In general, an ulcer is an erosion of tissue that produces a crater-like lesion. Specific kinds are outlined in more detail below.
Bedsore
(Decubitous Ulcer, Pressure Sore, Skin Sore)
A bedsore is caused by skin damage due to impaired blood flow and irritation, particularly over bony prominences. The skin has a very rich blood supply and when that blood supply is cut off for two to three hours or more, the skin begins to die.
The body protects itself from pressure sores through several methods. First, the normal movement of the body, e.g., while lying down, sleeping, or sitting, shifts pressure so that blood supply to any one particular area is not blocked for too long. In addition, the subcutaneous layer of fat helps cushion the skin and its blood vessels, especially over bony prominences, preventing them from being squeezed shut.
Canker
(Aphthous Stomatitis, Aphthous Ulcer, Canker Sore)
Cankers are small painful sores that develop inside the mouth, especially on the lips, cheek, tongue, soft palate, and occasionally, the throat. Smaller cankers are less than one centimetre in diameter and often occur in groups of two or three. They usually heal by themselves within seven to twenty-one days and do not leave scars. Larger ones are irregularly shaped and less common. They may take weeks to heal and frequently scar.
Leg Ulcer
A leg ulcer is an open sore that develops on the leg, usually in skin that is "thin" or deteriorating.
Peptic Ulcer
(Duodenum Ulcer, Gastric Ulcer)
An ulcer that occurs in the stomach is called a gastric ulcer, while one that forms in the duodenum (the first part of the small intestine) is called a duodenal ulcer. Collectively they are called peptic ulcers. Duodenal ulcers are four to five times more common than gastric ones. Peptic ulcers are more common in men than in women.
Symptoms and Signs:
Bedsore
Generally, bedsores cause pain and itching. You may not feel any discomfort at all, however, if your senses are dull due to nerve damage or medication.
Bedsores are categorized into six different stages, depending on severity:
Stage 1: A sore has not yet formed, the skin is still unbroken, but has become red. Stage 2: Skin becomes red and swollen, and often blisters. The most superficial layers of skin begin to die.
Stage 3: Skin has broken exposing the deeper layers of skin to the external environment.
Stage 4: Sore extends through the skin and into subcutaneous fat and muscle.
Stage 5: Sore has severely damaged the muscle.
Stage 6: Bone is exposed, is often damaged, and sometimes infected.
Canker
A canker can be seen as a round white-grey spot with a red border. It is usually accompanied by pain that lasts four to ten days. The pain worsens if your tongue rubs the canker or when you eat hot or spicy food, salt, or vinegar. Cankers are recurrent in some people and thus you may get them several times a year. Severe sores can cause fever, swollen neck glands, and malaise. Canker sores may resemble sores caused by herpes simplex virus (cold sores), but cankers are NOT caused by this virus.
Leg Ulcer
Leg ulcers appear as open sores on the leg and often take quite some time to heal.
Peptic Ulcer
Symptoms are chronic, yet occur periodically and are sometimes absent or vague. They include a burning, gnawing, aching, or cramp-like sensation in the stomach, abdominal tenderness, antacid use, or vomiting, acute hunger and pain forty-five to sixty minutes after a meal, and/or acute hunger and pain during the night that is relieved with eating.
Tests for blood in the stool are positive and a crater or deformity in the stomach or duodenum is seen on an X-ray or endoscopy.
Causes:
Bedsore
Bedsores generally occur where the skin is under pressure from a bed, wheelchair, cast, splint or other hard object for a prolonged period of time. As a result, they occur more frequently in people who are weak, restrained, or in a coma, or people who have sustained nerve damage (from stroke, diabetes, et cetera) as they cannot sense the pain. Malnutrition will hasten the formation of a bedsore since neither the protective subcutaneous fat layer will be present nor will the essential nutrients required for quick and proper healing.
Canker
The cause of canker sores is unknown, but stress, nutrient deficiency, and food allergies (especially milk and gluten) play a significant role in recurrent cases.
Studies show that allergic mechanisms are involved in producing canker sores in many recurrent cases. These include food allergies and other allergens such as benzoic acid, methylparagen, dichromate, and sorbic acid.
Gluten sensitivity is a primary cause in several cases. There is also an increased frequency of canker sores in people with celiac disease. Further, a person with recurrent canker sores coupled with an allergy or gluten sensitivity is more likely to have a vitamin or mineral deficiency.
Stress is often a precipitating factor, as it can cause a breakdown in immune function and/or impair the integrity of the mucosal lining.
