Preventing pressure sores on the buttocks comes down to reducing the time any single area of skin bears your body weight, keeping skin clean and dry, and making sure the body has the nutrition it needs to maintain healthy tissue. The buttocks are one of the most common sites for pressure injuries because two sets of bony prominences sit just beneath the skin there: the sacrum (the triangular bone at the base of your spine) when you’re lying down, and the ischial tuberosities (your “sit bones”) when you’re in a chair. Prolonged pressure over these bones squeezes blood out of the soft tissue sandwiched between bone and surface, starving it of oxygen and eventually causing damage that can start deep and work its way outward.
Why the Buttocks Are So Vulnerable
When you sit or lie on your back, your full body weight concentrates over a surprisingly small area of bone. The tissue between the bone and the mattress or cushion gets compressed, cutting off blood flow. If that compression lasts long enough, cells begin to die. This process, called ischemia, is the root cause of every pressure sore. Deep tissue injuries, the most severe form, actually originate right at the bone-muscle interface before any visible damage appears on the skin surface. That’s why prevention matters far more than treatment: by the time you can see a sore, significant damage may already exist underneath.
Repositioning: The Single Most Important Step
Changing position regularly is the foundation of pressure sore prevention. International guidelines recommend repositioning every two to three hours for anyone at risk, provided they’re also using an appropriate support surface (more on that below). Intervals of four hours or longer are not recommended as a routine schedule. For people who are critically ill or have poor circulation, even more frequent shifts may be necessary.
The ideal schedule depends on the individual. Factors that matter include how much you can move on your own, how well your skin tolerates pressure, your overall health, and what surface you’re lying or sitting on. Someone who can do small weight shifts independently may safely go a bit longer between full repositioning. Someone with thin, fragile skin or circulation problems may need more frequent changes.
If you use a wheelchair, pressure relief lifts or forward leans every 15 to 30 minutes help unload the sit bones. Even small shifts redistribute weight enough to restore some blood flow.
The 30-Degree Side-Lying Position
When repositioning in bed, the 30-degree side-lying position is one of the most effective ways to take pressure off the sacrum and tailbone. At this gentle angle, most bony landmarks on the buttocks and hips remain free of contact with the mattress, and you avoid putting weight directly on the hip bone (greater trochanter), which is itself a common pressure injury site.
To set up this position:
- Place a pillow or foam wedge behind the back to hold the 30-degree tilt
- Put a pillow between the legs and knees to prevent bone-on-bone contact
- Position the feet so heels are off the mattress or protected by a pillow
- Consider placing the top leg slightly in front of the bottom leg rather than stacking them directly, as long as it doesn’t increase pressure on the hip
Avoid ring-shaped or “doughnut” cushions. They concentrate pressure around their edges and can actually make things worse.
Choosing the Right Support Surface
Mattresses
A high-specification pressure redistribution foam mattress is the recommended first choice for anyone at risk. These are denser and more engineered than a standard hospital or home mattress, distributing weight more evenly across the body. If someone develops a sore despite a good foam mattress, or if their risk level is moderate to high, the next step is typically an alternating pressure air mattress. These active surfaces inflate and deflate cells in a cycle, constantly shifting where pressure falls. Other options include reactive air surfaces, low-air-loss mattresses that also manage heat and moisture, and medical-grade sheepskin overlays.
Wheelchair Cushions
Not all wheelchair cushions are equal when it comes to protecting the sit bones. Foam cushions are the most affordable but redistribute pressure less effectively than other types. Gel cushions place gel specifically under bony prominences and provide noticeably better pressure distribution than foam. Air-cell cushions tend to offer the greatest pressure relief of all three types, with research showing they significantly reduce tissue stress in the seated buttocks compared to foam. The tradeoff is higher cost and the need for occasional maintenance (checking air levels, for example). If you spend many hours a day in a wheelchair, an air or gel cushion is a worthwhile investment.
Keeping Skin Clean and Dry
Moisture from sweat, urine, or stool softens skin and makes it far more vulnerable to breakdown. For anyone dealing with incontinence, cleaning the skin promptly after every episode is essential. Use a gentle cleanser rather than soap, pat dry instead of rubbing, and apply a barrier cream or ointment after each cleaning. Products containing zinc oxide, lanolin, or petrolatum form a protective layer that shields skin from ongoing moisture exposure. Even with a barrier cream in place, you still need to clean and reapply after each incontinence episode.
Friction is the other surface-level threat. Dragging skin across sheets or cushion covers creates shearing forces that tear delicate tissue. When repositioning someone in bed, lift rather than pull. Smooth, low-friction bed linens and fitted sheets that stay taut also help reduce shear.
Nutrition That Supports Skin Integrity
Skin needs fuel to repair itself and resist damage. People at risk of pressure sores need more calories and protein than average. Clinical nutrition guidelines recommend 30 to 35 calories per kilogram of body weight per day and 1.25 to 1.5 grams of protein per kilogram. For a 150-pound (68 kg) person, that translates to roughly 2,000 to 2,400 calories and 85 to 102 grams of protein daily. Hydration matters too: aim for about 30 to 35 milliliters of fluid per kilogram of body weight, which works out to roughly 8 to 10 cups a day for most adults.
Protein is the critical nutrient here because it’s the raw material for tissue repair. Good sources include eggs, dairy, poultry, fish, beans, and protein supplements if appetite is poor. If someone is losing weight unintentionally or eating very little, a dietitian can help build a plan that meets these targets.
Spotting Trouble Early
Daily skin checks catch problems before they become serious. A Stage 1 pressure injury, the earliest stage, looks like a red, purplish, or bluish patch on the buttocks that doesn’t turn white when you press on it briefly with a fingertip. On darker skin tones, it may appear more purple or ashen rather than red. The area often feels warmer than surrounding skin and may burn or itch. If the discoloration persists for 30 minutes or more after pressure has been removed, that’s a clear warning sign.
To do the blanch test, press a finger firmly against the discolored area for a few seconds, then release. Healthy skin will briefly turn white (blanch) and then return to its normal color. Skin that stays red or dark without blanching has already sustained enough damage to count as a Stage 1 injury. At this point, all pressure needs to be kept off that area until it fully resolves.
Assessing Your Risk Level
Healthcare providers often use the Braden Scale to gauge someone’s likelihood of developing a pressure injury. It scores six factors: sensory perception, moisture exposure, activity level, mobility, nutrition, and friction or shear. Total scores range from 6 to 23, with lower numbers meaning higher risk. A score of 18 or below generally signals that someone is at risk, and the lower the score, the more aggressive the prevention strategy needs to be.
You don’t need to formally calculate a Braden score at home, but the six categories are useful as a mental checklist. If someone scores poorly in several of these areas (limited mobility, incontinence, poor appetite, inability to feel discomfort), they need the full prevention toolkit: frequent repositioning, a specialized support surface, meticulous skin care, barrier creams, and a high-protein diet. Someone with only one or two risk factors may do well with simpler measures like a good mattress and regular position changes.