An ulcer is an open sore that develops on your skin, the lining of an internal organ, or the surface of body tissue. Ulcers form when inflammation causes tissue erosion, leading to pain and discomfort in the area where the ulcer developed.
There are several types of ulcers, each with its distinct causes, symptoms, and treatment approaches. Some ulcers heal on their own with self-care measures and time, while others require medical treatments to relieve symptoms.
Ulcers can develop in various body parts, including externally on the skin and internally in the lining of organs or body tissues.There are four main locations where ulcers can occur, with 14 different types of ulcers you can develop.
Peptic (Stomach) Ulcers
Peptic ulcers (also called stomach ulcers) are sores that develop on the lining of the stomach, upper part of the small intestine (duodenum), or esophagus (food pipe):
- Gastric (stomach) ulcers: Occur in the stomach lining, causing symptoms like burning stomach pain, bloating, nausea, and vomiting
- Duodenal ulcers: Form in the duodenum (the first part of the small intestine), producing symptoms like bloating, stomach pain, nausea, and vomiting
- Esophageal ulcers: Develop on the inner lining of the esophagus, leading to symptoms such as painful swallowing, nausea or vomiting, dry cough, heartburn, and chest pain or discomfort
A protective mucus layer lining the stomach, intestines, and esophagus usually prevents damage from digestive acids. However, the breakdown of this protective layer allows digestive acids to reach and damage the stomach and intestinal walls, leading to a peptic ulcer. There are two main causes of peptic ulcers:
- Helicobacter pylori (H. pylori) bacterial infection
- Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen)
About 1-6% of adults in the United States have peptic ulcers. The risk of developing a peptic ulcer is higher in older adults, people who smoke, and those with a history of peptic ulcers.
Skin Ulcers
Skin ulcers are open sores that develop on the skin. They can vary in size and depth and have different causes. There are four subtypes of skin ulcers, which include:
- Arterial ulcers: Develop due to poor blood circulation in the legs. Lack of nutrient-rich blood to the tissues causes cell death and tissue damage, leading to ulcers. Arterial ulcers usually develop on the feet and legs and may appear dark red, yellow, black, or gray. Some cause aching pain in the legs and feet, but dangling the affected leg downward may relieve discomfort.
- Venous ulcers: Form on the legs (above the ankle) when veins in the legs do not push blood back up to the heart as they should. This causes fluid build-up in the leg that builds pressure and leads to an open sore. Venous ulcers are usually shallow, unevenly shaped, and red with a yellow tissue covering. The surrounding skin may be shiny, warm, or hot, and you may experience leg pain.
- Pressure ulcers (bedsores): Pressure ulcers occur on the skin over bony areas from prolonged pressure, often due to long-term bed rest or wheelchair use. They commonly develop on the heels, tailbone, shoulder blades, or the back of the head. They're initially red and warm to the touch and may cause burning pain or itchiness. As the sore worsens, it may look like a blister or open wound and cause worsening pain. Without treatment, pressure sores can deepen, and you may visibly see underlying tissues like muscle or bone.
- Neuropathic ulcers: Appear due to nerve damage. Neuropathic ulcers are common in people with uncontrolled diabetes and usually develop on the pad of the foot. With nerve damage, you may be unaware of an ulcer on your foot and continue walking and putting pressure on the sore. About 5% of people with diabetes develop neuropathic ulcers.
Mouth Ulcers
Mouth ulcers, or oral ulcers, are sores that develop inside the mouth. These ulcers include:
- Canker sores (aphthous ulcers): Small, painful ulcers with a red edge and white or yellow-colored center that appear on the inner lips, cheeks, palate, or gums. Rough toothbrushing, mouth injuries from dental work, biting your tongue or cheek, stress, hormonal changes, and food allergies can all trigger the development of canker sores.
- Cold sores (fever blisters): Blisters that form on the lips or around the mouth from a herpes simplex virus (HSV) infection. These sores can develop on the gums, lips, mouth, and throat. The blisters eventually break open and leak clear yellowish fluid, leaving a red ulcer that eventually crusts over as it heals. Cold sores may initially cause an itch or tingling sensation before developing, eventually becoming painful and uncomfortable until they scab over and heal.
