Bed rest used to be a common medical treatment for a variety of conditions, but research has shown it often does more harm than good. While short periods of bed rest may help certain injuries or illnesses heal, extended bed rest can lead to many complications and should generally be avoided.
Muscle loss
One of the biggest complications of prolonged bed rest is muscle loss. When you are lying in bed not bearing weight on your muscles or moving them through a full range of motion, the muscles start to weaken and atrophy surprisingly quickly. Studies have shown that bedridden patients can lose as much as 5% muscle mass per week. This muscle loss affects not only the large muscles in the arms and legs, but also the smaller muscles that play critical roles like breathing and maintaining posture.
In the first few weeks of bed rest, patients begin to feel tired and weak as their muscles waste away. As the muscles continue to atrophy over longer periods of bed rest, patients lose strength and have difficulty sitting up, standing, and walking. Physical therapy is usually required after prolonged bed rest to rebuild muscle mass and mobility.
Bone loss
Bones also weaken rapidly during periods of inactivity. Bones are living tissue that respond to stress – without the mechanical stress of standing and moving, bones start to lose minerals and become fragile and prone to fracture. Astronauts in space can lose up to 1-2% bone mass per month. Patients confined to bed rest lose bone mass at nearly the same rate as astronauts floating in space.
Weight bearing activities stimulate bones to grow stronger. The hips and legs tend to be affected most by bone loss during bed rest. A few weeks of bed rest can begin to reverse years of slow bone growth. Over time, osteoporosis can develop, causing bones to become brittle and fracture easily. Fractures are a major risk for bedridden elderly patients. Physical therapy focusing on weight bearing after bed rest can help rebuild some of the lost bone density.
Pressure injuries
Lying in the same position day after day can cause painful pressure injuries of the skin. These are also called bedsores or pressure ulcers. They develop when the blood supply to an area of skin is cut off due to prolonged pressure. Patients confined to bed are at high risk because they cannot shift position regularly to relieve pressure on bony areas like the tailbone, hips, heels, elbows, and shoulders.
Warning signs of a pressure injury include red, purple, or bruised looking skin, swelling, and sore spots. If untreated, these can turn into open wounds and serious skin infections. Moving positions at least every 2 hours is crucial for preventing pressure injuries in bedridden patients. Using pillows and specially designed mattresses to reduce pressure on vulnerable areas also helps prevent this dangerous complication.
Blood clots
Bed rest leads to poor circulation, increasing the risk of developing potentially deadly blood clots in the legs. This is known as deep vein thrombosis. When the legs remain immobile, blood tends to pool in the lower extremities rather than circulating back to the heart. Pooling blood may develop clots, which can break free and travel to the heart, lungs, or brain causing heart attack, stroke, or pulmonary embolism.
Blood clots affect 10-20% of patients on prolonged bed rest. Warning signs include leg pain and swelling. Preventive measures include moving the legs frequently, wearing compression stockings, and sometimes taking blood thinning medication. If a clot develops, immediate emergency treatment is needed.
Urinary problems
Bed rest can contribute to urinary problems including urinary tract infections (UTIs) and incontinence. Being immobile makes it more difficult for patients to empty their bladders fully. Residual urine allows bacteria to grow, increasing the risk of painful UTIs. Catheters are often needed to drain the bladder for bedridden patients.
Incontinence or leaking urine can also develop after prolonged bed rest. The muscles supporting the bladder and urethra weaken when they are not used regularly. Starting to walk again after bed rest puts extra pressure on already weakened muscles controlling urine flow. Doing pelvic floor muscle exercises can help maintain muscle tone during bed rest and prevent incontinence.
Constipation
Lack of physical activity together with pain medication side effects frequently lead to constipation for patients on bed rest. Moving the muscles of the abdomen stimulate healthy bowel function. Lying still in bed removes this beneficial muscular activity needed for having regular bowel movements.
Constipation causes bloating, abdominal discomfort, and loss of appetite. Straining to pass hard stools can lead to hemorrhoids. Preventing constipation during bed rest involves staying hydrated, eating foods with plenty of fiber, and taking laxatives or stool softeners if needed.
Skin breakdown
In addition to pressure injuries, extended time in bed allows other skin problems to develop. Skin naturally sheds dead cells all over the body every day. When patients are inactive in bed, these dead skin cells build up rather than shedding. This allows painful skin irritations and infections to occur.
Moisture from sweating also accumulates when airflow over the skin is reduced in bed. This moist environment encourages fungal and bacterial growth on the skin. Regular full-body washing, frequent sheet changes, and allowing the skin to air out can help prevent skin breakdown.
Pneumonia
Bed rest increases the risk of developing pneumonia, a lung infection. Normally humans clear bacteria from our airways by coughing and moving around upright. While lying still in bed, mucus accumulates rather than being cleared effectively. Bacteria can multiply in the stagnant mucus and move into the lungs more easily.
