Bed sores on the buttocks are largely preventable with consistent repositioning, proper nutrition, skin care, and the right support surfaces. The buttocks and tailbone are the most common sites for pressure injuries because these bony areas bear your full weight when lying down or sitting in a wheelchair. Preventing them comes down to reducing pressure, minimizing moisture, and keeping skin and tissue healthy enough to resist breakdown.
Why the Buttocks Are So Vulnerable
Bed sores form when sustained pressure compresses the skin and tissue between a bony prominence and an outside surface like a mattress or wheelchair seat. The tailbone, lower back, and hip bones have relatively little fat or muscle padding, so even moderate pressure can squeeze off blood flow to the skin. Without blood flow, tissue starts to die.
Two additional forces accelerate the damage. Shearing happens when your body slides against a surface, pulling skin in one direction while the bone underneath moves in another. This is especially common when the head of a bed is raised too high and gravity pulls the body downward. Friction, the rubbing of skin against sheets or clothing, strips away the outer protective layer and makes skin more fragile. The combination of pressure, shear, and friction is what makes the buttocks the single most frequent location for bed sores in both bed-bound and wheelchair-bound individuals.
Repositioning: The Single Most Important Step
Changing position regularly is the foundation of prevention. For someone who is bed-bound, the traditional guideline is to reposition every two hours. However, a systematic review of repositioning studies found that when a good-quality foam mattress is used, repositioning every four hours can be equally effective at reducing pressure injury rates. The key is consistency: a schedule that actually gets followed beats a more ambitious one that gets skipped.
When repositioning in bed, alternate between lying on the back, the left side, and the right side. A 30-degree side tilt is ideal because it shifts weight off the tailbone and onto the fleshier part of the hip and thigh without concentrating all the pressure on the bony point of the hip. Pillows or foam wedges placed behind the back can hold this angle in place.
Keep the head of the bed below 30 degrees whenever possible. Raising the bed higher creates a sliding force that drags the skin over the tailbone area downward while the skeleton stays in place. If the bed must be elevated for eating or breathing, try to limit the time spent at that angle and reposition promptly afterward.
For wheelchair users, shifting weight every 15 to 30 minutes is the goal. This can mean leaning forward, tilting to one side, or doing a brief lift-off if upper body strength allows. Power wheelchairs with tilt-in-space features can automate part of this process.
Choosing the Right Support Surface
A standard hospital mattress concentrates pressure on a small area. Specialized support surfaces spread that pressure across a larger zone of skin. Options range from high-density foam mattresses and gel overlays to alternating-pressure air mattresses that continuously cycle inflation between different cells. For wheelchair users, pressure-relieving cushions made of foam, gel, or air can significantly reduce the load on the tailbone.
No cushion or mattress eliminates the need for repositioning. These surfaces buy time and reduce peak pressure, but they don’t replace movement. Think of them as a complement to a turning schedule, not a substitute.
Nutrition That Protects Skin
Skin and underlying tissue need adequate calories and protein to stay resilient. When the body is under stress from illness or immobility, nutritional demands go up. Research published in the Indian Journal of Critical Care Medicine recommends 30 to 35 calories per kilogram of body weight per day, with protein intake of 1.25 to 1.5 grams per kilogram per day, to maintain a positive nitrogen balance and support tissue repair. For a 150-pound (68 kg) person, that translates to roughly 85 to 100 grams of protein daily.
Older adults have higher baseline protein needs than younger people. The minimum for maintaining skin integrity in elderly individuals is about 1.0 gram per kilogram of body weight, compared to 0.8 grams for younger adults. Good sources include eggs, dairy, poultry, fish, beans, and protein supplements if solid food intake is limited.
Hydration matters too. Dehydrated skin loses elasticity and tears more easily. Ensuring consistent fluid intake throughout the day, whether through water, broth, or other liquids, helps keep skin supple and more resistant to friction damage.
Managing Moisture and Skin Care
Moisture from incontinence, sweat, or wound drainage softens the skin and makes it far more susceptible to breakdown. Incontinence is one of the strongest risk factors for buttock pressure injuries because urine and stool are both irritating and wet. If incontinence is present, managing it aggressively is essential.
Use a gentle, pH-balanced cleanser after each episode rather than soap and water, which can strip the skin’s natural oils. After cleaning, apply a moisture barrier product to create a water-repellent layer between the skin and any future exposure. Effective barrier ingredients include petroleum jelly, zinc oxide, and dimethicone. These are available in creams, ointments, and barrier films. Apply them after every incontinence episode or at least three times daily if exposure is ongoing.
Absorbent incontinence pads or briefs should be changed promptly when soiled. Leaving wet material against the skin, even briefly, accelerates damage. Bed linens should be smooth and wrinkle-free, since bunched fabric creates localized pressure points and friction.
Checking Skin Daily for Early Warning Signs
The earliest sign of a developing pressure injury is a patch of skin that looks red (or darker than the surrounding area on darker skin tones) and does not turn white when you press on it with a finger. This “non-blanchable” redness means the tiny blood vessels underneath have already been damaged. On lighter skin this appears as a persistent red or purple discoloration. On darker skin it may look violet, dark brown, or simply different in tone from the surrounding area, and the spot may feel warmer or firmer than normal.
Inspect the tailbone, both buttock cheeks, and the hip bones at least once a day, ideally during repositioning or bathing. Use a mirror or ask a caregiver to check areas you can’t see. If you find a non-blanchable spot, take all pressure off that area immediately. Caught at this stage, the damage is fully reversible with pressure relief alone. Left unaddressed, it can progress to an open wound that reaches muscle or bone and takes months to heal.
Reducing Friction and Shear During Transfers
Moving someone in and out of bed or up in a chair is a high-risk moment for skin damage. Dragging the body across sheets creates friction burns, and the sliding motion generates shear forces deep in the tissue. Use a draw sheet or slide board to lift rather than drag. When adjusting someone’s position in bed, raise the whole surface briefly rather than pulling the person upward against the sheets.
Clothing and linens also play a role. Smooth, low-friction fabrics reduce drag. Some facilities use silk-like fitted sheets or heel protectors made from slippery materials specifically to cut friction during repositioning. Keeping skin lightly moisturized (but not wet) also reduces surface friction.
Who Is at Highest Risk
Some people need more aggressive prevention than others. Healthcare providers often use a scoring tool called the Braden Scale to estimate risk, rating factors like mobility, moisture exposure, nutrition, and the ability to perceive pain. A total score of 12 or below indicates high risk, while scores of 13 to 14 represent moderate risk. But you don’t need a formal score to recognize danger. The main risk factors are:
- Immobility: inability to change position independently, whether from paralysis, sedation, severe weakness, or post-surgical restrictions
- Incontinence: frequent or constant exposure to urine or stool
- Poor nutrition: low protein intake, unintended weight loss, or difficulty eating
- Reduced sensation: conditions like spinal cord injury or diabetic neuropathy that prevent feeling discomfort from pressure
- Advanced age: thinner skin, less subcutaneous fat, and slower healing
If several of these factors overlap, prevention measures should be more intensive: shorter repositioning intervals, a higher-grade support surface, more frequent skin checks, and close attention to protein and fluid intake. The more risk factors present, the smaller the margin for error.