A number of nutrient deficiencies can lead to the formation of canker sores, with the most significant being thiamin (B1). However, folic acid, iron, riboflavin (B2), pyroxidine (B6), or vitamin B12 deficiencies can also cause cankers.
Leg Ulcer
Generally, any condition that compromises circulation in the legs (long-standing diabetes, for example), and causes skin deterioration can lead to a leg ulcer. They are more common among people with varicose veins, poor circulation, or thrombophlebitis.
Peptic Ulcer
Over-secretion of gastric acid is generally not the cause of peptic ulcer formation. Although the gastric acid required to digest food is very corrosive, with a pH of 1 to 3, the stomach has a number of protective factors in place to prevent ulcer formation, even with acid over-secretion. The lining of the stomach and duodenum is covered by a layer of mucous called mucin. Other protective factors include the constant renewal of intestinal cells and the secretion of factors that neutralize acid when it contacts the stomach or intestinal lining.
Peptic ulcers occur when the protective factors that line the stomach or duodenum are damaged. Historically it was thought that over-secretion of stomach acid was the culprit. Current theories, however, focus on Helicobacter pylori infection and non-steroidal anti-inflammatory drug (NSAID) use, such as acetylsalicylic acid, et cetera. Smoking, alcohol consumption, nutrient deficiencies, stress, food allergies, and steroid use can also compromise the protective factors.
H. pylori infects 50% of the population over the age of fifty. This bacterium is found in 91% to 100% of people with duodenal ulcers and 70% of people with gastric ulcers. Factors that contribute to H. pylori infection include decreased gastric acid secretion and low antioxidant content of the gastrointestinal (GI) lining.
NSAID use is associated with an increased risk of developing a peptic ulcer. Daily use of aspirin and other NSAIDs is often prescribed for the prevention of heart attack and stroke. This can also increase the risk of GI bleeding from a peptic ulcer.
Smoking plays a significant role in the occurrence and severity of peptic ulcers. Smoking increases peptic ulcer frequency, decreases response to therapy, and increases the chance of dying due to complications of peptic ulcers. Smoking increases the back-flow of bile into the stomach, which irritates the lining of both the stomach and duodenum. Bicarbonate secretion by the pancreas (to neutralize gastric acid) also decreases, while the passage of food from the stomach to duodenum increases. In addition, the chronic anxiety and psychological stress associated with smoking often increase the severity of ulcers.
NSAID use combined with smoking further complicates matters. The NSAID causes the ulcer, while smoking stimulates gastric output to worsen symptoms and severity.
Stress seems to play a role in the development of peptic ulcers. The amount of stress a person is under is not as important as how they deal with the stress. It is often found that people who repress their emotions may have an increase in incidence of peptic ulcers.
Food allergies can also cause peptic ulcers and milk consumption tends to lead to a number of problems. Pasteurized milk increases stomach acid secretion and higher milk consumption has been associated with a higher incidence of peptic ulcer formation. This is rather paradoxical, considering many people find symptomatic relief of peptic ulcers after drinking a glass of milk.
What to Expect:
Bedsore
An infection is possible whenever the skin is broken. Infection delays healing of the sore and can be life-threatening with deeper sores. Stage 6 sores may lead to osteomyelitis (a bone infection) that is difficult to cure and may spread through the blood stream. Prevention is key.
Canker
Cankers can be a recurrent problem for people with food sensitivities/allergies or nutrient deficiencies.
Leg Ulcer
These ulcers may become infected, prolonging healing time.
Peptic Ulcer
Peptic ulcers must be monitored by your naturopath or other health practitioner, as there can be very serious consequences if the ulcer is not effectively treated. Complications include hemorrhage, perforation, and obstruction, all of which require immediate medical attention.
Remedies
Bedsore
Herbs
Comfrey can be applied to the sore in the form of a compress, ointment, or cream, to sooth the ulcer. To prepare a compress, use a clean cloth-made either of cotton, gauze, or linen, and soak it in a hot infusion or decoction. Place this as hot as possible on the affected area and either change it when it cools or cover the cloth with plastic or waxed paper and place a hot water bottle on top. Heat enhances the activity of these herbs.
Garlic improves circulation, promotes healing, and helps prevent infection. Take 400 to 500mg up to three times daily. Add more fresh garlic to your diet as well.