Signs of pneumonia include fever, chills, cough, and difficulty breathing. Pneumonia can be mild or life-threatening. Preventive measures for bedridden patients include deep breathing exercises to expand the lungs fully and forceful coughing to clear mucus.
Joint stiffness
Joints become stiff if they are not moved regularly through their full range of motion. During bed rest, even routine movements like walking, bending, straightening, and reaching are restricted or absent. The joints compensate by tightening up muscles around each joint for stability. This leads to stiffness and pain, especially in the hips, knees, shoulders, and spine.
Physical therapists guide bed rest patients through flexibility and strengthening exercises. They may gently move each joint multiple times a day to maintain flexibility despite immobility. Applying heat and massage to stiff, painful joints also provides some relief.
Mental fog and delirium
Staring at the same ceiling day in and day out takes a toll on mental sharpness. Inactive patients confined to bed report struggling with boredom, depression, anxiety, and frustration. Carrying on normal social relationships can be very difficult.
Studies show that bed rest disrupts sleep cycles and impairs cognitive function. Combining inactivity with illness or pain medications exacerbates mental decline. Some bedridden patients develop a sudden acute confusional state known as delirium with disorientation and hallucinations. Delirium is more common among elderly patients.
Mental stimulation through games, books, TV, visitors, music, and physical therapy helps prevent cognitive decline during bed rest. Treatment for depression or anxiety may also be warranted.
Deconditioning
After just a few days of bed rest, the body becomes rapidly deconditioned overall. The heart weakens because it does not have to work against gravity to pump blood through the circulatory system. Orthostatic hypotension occurs when upright activity suddenly causes blood to pool in the legs away from vital organs.
The lungs become weak and stiff without normal movements of breathing. Nutrition suffers from poor appetite and gastrointestinal effects. The immune system falters from lack of activity. Nearly every body system is impacted negatively by prolonged inactivity.
Restarting normal activity levels has to be done gradually after bed rest. It may take weeks or months of rehabilitation to rebuild cardiovascular endurance, muscle strength, flexibility, balance, and coordination.
Economic impact
Bed rest also comes with significant economic costs for individuals, families, and the healthcare system. A bedridden patient requires caregiving by family members or paid nursing staff. Home modifications like hospital beds, lifts, and ramps may be needed. Employment and income are impacted.
Hospital costs average $3,000 per day for an ICU bed. Skilled nursing facility costs range $150-$350 daily. Home health aides cost $20-$25 per hour. Rehabilitation services and medical equipment add more costs over weeks or months.
Prolonged bed rest is estimated to cost the US healthcare system over $1.5 billion per year in direct costs. The total costs including lost wages, reduced productivity, and ongoing disability are likely much higher.
Increased mortality
Perhaps the most serious risk of prolonged bed rest is increased mortality. Historical data show that patients who are confined to bed rest for two weeks face a 4% mortality rate. After four weeks of bed rest, the mortality rate jumps to 19%. Extended bed rest itself directly contributes to death.
Complications like blood clots, pneumonia, and delirium combined with dramatic physical deconditioning increase risks of heart attack, stroke, lung damage, and other life-threatening conditions. Patients who manage to survive find their quality of life greatly reduced after extended time immobilized in bed.
Conclusion
Bed rest may still be prescribed in limited circumstances such as after some surgical procedures, spine or brain injuries, or during late pregnancy. However, strict bed rest extending beyond a few days is now recognized as harmful for most medical conditions. Mobilizing patients as soon as safely possible is the standard of care.
Some degree of reduced activity may be medically helpful at times. However, complete immobilization through prolonged bed rest should be avoided whenever possible due to the many serious complications it can cause.
Keeping bed rest periods brief, gently moving within individual tolerance, using compression garments, and providing mental stimulation are all important mitigation strategies. With guidance from medical providers, most patients are now encouraged to move around and participate in physical therapy early in the course of injury or illness to avoid negative effects of bed rest.
Summary table of bed rest complications
| Complication | Onset | Effects | Prevention |
|---|---|---|---|
| Muscle loss | 1 week | Weakness, fatigue, loss of mobility | Gentle range of motion exercises |
| Bone loss | 1-2 weeks | Fractures, osteoporosis | Weight bearing activity |
| Pressure injuries | 1-2 weeks | Skin wounds, infection | Repositioning every 2 hours |
| Blood clots | 2+ weeks | Stroke, heart attack, PE | Leg exercises, compression stockings |
| Urinary issues | 2+ weeks | UTIs, incontinence | Catheters, pelvic exercises |
| Constipation | 3-5 days | Discomfort, straining | Fluids, fiber, laxatives |
| Skin breakdown | 1+ week | Rashes, infections | Washing, air exposure |
| Pneumonia | 1+ week | Lung infection | Deep breathing, coughing |
| Joint stiffness | 1 week | Decreased mobility | Range of motion exercises |
| Mental effects | 1+ week | Depression, delirium | Mental stimulation |
| Deconditioning | 3-5 days | Weakness of all systems | Gradual reconditioning |