It starts as a faint pink smudge. You might think it’s just a bit of irritation from sitting too long or a heat rash that’ll clear up by morning. But if that spot doesn't turn white when you press on it—a process doctors call blanching—you aren't looking at a simple rash. You are looking at the beginning of a pressure injury. Honestly, looking for pictures of bed sores on buttocks is one of the most common things people do when they are caring for an elderly parent or recovering from surgery, because these wounds change fast.
Deciphering what you see on a screen versus what is happening on a person’s skin is tricky. Skin tone matters a lot here. On lighter skin, a Stage 1 sore looks like a persistent red mark. On darker skin tones, it might look purple, ashen, or even slightly blue. It’s not just about the color, though. It’s about the "feel." Is the skin firmer than the area around it? Is it warmer? These are the subtle clues that photos often miss, but they are the difference between a minor issue and a medical emergency.
Pressure ulcers—the technical term for bed sores—happen because blood flow gets cut off. The buttocks are the "perfect storm" for this. You’ve got the tailbone (coccyx) and the sit-bones (ischial tuberosities) pushing from the inside out, while the chair or bed pushes from the outside in. The skin gets trapped in the middle. It dies.
What the stages look like in reality
If you’ve seen pictures of bed sores on buttocks, you know they are categorized by stages. But those stages aren't always a linear path. Sometimes a wound can look like a Stage 2 and actually be much deeper.
Stage 1: The Warning Shot
This is the only stage where the skin is still intact. It’s "non-blanchable erythema." Basically, if you press it and it stays red, the capillaries are already damaged. At this point, the damage is often reversible. If you get the pressure off immediately and keep the area clean and dry, it can heal in a few days. If you don't? It's going to open up.
Stage 2: The Broken Surface
Now the top layer of skin (the epidermis) is gone. It looks like a shallow crater or even a popped blister. It’s usually red or pink and very painful because the nerve endings are exposed. This is where most people start to panic. It’s important to note that Stage 2 sores shouldn't have slough—that yellowish, stringy dead tissue. If you see yellow, you’re likely looking at Stage 3.
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Stage 3 and 4: The Deep Stuff
Stage 3 goes into the fat layer. It looks like a deep hole. Stage 4 is the nightmare scenario where you can see muscle, tendon, or even bone. When you see pictures of bed sores on buttocks at this stage, you’ll often notice "tunneling." This is exactly what it sounds like—the wound is literally burrowing under the visible skin. You might see a small hole on the surface, but underneath, there's a cavity the size of a golf ball.
Why the buttocks are so vulnerable
It’s about anatomy. And moisture. And friction.
When someone is bedridden or using a wheelchair, the sacrum (that flat bone at the base of the spine) takes the brunt of the weight. But there is another factor: shear. Imagine someone sliding down in bed. Their skin sticks to the sheets, but their skeleton slides down. This stretching tears the tiny blood vessels.
Then there is the moisture issue. Incontinence is a massive risk factor. Urine and feces change the pH of the skin, making it "macerated" or soggy. Soggy skin breaks under pressure ten times faster than healthy, dry skin. This is why many pictures of bed sores on buttocks also show surrounding skin that looks white, wrinkled, or waterlogged.
The National Pressure Injury Advisory Panel (NPIAP) actually updated their guidelines recently to emphasize that medical devices—like catheters or oxygen tubes—can also cause these sores, but for the buttocks, it is almost always a combination of immobility and poor nutrition.
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The "Unstageable" Trap
Sometimes you look at a wound and it’s just covered in a thick, leathery black or brown layer. This is called eschar. Or it’s filled with yellow/tan gunk called slough.
Doctors call this "Unstageable."
You literally cannot tell how deep the hole is because the "trash" is in the way. Do not try to peel this off yourself. Black eschar on the heels is actually sometimes left alone to act as a natural "scab," but on the buttocks, it usually needs to be debrided (removed) by a professional because the risk of infection is so high.
If you see a purple or maroon localized area of discolored intact skin, that might be a Deep Tissue Pressure Injury (DTPI). These are deceptive. They look like a bruise. But they aren't a bruise. The damage started at the bone level and is working its way up. Often, these "bruises" eventually open up to reveal a Stage 3 or 4 wound that was there all along.
How to actually manage what you’re seeing
If you are looking at a reddened area on a loved one right now, stop reading and turn them.
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The "Rule of 30" is a good baseline: tilt the person at a 30-degree angle using pillows. Don't prop them straight up on their side, as that just puts all the pressure on the hip bone (the trochanter).
- Protein is king. You cannot heal a hole in the body if you aren't eating enough protein. The body will literally "steal" protein from muscles to try to fix the skin, but if the tank is empty, the wound stays open.
- Hydration. Dehydrated skin is brittle. Brittle skin breaks.
- Barrier creams. Use a zinc-based cream if moisture is the problem, but don't slather it so thick that you can't see the skin underneath to check for changes.
- Specialty surfaces. A standard hospital mattress is often not enough. You might need an alternating pressure mattress that inflates and deflates different cells to keep blood moving.
When it becomes an emergency
Bed sores aren't just "skin deep." They kill people. Sepsis is the real threat. If the area around the sore starts to feel hard (induration), if there is a foul smell, or if the person develops a fever, the infection has likely hit the bloodstream or the bone (osteomyelitis).
According to research published in the Journal of Wound, Ostomy and Continence Nursing, the mortality rate for patients who develop a new pressure injury in a hospital setting is significantly higher than those who don't. It’s a systemic failure, not just a skin failure.
You should also look for "crepitus." If you press near the wound and it feels like Rice Krispies popping under the skin, that’s gas trapped in the tissues. That is a surgical emergency.
Actionable Next Steps
If you are currently managing a pressure injury or trying to prevent one, here is what needs to happen today:
- Perform a Head-to-Toe Skin Check: Do this twice a day. Use a mirror to see the underside of the buttocks if you are checking yourself. Don't skip the "hidden" spots like the crease between the buttocks.
- Document Everything: Take your own pictures of bed sores on buttocks every single day. Use a ruler in the photo for scale. This is vital for your doctor to see if the treatment is working or if the wound is "stalling."
- The "Two-Hour" Rule is a Minimum: If a reddened area is present, two hours is too long to stay in one position. Switch it up every hour if possible.
- Check the Sheets: Ensure there are no crumbs, wrinkles, or plastic IV caps under the patient. Even a small wrinkle in a bedsheet can create enough pressure to start a Stage 1 sore in a high-risk individual.
- Consult a WOC (Wound, Ostomy, and Continence) Nurse: These are the real experts. General practitioners are great, but WOC nurses have a specialized eye for the nuances of "slough" vs. "fibrin" and can prescribe the right dressings—like hydrocolloids or alginates—that keep the wound moist enough to heal but dry enough to stay healthy.
Healing a bed sore on the buttocks is a marathon. It takes months, not days. But by catching it at the "pink smudge" stage, you can avoid the specialized wound vacs and surgeries that come with the later stages. Keep the pressure off, keep the skin clean, and keep the protein levels high.