Lifestyle
Preventing bedsores is easier than treating them. Thus, take the following precautions before the sores begin to develop:
Carefully inspect skin daily for early redness and bony projections should be protected with soft materials, e.g., add padding to beds, chairs, and wheelchairs to reduce pressure. People that are unable to move themselves or are bedridden should be repositioned frequently. They should be turned every two hours and their skin should be kept dry and clean. You can obtain special water or air filled mattresses for bedridden people. Make sure bed linens and clothes are smooth and wrinkle free, as wrinkles add more pressure to the skin.
If sores have begun to develop, the following will help hasten healing. In general, good health can speed the healing process, thus a protein and calorie supplement is beneficial. In the early stages, bedsores can heal by themselves once the pressure is removed. If the skin is broken, protect it with gauze. Special air-filled mattresses or sponge rubber "egg crate" mattresses are designed to shift pressure and offer extra relief for people that have already developed bedsores. An "air-suspension" mattress may be required for people that have developed deep bedsores.
If a sore appears to be infected or oozes, rinse and wash the area gently with soap and disinfectant, but be cautious as cleansing too harshly can slow healing. Antibiotics may be required if an infection develops deep within the sore or if it has spread through the bloodstream.
Minerals
Zinc aids in wound healing and boosts immunity. Take 50 to 80mg daily.
Miscellaneous
Topical administrations of colloidal silver can minimize inflammation, prevent or treat infection, and encourage healing.
Vitamins
Vitamin A is beneficial for healing skin. Take 50,000 IU daily for one month, then reduce this to 15,000 IU daily, each in divided doses. If you are pregnant, do not take more than 10,000 IU daily.
Vitamin C improves circulation, promotes healing, and prevents infection. Take 3,000 to 10,000mg daily in divided doses. Start at the lower dosage and increase up to bowel tolerance.
Vitamin D is necessary for wound healing and is especially important for people who are bedridden and do not get enough sunshine. Take 400 to 1,000 IU daily in divided doses.
Vitamin E improves circulation, increases tissue oxygenation, and promotes wound healing. Take 400 to 1,600 IU daily in divided doses. You may also apply vitamin E directly to the sore and bandage it loosely. Be sure to change the bandage daily. Vitamin E may be mixed with goldenseal powder, aloe vera gel, or a few drops of tea tree oil and applied to the sore.
Canker Sore
Amino Acids
A deficiency of lysine may cause sores to develop around and in the mouth. Take 500mg L-lysine 3 times a day. It is best to take it on an empty stomach with an extra 50mg of B6 and 100mg of vitamin C for optimal absorption. Do not take with milk and do not take for more than 6 months at a time.
Herbs
Deglycyrrhizinated licorice can promote the healing of canker sores. Take 1 to 2 380mg chewable tablets 20 minutes before meals.
Homeopathy
Certain remedies can be used in acute situations if your symptoms fit the symptom picture of the remedy. For dosages, see the dedicated section on Homeopathy. Consult your homeopath or naturopath to determine your constitutional remedy: the remedy that best fits you as a whole person. Your homeopath or naturopath will take a complete case history considering all of your mental and physical ailments and match these symptoms with the symptom picture of the remedy.
Lycopodium: For painful canker sores of the tongue. Pain relieved by warm applications.
Metallum Album (Arsenicum): Burning canker sores relieved by warm applications.
Mercurius Vivus: Canker sores appear throughout the inside of the mouth. Gums bleed easily and there is stinging, throbbing pain. Increased secretion of saliva.
Natrum Muriaticum: Eruptions appear on the tongue, mouth and lips. Sores are swollen and burn and occur when the person gets a cold.
Nux Vomica: Canker sores appear on the gums. Gums are swollen, white, and bleeding.
Rhus tox.: Canker sores occur with a fever and usually appear at the corners of the mouth and around the mouth and chin. Sores are very itchy and feel better with warm applications.
Lifestyle
Avoid sugar, citrus fruits, coffee, processed or refined foods, and tobacco.
Onions contain sulfur, which promotes healing. Add raw onions to your sandwiches or salads.
Miscellaneous
Quercetin can be useful in cases where allergies are the cause of outbreaks.
Therapies, Healing Aids, and More
See your naturopath or other health care practitioner to test for food sensitivities or allergies. Eliminate allergenic compounds or foods from your diet.
You can also ask your naturopath or other health care practitioner to check for nutrient deficiencies.
Find ways to reduce stress. You can begin a new exercise program, visit a massage therapist, or take yoga or tai chi classes. Meditation is also very relaxing and balancing.
