Coccyx (Tailbone) Wounds in Hospital Beds: How Alternating Pressure Mattresses Can Help

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Coccyx (Tailbone) Wounds in Hospital Beds: How Alternating Pressure Mattresses Can Help

Tailbone wounds—often called coccyx pressure injuries—are common in patients with limited mobility or who are bed-bound. They can be painful, slow to heal, hard to treat, recur often, and be a pathway to potentially devastating infection. While these wounds are often described as being caused by “pressure,” pressure alone is rarely the full explanation. In a hospital bed, coccyx wounds typically develop from a combination of factors that must all be addressed.

For patients and caregivers, understanding how these wounds develop in a hospital bed environment can help prevent them from occurring and offer effective ways to promote healing.

Why Coccyx Wounds Develop in Bed

The tailbone, aka coccyx, is a small bony structure at the base of the spine. As the name suggests, the tailbone is the remnant of a tail humans once had and is not designed to support body weight for long periods. The skin over the coccyx bone is thin and prone to breakdown. In patients who spend extended time in bed, tissue damage can occur when external forces repeatedly reduce blood flow, weakening the skin and underlying tissues.

Clinically, six prime external factors contribute to coccyx wound development:

• Pressure
• Shear
• Friction
• Heat
• Moisture
• Positioning

All six factors are usually present, but in hospital beds, shear and pressure together are often the most damaging.

How Alternating Pressure Mattresses Support Healing

Alternating Pressure Mattress Systems are a therapeutic hospital bed mattress designed to redistribute pressure by reducing how long any one area of the body bears weight. Alternating pressure mattresses work by gently inflating and deflating air cells beneath the patient in repeating cycles. Many Alternating Pressure Mattresses feature Low Air Loss therapy and other automated features specifically designed to help prevent or treat coccyx wounds.

Some mattress designs also aim to improve stability and reduce sliding, which can help limit shear when combined with proper positioning and regular care.

The Role of Shear in Bed-Related Coccyx Wounds

Pressure redistribution is essential for prevention and treatment of coccyx wounds…. eliminating skin shear is equally important. Shear occurs when the skin stays in place against the mattress while the body slowly slides downward. This commonly happens when:

• The head of the bed is elevated
• Patients gradually slide toward the foot of the bed
• Patient sinks into the mattress
• Repositioning is incomplete or infrequent
• The patient is not positioned properly
• The bed frame sags

As the body slides, the skin stretches beyond its elasticity and tears. These tears can occur on the surface or underneath making them difficult to see. Shearing can lead to deeper, harder-to-heal and recurring coccyx wounds. Heat and moisture—especially from perspiration or incontinence—further weaken the skin, making it more vulnerable to injury.

Alternating Pressure Mattress System

In a bed environment, alternating pressure mattress systems may help prevent and treat coccyx wounds by:

• Reducing the amount of time pressure remains on the coccyx
• Allowing blood flow to return to previously compressed areas
• Supporting overall skin and tissue tolerance during long periods in bed
• Controlling heat and moisture
• Reducing shearing
• Dynamically adjusting to compensate for patient position
• Provide comfort
• Prevent bottoming out
• Helping to offset the sag often found on spring frames

When it comes to preventing or treating coccyx wounds, choose a quality system with specific coccyx related features. Not all alternating pressure mattress systems are equal. Support surfaces should always be selected based on the full spectrum of the patient’s wound care needs and on how and where the wound developed.

Important Consideration for Healing

There are other secondary considerations in preventing or treating a coccyx wound using an alternating pressure mattress:

• Ensuring the bed frame itself provides adequate support
• A patient’s body shape
• Use of slide sheet
• Proper type and use of incontinence pads
• Proper use of settings of the mattress

It is important to recognize that many coccyx wounds begin outside the bed, often in a wheelchair or chair, and patients are later placed on a mattress in an effort to heal. In these cases, the mattress must support healing while also preventing additional pressure and shear from occurring during recovery.

Key Takeaway

Coccyx wounds in hospital beds are rarely caused by pressure alone. They most often result from a combination of shear, pressure, positioning, heat, and moisture. When used appropriately and in conjunction with good positioning, skin care, and clinical oversight, alternating pressure mattresses can support coccyx wound healing and help prevent further tissue damage.

Authored by Jeff Adise

Jeff has dedicated over 28 years to advancing wound care solutions. He is a product specialist and developer of therapeutic support surfaces for the prevention and treatment of Stage I–IV pressure injuries in hospital beds, home recliners, lift chairs, wheelchairs, and more.