Staying in bed for a long time without regular physical activity, as may occur in a hospital, can cause many problems. (See also Problems Due to Hospitalization.)
A leg injury, leg surgery, or bed rest may prevent people from using their legs. When the legs are not being used, blood moves more slowly from the leg veins to the heart. Blood clots are more likely to form in this slow-moving blood. Blood clots sometimes travel from veins in a leg to the lungs and block a blood vessel there (called pulmonary embolism). These clots can be life threatening.
Pneumatic compression stockings may be used to prevent blood clots. Powered by an electric pump, these stockings repeatedly squeeze the calves and move blood into and through the veins.
People at high risk of developing blood clots may be given an anticoagulant (such as heparin), injected under the skin of the abdomen or arm. Sometimes an anticoagulant pill is given by mouth. Anticoagulants help keep blood from clotting.
When people stay in bed or are less active, stool (feces) moves more slowly through the intestine and rectum and out of the body. Thus, constipation is more likely to occur. Also, people staying in the hospital may be taking drugs (such as certain pain relievers) that cause constipation.
To prevent constipation, staff members encourage people to drink plenty of fluids, and extra fiber is included as part of meals or as a supplement. Stool softeners or laxatives may be prescribed.
Staying in one position in bed for a long time puts pressure on the areas of skin that touch the bed. The pressure cuts off the blood supply to those areas. If the blood supply is cut off too long, tissue breaks down, resulting in a pressure sore (also called pressure ulcer or bedsore). Pressure sores can begin to form in as few as 2 hours.
Pressure sores are more likely to develop in people who
Being undernourished makes the skin thin, dry, inelastic, and more likely to tear or break. Being incontinent exposes the skin to urine, which softens it, causing it to break open.
Pressure sores usually occur on the lower back, tailbone, heels, elbows, and hips. Pressure sores can be serious, leading to infection that spreads to the bloodstream (sepsis).
If a person has difficulty moving, staff members periodically change the person's position in bed to help prevent pressure sores from forming. The skin is inspected for any sign of pressure sores. Pads may be placed over parts of the body that are in contact with the bed, such as the heels, to protect them. If a person already has pressure sores, a special bed that uses air to redistribute pressure may be used so that pressure does not remain on any one area too long.
When muscles are not used, they become weak. Staying in bed can make joints—muscles and the tissues around them (ligaments and tendons)—stiff. Over time, muscles can become permanently shortened, and stiff joints can become permanently bent—called a contracture.
A vicious circle may result: People stay in bed because of a disorder or surgery, resulting in weak muscles and stiff joints, which make moving (including standing and walking) even more difficult.
Steps to prevent problems related to bed rest may seem bothersome or too demanding, but they are necessary for a good recovery.
Moving as soon and as much as possible can help prevent most problems, including constipation. People are encouraged to get out of bed as soon as they can. If people cannot get out of bed, they should sit up, move, or do exercises in bed. Flexing and relaxing muscles in bed can help keep muscles from weakening.
For people who cannot exercise on their own, a physical therapist or another staff member moves their limbs for them. Furnishings, such as handrails, grab bars in the bathroom, raised toilet seats, low beds, and carpeting, can make movement easier.
For children, hospitals frequently have playrooms to encourage activity and to prevent boredom or depression.