Vitamins
Vitamin A promotes healing of mucous membranes. Take 50,000 IU daily for 2 weeks, then 25,000 IU daily, all in divided doses. Do not take more than 10,000 IU daily if you are pregnant. You can place a few drops of vitamin A oil directly on the canker as well.
Take 1,000 to 8,000mg of vitamin C daily in divided doses. Start at the lower dosage and increase up to bowel tolerance.
Take a high potency multivitamin and mineral supplement to help balance any deficiencies you may have.
Leg Ulcer
Amino Acids
Dimethylglycine (DMG) can be used to improve blood flow and increase oxygenation of blood. Take as part of a multi-amino acid complex
Foods
Flaxseed oil can help minimize the formation of blood clots and helps keep veins pliable. This is especially good for people with varicose veins. Take 2 tablespoons daily. Do not cook with this oil, as it will turn rancid. Add to salads, shakes, or yogurt instead.
Food Supplements
Dimethylsulfoxide (DMSO) promotes leg ulcer healing when applied topically. NOTE: Do not use the DMSO that can be found in hardware stores.
Herbs
Apply a comfrey tea compress to soothe inflamed leg ulcers. To prepare a compress, use a clean cloth-made either of cotton, gauze, or linen, and soak it in a hot infusion or decoction. Place this as hot as possible on the affected area and either change it when it cools or cover the cloth with plastic or waxed paper and place a hot water bottle on top. Heat enhances the activity of these herbs.
Garlic improves circulation, promotes healing, and helps prevent infection. Take 400 to 500mg up to three times daily. Add more fresh garlic to your diet as well.
A goldenseal poultice applied to the sore can help prevent or treat infection. A poultice can be made using either fresh or dried herbs. Fresh herbs can be bruised and applied directly to the skin. Dried herbs must be made into a paste first using either hot water or apple cider vinegar. This can either be applied directly to the skin, placed in a disposable infusion bag, or wrapped in a piece of cheesecloth, then applied to the breasts. The beneficial effects will be enhanced by keeping the poultice warm. Keep the poultice in place by using a strip of cotton and wrap with plastic or waxed paper and place a hot water bottle on top. Poultices can usually be left in place for several hours or overnight.
Lifestyle
Keep the area clean, but do not overdo it. Over-cleansing may irritate the situation.
If you have poor circulation, see the dedicated section on Circulatory Problems for ways to improve the situation.
Minerals
Zinc promotes wound healing and boosts immunity. Take 50mg daily.
Miscellaneous
Topical administrations of colloidal silver can minimize inflammation, prevent or treat infection, and encourage healing.
Vitamins
Coenzyme Q10 is beneficial for increasing tissue oxygenation. It also increases resistance to developing leg ulcers. Take 60mg daily.
Vitamin C improves circulation, promotes healing, and prevents infection. Take 2,000 to 10,000 mg per day in divided doses. Start at the lower dosage and increase up to bowel tolerance.
Vitamin E helps increase tissue oxygenation and promotes wound healing. Take 400 to 1,600 IU daily in divided doses. You can also apply vitamin E (mixed with a couple drops of tea tree oil, if you like) directly to the ulcer and bandage it loosely. Be sure to change the bandage daily.
Peptic Ulcer
Conventional Approaches
Common approaches to dealing with ulcers focus on the symptom, i.e. an ulcer, and not the source of the problem that initially aggravated this condition. Approaches include the use of antacids, acid blockers, sulcrafates, and antibiotic combinations. Antacids neutralize excess acidity. Acid blockers block acid secretion. Sulcrafates form a protective layer over the ulcer crater. Antibiotic combinations are given in addition to one of the other three methods listed above. Success rate is typically eighty percent. One strategy is to administer two types of antibiotics in combination with an acid blocker. Another strategy is to administer two weeks of bismuth in addition to two types of antibiotics, plus an acid blocker. However, beneficial bacteria are also destroyed in the process and must be restored before harmful bacteria successfully re-establish themselves.
Amino Acids
Glutamine helps strengthen the lining of the stomach and duodenum. Take 500mg 3 times daily.
Aromatherapy
Lemon oil, chamomile, and geranium have been used to help treat peptic ulcers.
Foods
Drink 1 litre of cabbage juice daily in divided doses. It can be combined with carrot or celery juice. The high glutamine content is probably responsible for its high efficacy in the treatment of peptic ulcers
Raw potato juice is also recommended for stomach (gastic) ulcers.
Use flaxseed oil on salads daily.
