Decubitus Ulcer

Decubitus Ulcer (Bedsore)

A decubitus ulcer or pressure ulcer is an area of skin that breaks down when you stay in one position for too long without shifting your weight. This often happens if you use a wheelchair or you are bedridden, even for a short period of time (for example, after surgery or an injury). The constant pressure against the skin reduces the blood supply to that area and the affected tissue dies.

A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back and the back of the head.

Causes

• These factors increase the risk for pressure ulcers :
• Being elderly.
• Inability to move certain parts of your body without assistance, such as after spinal or brain injury or if you have a neuromuscular disease (like multiple sclerosis).
• Malnourishment.
• Being bedridden or in a wheelchair.
• Having a chronic condition, such as diabetes or vascular disease, that prevents areas of the body from receiving proper blood flow.
• Urinary incontinence or bowel incontinence. (Moisture next to the skin for long periods of time can cause skin irritation that may lead to skin breakdown.)
• Fragile skin.
• Mental disability from conditions such as Alzheimer’s disease. (The patient may not be able to properly prevent or treat pressure ulcers.)

Symptoms

• Pressure sores are categorized by severity, from Stage I (earliest signs) to Stage IV (worst) :
• Stage I : A reddened area on the skin that, when pressed, is “non-blanchable” (does not turn white). This indicates that a pressure ulcer develops.
• Stage II : The skin blisters or forms an open sore. The area around the sore may be red and irritated.
• Stage III : The skin breakdown now looks like a crater where there is damage to the tissue below the skin.
• Stage IV : The pressure ulcer has become so deep that there is damage to the muscle and bone and sometimes tendons and joints.

Role of Noni

Anti-inflammatory and analgesic activities

Noni has an effective anti inflammatory and analgesic property. It helps to check the inflammatory process of the decubitus ulcers, if used it both externally and internally. The ulcer can be dressed with Noni twice a day and also internally Noni should be taken as per the normal dose.

There are so many factors that cause inflammation like bacterial infection, viral infection, any chemical or physical injury to cells, autoimmune reactions etc. The cell membrane is made up of phospholipids. When cell gets injured, the phospholipids convert to arachidonic acids. The arachidonic acid liberates prostaglandins and leukotrienes by the action of COX enzyme and 5LOX enzyme respectively. Those substances prostaglandins and leukotrienes are the potent mediator of inflammation. COX enzyme is of two types, the COX 1 and COX 2. The COX2 is actually the mediator of inflammation. The COX1 has many beneficial effect in our body like protecting kidney cells and healthy mucousa.

Noni is a selective COX2 inhibitor and inhibits the 5LOX enzymes and thus block both the paths of arachidonic acid inflammatory pathways. When both of COX2 and 5LOX enzymes are blocked, inflammatory leukotrienes and prostaglandins are suppressed equally and balance is achieved safely. Noni reduces pain and inflammation effectively and safely.

Antibacterial activity

Scopoletin, acubin, L-asperuloside and alizarin and some other anthraquinone compounds in Noni have antibacterial property against many infectious bacteria strains. Long term use of Noni checks the infection course in all diseases and also can help in decubitus ulcer case.

Cell rejuvenating property

Noni contains all the vitamins, all important trace minerals, 18 amino acids and 150 above phytochemicals. All those micronutrients help to fulfil any cellular micronutrient deficiency and thus prevent the cell from degeneration. Xeronine which is the alkaloid of Noni has the property of rejuvenation and repair of any damage or injured cell. So Incase of ulcerative changes at any area, if Noni is going to be used externally and internally both, then it may help to check the ulcerative process further and can cure the existing ulcer by its cellular rejuvenating property. It is found that Noni gives excellent effect for healing of decubitus ulcer.

Other important management practices for bedsore are

1. Once a pressure ulcer is identified, steps must be taken immediately : 2. Relieve the pressure on that area. Use pillows, special foam cushions and sheepskin to reduce the pressure. 3. Treat the sore based on the stage of the ulcer. Your health care provider will give you specific treatment and care instructions. 4. Avoid further trauma or friction. Powder the sheets lightly to decrease friction in bed. (There are many items made specifically for this purpose). 5. Improve nutrition and other underlying problems that may affect the healing process.

If the pressure ulcer is at Stage II or worse, your health care provider will give you specific instructions on how to clean and care for open ulcers. It is very important to do this properly to prevent infection.

Keep the area clean and free of dead tissue. Your health care provider will give you specific care directions. Generally, pressure ulcers are rinsed with a salt-water rinse to remove loose and dead tissue. The sore should be covered with special gauze dressing made for pressure ulcers.

Do not massage the area of the ulcer. Massage can damage tissue under the skin.

Donut-shaped or ring-shaped cushions are NOT recommended. They interfere with blood flow to that area and cause complications.

Prevention

If bedridden or immobile with diabetes, circulation problems, incontinence or mental disabilities you should be checked for pressure sores every day. Look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores or craters. In addition, take the following steps:

Change position at least every two hours to relieve pressure.

Use items that can help reduce pressure — pillows, sheepskin, foam padding, and powders from medical supply stores.

Eat healthy and well-balanced meals.

Exercise daily, including range-of-motion exercises for immobile patients.

Keep skin clean and dry. Incontinent people need to take extra steps to limit moisture.

Recommended Dosage

Divine Noni Concentrate

5ml morning and 5ml evening for 3 days. Then

10ml morning and 10ml evening for next 3 days. Then

15ml morning and 15ml evening for next 8 months.