- Oral thrush: An oral yeast infection caused by an overgrowth of Candida yeast in the mouth, which leads to painful, white-colored ulcers on the inner lining of the mouth and tongue. Oral thrush ulcers may bleed when brushing teeth or when eating.
Genital Ulcers
Genital ulcers are sores that develop on the vagin*, penis, anus, or perineum (a small patch of skin between your genitals and anus). Most genital ulcers develop as a result of a sexually transmitted infection (STI), but can also occur due to trauma to the genital area, infections like mononucleosis, and inflammatory conditions like psoriasis. Subtypes of genital ulcers include:
- Genital herpes: Develops from the herpes simplex virus (HSV), causing painful blisters and sores to form on the genitals, buttocks, or thighs.
- Syphilis: Causes painless ulcers (called chancres) that are round, firm, and painless. Sometimes, the sores can also be open and wet. Syphilis sores can develop on the vulva, vagin*, anus, scrotum, and penis. However, some can grow in hard-to-see spots, such as deep inside the vagin*, under the foreskin, or inside the rectum.
- Lymphogranuloma venereum: Affects the lymphatic system and occurs due to the strains of the Chlamydia trachomatis bacteria, which develops within a few days to a month after exposure. This STI causes small, painless ulcers on the genitals, fluid draining from the skin near the groin lymph nodes, swelling and redness of the labia or scrotum, and painful bowel movements.
- Chancroid: Happens when you develop an infection with Haemophilus ducreyi bacteria. Within a day to two weeks after infection, a small bump develops on the penis or vagin*, which becomes an ulcer after a day. Chancroid ulcers are soft and painful, with a gray or yellowish-gray appearance, and bleed when bumped or scraped.
How To Know Which Type You Have
Determining the type of ulcer you have requires a comprehensive evaluation by a healthcare provider. While your symptoms can provide initial clues, healthcare providers will review your medical history, perform a physical examination, and order diagnostic tests to give a definitive diagnosis.
Diagnostic tests to confirm the type of ulcer you have may include:
- Endoscopy: Involves passing a thin, flexible tube with a light and camera through your mouth to examine the esophagus, stomach, and upper small intestine
- Blood test: Checks for infections, inflammation, or other underlying conditions
- Stool test: Detects blood or the presence of H. pylori bacteria
- Imaging test: Uses CT scans or ultrasounds to help visualize the ulcer and its affected area
While some types of ulcers (like canker sores) may go away with self-care, most require medical attention for an accurate diagnosis and effective treatment. Over-the-counter (OTC) medications may temporarily relieve some ulcer symptoms, but they don’t address the underlying cause.
It's important to seek medical attention if you experience any of the following symptoms:
- Severe abdominal pain
- Bloody, tarry, or black stools
- Vomiting blood
- Difficulty swallowing
- Rapid heartbeat
- Fainting or dizziness
Treatments vary widely, depending on the type of ulcer, and may include:
- Medications to reduce stomach acid
- Antibiotics to eradicate bacterial infections
- Antivirals to treat viral infections
- Antifungals to treat fungal infections
- Lifestyle changes, such as avoiding irritants like alcohol and spicy foods
- OTC or prescription topical ointments and creams or oral mouthwashes
Preventing Ulcers
Implementing certain lifestyle habits can help prevent new or future ulcers. While not all ulcer types are entirely preventable, healthy habits may help lower your risk of certain types.Consider the following tips:
- Peptic ulcers: Avoid prolonged or excessive NSAID use, avoid smoking, limit alcohol intake, and seek treatment for ongoing acid reflux (heartburn)
- Skin ulcers: Practice good skin hygiene, moisturize regularly, promptly address skin injuries, quit smoking, and maintain a weight that's right for you
- Mouth ulcers: Implement good oral hygiene (such as toothbrushing and flossing daily), avoid irritants, and manage stress
- Genital ulcers: Practice safe sex by using condoms and dental dams
Ulcers are open sores that can develop in several body areas, including the skin, internal organs, and genitals. Each ulcer type has distinct causes, symptoms, and treatments.
Most ulcers require medical treatment, so talk to a healthcare provider if you have a visible ulcer or have symptoms of an ulcer inside the body, such as stomach pain or painful swallowing.Treatments like medications and lifestyle changes can help relieve symptoms and improve your overall quality of life.
