers occur in the upper portion of the small intestine, known as the duodenum. The primary causes are infection with H. pylori bacteria and the long-term use of NSAIDs. These factors disrupt the protective mucus layer, allowing digestive acids to erode the tissue.
Skin Ulcers
Skin ulcers are open wounds caused by factors that lead to tissue breakdown. Common types include:
- Venous ulcers, which form around the ankle due to poor blood circulation in leg veins.
- Arterial ulcers, which result from damaged arteries failing to deliver nutrient-rich blood to tissues, often on the feet and legs.
- Pressure ulcers (bedsores), which develop from sustained pressure cutting off blood supply, often over bony areas like heels and the tailbone.
- Diabetic foot ulcers, which arise from nerve damage and poor circulation related to diabetes, making feet vulnerable to injury.
Mouth Ulcers
Mouth ulcers, or canker sores, are small, painful sores that form inside the mouth on the tongue, gums, or inner cheeks. While the exact cause is often unknown, triggers can include minor injury, stress, or certain foods. Most are harmless and heal on their own within a couple of weeks.
Signs and Symptoms
The signs and symptoms of an ulcer depend on its location.
For internal ulcers, such as peptic ulcers, the most common symptom is a burning or dull pain in the abdomen. This pain is felt anywhere from the navel to the breastbone and may worsen between meals or at night. Other associated symptoms include feeling full after eating very little, bloating, belching, and nausea. In severe cases, bleeding ulcers can cause symptoms like vomiting blood, which may look red or black, and passing dark, tarry stools.
External skin ulcers appear as a crater or open sore. The surrounding area may be red, swollen, and tender. The ulcer might look red, yellow, or black and may ooze clear fluid, pus, or blood. Venous ulcers are associated with itchy, thickened skin and swelling, while arterial ulcers can cause the skin to feel cool due to poor circulation.
Diagnosis and Medical Evaluation
Diagnosing an ulcer requires a medical evaluation that begins with a physical examination and a review of your medical history. For skin ulcers, a visual inspection is often sufficient to begin the process.
For suspected internal ulcers, particularly peptic ulcers, an upper endoscopy is a common diagnostic procedure. This involves guiding a thin, flexible tube with a camera (endoscope) down the throat to view the esophagus, stomach, and duodenum directly. During the procedure, a small tissue sample (biopsy) may be taken to test for the presence of H. pylori bacteria.
Blood, stool, or breath tests are also frequently used to detect an H. pylori infection. For skin ulcers related to circulation, a doctor may order imaging studies to measure blood flow in the limbs to assess artery and vein health.
General Treatment Approaches
Treatment for ulcers is directed at addressing the underlying cause, relieving symptoms, and promoting healing. For a peptic ulcer caused by an H. pylori infection, a course of antibiotics is prescribed. If long-term NSAID use is the culprit, a doctor will recommend stopping or changing the medication.
Medications that reduce or neutralize stomach acid, such as proton pump inhibitors (PPIs) and H2 blockers, are used to help peptic ulcers heal. These create a less acidic environment, allowing the damaged tissue to repair itself.
Wound care is central to managing external skin ulcers. This involves using special dressings to keep the wound clean and moist to facilitate healing. For venous ulcers, compression therapy using specialized stockings or bandages helps improve circulation. For pressure ulcers, relieving the pressure on the affected area is the primary goal to allow blood flow to return.