What Is a Stage 4 Pressure Ulcer?

When you sit or lay in the same position for an extended period, you risk developing a pressure ulcer. If you or your healthcare provider diagnoses the ulcers early enough, they will heal in most cases, without much pain or discomfort. However, without any medical treatment or intervention, you can go through different pressure ulcer stages as they worsen. 

If you or someone you know is a victim of abuse or neglect, a personal injury lawyer could help you recover damages from sustained injuries.

What Is a Pressure Ulcer?

An elderly man in a wheel chair at risk of a pressure ulcer
Mid section of lonely senior man sitting in wheelchair in bedroom of nursing home and looking through the window

A pressure ulcer is a medical condition where the underlying tissue and the skin in affected areas begin to break down and degrade. This is caused by the tissues not receiving sufficient oxygen and nutrients because the blood flow has been cut off. 

Continued constant pressure on the affected areas will cause necrosis of the tissue where it dies. As it does, it continues to advance through wound stages, causing further damage to surrounding tissues. Eventually, it expands into the bone and creates a deep open wound through the skin as it progresses through the 4 stages of pressure ulcers. 

Are Bed Sores the Same as Pressure Ulcers?

Bed sores are the same as pressure ulcers. Other commonly used terms are decubitus ulcers and pressure wounds. Bed sores can occur in anyone regardless of age. However, they occur more commonly in people confined to wheelchairs and on extended bed rest. 

For example, pressure ulcers can occur in senior citizens in nursing homes who are neglected and left in their wheelchairs or confined to their beds most of the day.

What Is a Stage 4 Pressure Ulcer?

A medical person wrapping a persons foot due to a pressure ulcer

A stage 4 pressure ulcer is the worst of the different pressure injury stages. At this wound stage, the necrosis of the tissue has spread deep into the muscle, tendons, and even bone. There are also increased risks of infections and sepsis1. 

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What Are the 4 Stages of Pressure Ulcers?

Pressure ulcers can occur anywhere on the body. However, the most common areas2 where they occur include:

  • Ankles
  • Hips
  • Heels
  • Tailbone
  • Elbows
  • Shoulder blades
  • Buttocks
  • Lower back

Stage 1 Pressure Ulcer

A stage 1 ulcer is the least severe. The skin can appear red, and it does not become light when applying pressure to the area. The bed sore has only affected the upper skin tissue layers. 

Some of the common symptoms you may notice in the infected area are:

  • Itching
  • Pain
  • Burning

Treating a stage 1 wound requires eliminating the pressure on the infected area. Therefore, keeping all pressure off the infected area until it heals would be best. Additionally, you need to change positions more frequently to reduce the risk of the ulcer returning. Typically, the wound will heal in about three to four days. 

Stage 2 Pressure Ulcer

A stage 2 ulcer will be painful and cause discomfort when touching the infected area because it spreads deeper under the skin. Although, with the proper treatment and care, the wound can heal fully. 

The symptoms associated with a stage 2 wound include:

  • Broken skin
  • Oozing pus and fluid
  • Swelling

Treating the ulcer requires washing and cleaning it several times daily and keeping it dry. In addition, you need to alleviate all pressure off the wound until it heals, which can take between one to three weeks. 

Stage 3 Pressure Ulcer

A stage 3 ulcer expands into the lower layers of the skin and fat tissues. The skin around the wound will start to turn black as it dies. The center of the wound will begin to form a crater. Other symptoms you may notice are:

  • Foul-smelling pus
  • Fluid leakage
  • Slight fever
  • Infection

The wound can also feel warmer to the touch than the surrounding skin. Additionally, there may be very little pain at this stage because the tissue around the wound is dying.

Treatment for a stage 3 wound requires seeing your healthcare provider. The dead skin tissues have to be removed. You also may require an antibiotic to eliminate the infections. With proper medical care, the wound will heal but can take as long as four months. 

Stage 4 Pressure Ulcer

A stage 4 ulcer is the most severe because it has expanded into muscle, tendons, and bone. The wound will be open, and if you look into the crater, you may see deep inside down to the bone. Since the tissues are extensively damaged, there is often no noticeable pain. 

You may notice common symptoms, such as:

  • Infected, black skin
  • Red edges
  • Pus and fluid leakage
  • Unpleasant odor
  • Fever

The only way to treat a stage 4 wound is with medical intervention. First, your healthcare provider must remove dead tissues around the wound. Then, depending on the extent of damage, surgery may be required. You will also need antibiotics to fight the infection. 

It is essential to follow your doctor’s instructions and care if you want the wound to heal. It can take between three months to a year or longer for it to heal fully.  

Pressure Injury Stages: When to Seek Medical Help

A woman wrapping an ulcer on her leg with a medical bandage

Pressure ulcers can occur in anyone who sits for prolonged periods or is confined to bed rest. The best way to prevent pressure wounds is to alternate how you sit or lay in bed. While you can treat stage 1 and stage 2 ulcers at home, if you do not see any change in your symptoms within two to three days, you should see your doctor. 

The longer bed sores go untreated, the more likely they will advance into later stages and cause significant tissue, muscle, tendon, and bone damage.

A personal injury lawyer can help you create a case if you’re dealing with injuries due to neglect or abuse. The team at Jack Bernstein, Injury Attorneys have extensive experience in dealing with personal injury claims due to accidents, neglect, medical malpractice, and more. Contact us today for a free consultation.


  1. Mayo Clinic. Sepsis Symptoms and Causes. Retrieved 13 June 2022.

Mayo Clinic. Bedsores (Pressure Ulcers) Symptoms & Causes. Retrieved 13 June 2022.