Why Won't an Ulcer Heal? Understanding Persistent Causes and Treatments

October 1, 2025 •

5 min read

Chronic ulcers, defined as wounds that fail to progress through the normal healing process, affect millions of people worldwide and can be a source of significant distress. Addressing the underlying cause is the first step toward finding out why won't an ulcer heal and getting on the path to recovery.

Quick Summary

Chronic ulcers fail to heal due to underlying issues like poor circulation, unresolved infection, or chronic diseases such as diabetes. Other factors include repeated trauma, poor nutrition, and specific medications that disrupt the natural healing process. Effective treatment requires correctly diagnosing and managing the root cause.

Key Points

Underlying Medical Conditions: Chronic diseases like diabetes, vascular issues (PAD, venous insufficiency), and autoimmune disorders are major reasons why ulcers won't heal.
Infection and Inflammation: Unresolved bacterial infections within or around the wound can create an environment that halts the natural healing process.
Inadequate Blood Flow: Poor circulation, whether from blocked arteries or faulty veins, prevents oxygen and nutrients from reaching the ulcer, stopping its repair.
Continued Pressure or Trauma: For skin ulcers, persistent pressure, friction, or re-injury keeps the wound from closing properly.
Lifestyle Choices: Smoking, excessive alcohol consumption, and poor nutrition significantly hinder the body's ability to heal ulcers.
Medication Interference: The use of certain medications, including NSAIDs and steroids, can disrupt the healing cascade.
Proper Treatment Adherence: For peptic ulcers, failing to complete a full course of antibiotics for H. pylori is a common reason for non-healing.

Introduction to Non-Healing Ulcers

An ulcer is an open sore on the skin or mucous membrane that results from a breakdown of tissue. In a healthy body, the wound healing process is a complex, multi-stage physiological event that typically resolves within a few weeks. However, when this process is interrupted or stalled, an ulcer can become chronic and fail to heal, leading to pain, infection, and other serious complications. The reasons for this can be systemic, relating to an individual's overall health, or local, concerning the immediate wound environment.

Common Reasons for Refractory Peptic Ulcers

Peptic ulcers are sores that develop on the lining of the stomach, esophagus, or upper part of the small intestine. When these fail to heal with standard treatment, they are called refractory ulcers.

Persistent H. pylori Infection: The most common cause of peptic ulcers is the bacterium Helicobacter pylori (H. pylori). If the initial course of antibiotics fails to eradicate the bacteria—perhaps due to antibiotic resistance or incomplete treatment—the ulcer may not heal and can recur.
Chronic NSAID Use: Long-term or regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin is another major cause. These medications inhibit substances that protect the stomach lining, and continued use will prevent healing.
Lifestyle Factors: Smoking is a significant impediment to healing, as it damages the stomach lining, increases stomach acid, and decreases mucosal blood flow. Excessive alcohol consumption and high-stress levels can also worsen symptoms and delay recovery.
Other Conditions: Less common causes include Zollinger-Ellison syndrome, a rare condition that causes the overproduction of stomach acid, and other systemic diseases.

Reasons for Non-Healing Skin Ulcers

Skin ulcers, such as those on the legs or feet, commonly fail to heal due to issues with blood flow or nerve function.

Poor Circulation: Arterial ulcers are caused by peripheral arterial disease (PAD), where arteries narrow and restrict blood flow, starving the tissue of oxygen and nutrients needed for repair. Venous ulcers result from venous insufficiency, where blood pools in the lower legs due to faulty vein valves, leading to increased pressure and tissue damage.
Diabetes and Neuropathy: High blood sugar levels in people with diabetes can damage nerves (neuropathy) and blood vessels, leading to reduced sensation and poor circulation. This can cause minor injuries to go unnoticed and worsen into chronic, non-healing ulcers.
Infection: Bacteria can invade an open wound, and the body's prolonged inflammatory response can prevent new, healthy tissue from forming. An untreated infection can progress and prevent healing entirely.
Pressure and Reinjury: Pressure ulcers, also known as bedsores, occur from constant pressure on the skin, which damages underlying tissue. In skin ulcers, repeated trauma from walking, ill-fitting shoes, or movement can continuously disrupt the healing process.

General Factors That Impede Healing

Regardless of the ulcer type, several factors can prevent proper healing.