Food Supplements
Acidophilus and Bifidus supplementation will restore beneficial bacteria counts in the digestive tract and help keep harmful bacteria at bay. It is essential that these bacteria be restored to the body, particularly after the use of antibiotics. Look for a dairy-free formulation with at least 2.5 billion viable cultures per capsule and keep refrigerated. Take 2 or 3 capsules daily before meals, preferably in the morning. Supplements with Fructooligosaccharides (FOS) provide a beneficial "bed" and initial food source for the bacteria. If dairy allergies have been ruled out, you can also eat yogurt that has had either bacterial culture added.
Herbs
Aloe vera juice can be used to help treat gastrointestinal bleeding. Drink 1 litre daily in divided doses, 20 minutes before each meal. Use until bleeding stops.
Licorice root extract is commonly used in Europe as a preventative. It helps stimulate the normal defense mechanisms of the stomach lining, helps prevent ulcer formation, and inhibits H. pylori bacteria growth. It has shown to be more effective and less costly than pharmaceutical treatments, and without side effects (when taken in DGL form). Take a DGL licorice preparation that is free of glycyrrhizin -- licorice's sweetener that can also raise blood pressure. DGL can also reduce gastric bleeding caused by long-term NSAID use and thus is recommended for the prevention of gastric ulcers in patients requiring such use of NSAIDs. Treatment with DGL should continue 8 to 16 weeks after a full therapeutic response is achieved. Thoroughly chew 2 380mg tablets 20 minutes before each meal. The capsule form is not recommended for the treatment of ulcers because the DGL must mix with saliva to be effective.
Rhubarb has astringent properties that are useful with active intestinal bleeding. One study showed that 90% of patients using rhubarb tablets stopped bleeding within 60 hours. Use alcohol-extracted rhubarb tablets and take as directed on the label.
You can also try an infusion of marshmallow, calendula, meadowsweet, chamomile, and goldenseal taken 3 times per day. These herbs have demucelent, antacid, astringent, and vulnerary properties.
Lifestyle
It is very important to isolate the root cause(s) of your ulcer. While the alternative remedies listed throughout this section will help deal with an existing ulcer, prevention is the preferred approach.
Reduce stress and anxiety levels, which commonly irritate ulcers. Analyze your lifestyle and determine those elements that should be changed and/or removed to reduce the resulting physical/emotional/psychological strain placed upon yourself. Yoga, meditation, and biofeedback are all great ways to reduce stress.
A high fibre diet will help reduce the incidence and prevent recurrence of ulcers. It is best to obtain your fibre by consuming a greater portion of plant foods.
Avoid fats, alcohol, caffeine, milk, smoking, and sugar, all of which can either promote ulcer formation of exacerbate existing symptoms.
Food allergy testing (see Therapies, Healing Aids, & More, below) should be performed and these foods should be eliminated from the diet.
Minerals
Bismuth is a naturally occurring mineral with antibacterial properties and proves useful against H. pylori. Bacteria also do not develop a resistance to the mineral, improving its effectiveness. The most common form is bismuth subsalicylate (eg. Pepto-Bismol). Take 500mg 4 times daily. This form should not be taken by children recovering from viral infections (flu, chicken pox, et cetera) as it can mask nausea/vomiting associated with Reye's syndrome, a rare but very serious illness. Bismuth subcitrate is the most ideal form, yet more difficult to find. It is more effective against H. pylori and the treatment of peptic ulcers. Take 240mg twice daily before meals. This form may cause a temporary darkening of the tongue or stool, however, these changes are harmless.
Zinc increases mucin production, resulting in greater protection of the gastrointestinal lining. Take 20 to 30mg daily.
Therapies, Healing Aids, & More
Allergy testing should be performed to indicate sensitive foods that can also irritate your ulcer. These foods should be eliminated from the diet. Common food allergies include cow's milk, wheat, corn, and soy. Remember that the foods we are the most allergic to are also the ones we most crave and most frequently consume. Skin tests or positive IgE RAST testing can help isolate specific allergens.
Acupuncture, acupressure, hydrotherapy, and fasting have also been helpful for treating peptic ulcers.
Vitamins
Studies show that flavonoids can inhibit H. pylori and have significant anti-ulcer properties. Take 500mg 3 times daily.
Animal studies show that vitamin A inhibits the development of stress ulcers and helps maintain the integrity of the mucosal lining. Take 5,000 IU daily in divided doses.
Vitamin E has similar anti-ulcer properties as vitamin A. Take 100 IU three times daily.
Actions and Remedy Listings
Bedsore
Canker
Leg Ulcer
Peptic Ulcer
See also
Anxiety Disorder,
Stress
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