The most common pressure injury is also the hardest to treat. Here's why

It usually starts with something small. A daughter helps her father turn onto his side, the way the nurse showed her, and notices a patch of pink skin at the base of his spine.

It does not look like much. It does not hurt him yet. But anyone who has cared for a bedridden loved one knows that this little mark can be the first sign of one of the most stubborn problems in home care: a pressure injury.

In hospitals, nursing homes and home care settings alike, pressure injuries affect anyone who spends extended time lying or sitting in one position.

Roughly one in eight hospitalized adults worldwide develops one, according to a meta-analysis of more than 2.5 million patients published in the International Journal of Nursing Studies. Among nursing home residents, pooled prevalence runs above 11%.

The most vulnerable spot, by a wide margin, is the sacrum, the broad bone at the base of the lower back. Clinicians refer to pressure injuries in this area as sacral wounds.

Below, Dimora Medical looks at the causes and care of these common pressure injuries.

Why the sacrum is the hardest place to heal

The sacrum accounts for around 40% of pressure injury cases in some clinical series and as much as 51% in a recent large-scale study of community-acquired injuries.

Sacral wounds are also stubborn to heal. One 2025 review by the Brazilian Society of Dermatology calls pressure injuries "one of the most challenging clinical problems" in medicine, noting that they harm patients "in emotional, psychological, physical and social aspects." Three things explain why this spot is so difficult to treat.

First, movement in bed can cause shear. When a patient slides down in bed, even slightly, the skin stays put while the tissue underneath shifts, tearing the tiny blood vessels that keep deep tissue alive. Wounds here are often far worse beneath the surface than they look.

Second, the location creates its own problems. Wounds at the base of the spine sit close to the groin, and are regularly exposed to sweat, urine and stool. Skin that stays wet breaks down fast, and there is a constant risk of infection.

Third, the shape of the area makes it hard to keep a wound dressing in place. The lower back curves, the skin folds between the buttocks, and the whole area shifts every time the patient moves. It is a hard place to keep any dressing attached.

For years, standard dressings made these problems worse rather than better. Gauze drapes well over curves, but it does not stay anchored on a part of the body that is always moving, and it cannot hold fluid under a patient's weight. It slips, it leaks, and it needs constant changing, disturbing fragile skin each time. Thankfully, dressing design has been catching up.

What good sacral care actually looks like

As an alternative to standard dressings, clinicians can reach for dressings that pair a superabsorbent core with a soft silicone surface: one to handle the fluid, the other to protect the skin.

Start with absorption. Where gauze soaks through and presses fluid back against the body, a superabsorbent core pulls fluid in and traps it, even under a patient's full weight.

Shape matters too. Standard dressings are flat squares, built for flat surfaces. Newer designs have broader coverage, are cut specifically for the sacral area (following the curve of the lower back so edges stay down), and the dressing holds its position as the patient moves. A soft silicone surface grips gently and lifts away cleanly without disturbing healing skin.

The approach has clinical backing. In a study covering 171 patients treated by 55 clinicians, superabsorbent dressings were rated as having good absorbent capacity in 98% of cases, and clinicians reported less damage to the skin around the wound.

Of course, no dressing works in isolation. It has to sit within a broader care routine, and international guidance is clear on the basics: Turn the patient every two to three hours, and do not expect a mattress or cushion to do that job for you. But dressings are a solid second line.

The cost question

Superabsorbent dressings do cost more upfront than traditional gauze. However, a dressing that stays on for days instead of hours means fewer changes, fewer supplies, and less damage to healing skin. For hospitals and nursing homes, it also means fewer nursing hours.

One clinical study tracked what happened when a group of patients switched to a superabsorbent dressing. Costs fell by almost half, not because the dressings were cheaper, but because patients needed fewer of them and nurses spent less time changing them.

For family caregivers, many of whom have no formal medical training, ease of use is an important consideration. In home care, dressings that remain securely in place and require less frequent attention can help simplify daily care routines, reducing some of the practical burden on caregivers.

Pressure injuries will keep forming where bone meets bed. But caught early and covered well, the pink patch the daughter spotted on her father's back can stay exactly what it was that morning: a warning, not a wound.

This story was produced by Dimora Medical and reviewed and distributed by Stacker.