How to Avoid Pressure Sores
Many people with spina bifida will, at some time or another, develop a pressure sore. This is usually no one's fault and there are many things that can be done to prevent them but, to do this, it is important to understand what causes them.
Causes
Poor circulation below the waist means that the cells don't get adequate supplies of oxygen and nutrients to keep them healthy. Nor do their get rid of all their waste products.
A system of the body called the lymphatic system works together with the circulation to remove fluid and waste products. This also does not work as efficiently in people with spina bifida as it should, so there can be a build-up of fluid in the legs. This is called oedema. All these things together mean that pressure sores can develop very rapidly and then be very slow to heal.
Neurological (nerve) problems associated with spina bifida and the resulting loss of feeling means that little or no discomfort is felt and therefore there is no trigger telling you to move and reduce the pressure on a particular part of the body.
Incontinence will cause the skin to become even more prone to damage as both urine and faeces contain substances that break down the skin and cause it to become infected.
Prevention (reducing the risk)
Change your position
Every 20 minutes lift your bottom off the chair and change the position of your legs. This allows the blood to flow normally for a few seconds (that's all it needs!). If it is too difficult to lift your bottom, then try a change of position; leaning forwards or to one side then the other.
Regular inspection of the skin
Ideally the whole body should be inspected night and morning for signs of any redness or changes in the skin. If you find a red patch and it disappears quickly after you have eased the pressure in that area, there is no cause for alarm. But if the red colour remains, this could be the first sign of a sore developing. A close eye should be kept on this area and no further pressure should be put on it. A long-handled mirror is very useful for inspecting the back and bottom!
Diet
A good balanced diet is essential for both the prevention and healing of pressure sores. An adequate intake of fluids helps to keep the skin supple and hydrated. Complex carbohydrates (bread, rice, pasta) will keep the muscles healthy. Iron-rich food such as spinach, will help the blood carry the oxygen around the body to the cells. Vitamin C and zinc (a mineral) both help wound healing, as does an adequate supply of protein (found in meat, fish and dairy products).
Wear suitable clothing
Avoid clothes that are too tight or have hard seams, zips or buttons that might cause pressure. Good fitting shoes, with the feet put in properly, are essential. Take care when transferring from your wheelchair not to knock or drag the body. Barrier creams such as Sudocrem, Conotrane or Zinc and Castor Oil Cream, can be useful protection for the skin against incontinence but the most important protection is to clean up and change as soon as an accident has happened.
