For some medical conditions, bed rest is essential as a medical measure. However, the rule nowadays is that bed rest should be ordered as long as necessary but as short as possible.
What is bed rest in medicine?
In some medical conditions, bed rest is indispensable as a medical measure. However, the rule nowadays is that bed rest should be ordered as long as necessary but as short as possible. Bed rest is defined in medicine as maintaining a lying position in bed not only at bedtime, but for a whole day or even for several days. A distinction is made between strict bed rest, in which the sick person is not allowed to get up at all, must wash or is washed in bed, and must use the bedpan instead of going to the toilet, and restricted bed rest, in which brief periods of getting up are allowed under supervision. Because strict bed rest brings health disadvantages, the emphasis in medicine today is on gentle mobilization and rehabilitation of the sick as early as possible, and bed rest is ordered only for clear indications and is kept as short as possible.
The purpose of bed rest in illness and for convalescence
Bed rest is ordered not only for seriously ill patients, who are called bedridden when they have no choice but to lie in bed, but also for certain indications where any getting up would work against recovery. These indications include, for example, the condition immediately after a heart attack, severe heart failure, pulmonary embolism or in the case of extensive thrombosis, shock condition, ventilation, untreated fracture of the femoral neck or other bones of the lower extremities, unstable fractures of the vertebral bodies or pronounced risk of falling. Strict bed rest must also be observed during dialysis. In addition, pregnant women are prescribed more or less strict bed rest if there is a risk of premature birth due to weakness of the cervix or in the case of twin or multiple pregnancies, the occurrence of vaginal bleeding, miscarriage, premature birth or stillbirth in the pregnant woman’s medical history, a malposition or adhesion of the placenta, delayed development of the fetus or if the pregnant woman suffers from preeclampsia, i.e. pregnancy hypertension in connection with proteinuria, which means increased protein excretion in the urine. In modern medicine, illnesses that are accompanied by – possibly high – fever, such as pneumonia, acute bronchitis, cystitis or renal pelvic inflammation, and influenza, are no longer treated with prolonged bed rest in conjunction with medication; instead, bed rest is kept as short as possible and patients with weak circulation are offered help in getting up and encouraged to take light exercise. Prolonged bed rest would result in further health problems.
Risks and side effects
During prolonged bed rest, numerous processes happen in the human body that greatly affect the general health and even bring acute dangers. Oxygen uptake is decreased during lack of exercise, and this reduced ventilation of the lungs can result in pneumonia. The stroke volume of the heart is also decreased, while blood pressure tends to rise. The number of red blood cells decreases, the concentration of blood lipids increases, and the blood’s ability to clot changes. As a result, there is an increased risk of thrombosis. Muscle is broken down, fatty substance is built up and the strength of the outer bone substance decreases due to calcium loss. Blood sugar can no longer be utilized well enough and – temporary – diabetes can be the result. In addition, hearing can deteriorate, as can memory and sleep disturbances can occur. The sense of taste often suffers as well. Long-term bed rest can lead to bedsores in the breech area, a condition known as decubitus. After prolonged bed rest, patients have to struggle with muscle and circulatory weakness when they start to mobilize again. The psychological aspects should not be neglected either, because a patient who is prescribed strict bed rest will feel sicker than a patient who is allowed to get up at least temporarily.For all these reasons it is nowadays very carefully weighed whether the disadvantages of prolonged bed rest are outweighed by the benefits which bed rest offers in the particular case, and, although rest and sparing are of course necessary in many clinical pictures, bed rest is kept only as long as unavoidably necessary and as short as at all possible.