Malnutrition: The body requires sufficient protein, vitamins, and minerals (like Vitamin C and zinc) to repair tissue. A poor diet can leave the body without the necessary building blocks for healing.
Medications: Beyond NSAIDs, other drugs can interfere with healing, including steroids, chemotherapy drugs, and some immunosuppressants.
Underlying Medical Conditions: Chronic diseases such as kidney failure, liver cirrhosis, and autoimmune disorders can all affect the body's ability to heal.
Age: The skin's ability to regenerate and repair itself slows down with age, which can contribute to delayed healing in older individuals.

Comparing Types of Non-Healing Ulcers


Feature	Peptic Ulcer (Refractory)	Diabetic Foot Ulcer	Venous Leg Ulcer	Arterial Leg Ulcer
Location	Stomach, esophagus, or duodenum	Soles of feet, under calluses, toes	Lower legs, often around the ankle	Toes, heels, or other pressure points on the foot
Primary Cause	Persistent H. pylori or chronic NSAID use	Neuropathy and poor circulation from diabetes	Venous insufficiency (faulty vein valves)	Peripheral Arterial Disease (PAD)
Appearance	Varies; often visible via endoscopy	Variable, can be deep with callus edges	Shallow with irregular borders; significant exudate	Deep, often "punched out" with dry, necrotic tissue
Pain	Often severe, can be worse on an empty stomach	Reduced sensation due to nerve damage	Mild to moderate, dull, aching pain	Often severe, especially at night or when legs are elevated
Other Symptoms	Heartburn, nausea, weight loss	Skin discoloration, numbness, warmth	Significant swelling (edema), discolored skin	Cold to the touch, loss of hair on leg
Key Treatment	H. pylori eradication or NSAID cessation	Blood sugar control, pressure relief, wound care	Compression therapy, managing venous disease	Improving arterial blood flow (surgery or stenting)

Treatment for Non-Healing Ulcers

For an ulcer to heal, the underlying cause must be addressed. Treatment varies significantly based on the type of ulcer.

Accurate Diagnosis: A healthcare provider will typically perform tests, such as an endoscopy for peptic ulcers or vascular studies like an ankle-brachial index (ABI) for leg ulcers, to determine the root cause.
Targeted Therapy: This could involve a different course of antibiotics for drug-resistant H. pylori, or managing underlying conditions like controlling blood sugar for diabetic ulcers. For vascular ulcers, therapies to improve circulation may be necessary.
Wound Care: For skin ulcers, proper wound management is critical. This includes debridement to remove dead tissue, keeping the wound moist with appropriate dressings, and protecting it from pressure or injury. Advanced therapies like hyperbaric oxygen therapy or skin grafts may be used in severe cases.
Lifestyle Changes: Quitting smoking and reducing alcohol intake are crucial for both peptic and skin ulcers. A balanced, nutritious diet supports the body's natural healing processes.
Medication Review: A doctor may review your medications and suggest alternatives to NSAIDs or other drugs that hinder healing.

The Critical Role of Seeking Professional Help

A chronic or non-healing ulcer is not just a stubborn wound; it's a signal that something is wrong beneath the surface. Ignoring it can lead to serious complications, including severe infections, tissue death, and, in extreme cases, amputation. Early and accurate diagnosis by a healthcare professional is essential for proper treatment and prevention of further damage. If your ulcer hasn't shown significant improvement after several weeks of initial care, it's vital to seek medical advice. A vascular specialist or wound care clinic can provide the multidisciplinary expertise needed to identify the root cause and develop an effective treatment plan.

Center for Vascular Medicine

Conclusion

While frustrating, a non-healing ulcer is not a dead end. Its persistence often points to an unaddressed underlying medical issue, ranging from bacterial infection to complex vascular problems. By identifying and treating the specific root cause, whether through medication, improved wound care, or surgical intervention, the body can get back on track with its natural healing process. Prioritizing accurate diagnosis and adhering to a comprehensive treatment plan are key to resolving the ulcer and preventing its recurrence, leading to improved health and quality of life.

Frequently Asked Questions

A refractory ulcer is a peptic ulcer that does not heal completely after 8 to 12 weeks of standard anti-secretory drug treatment. It is often caused by persistent H. pylori infection, continued NSAID use, or other factors.

Yes, a non-healing ulcer can indicate an underlying medical issue, such as uncontrolled diabetes, peripheral artery disease (PAD), or even a form of skin cancer. It is crucial to have it professionally diagnosed.

Yes, smoking is a major factor that delays ulcer healing. It reduces blood flow to the stomach lining, increases stomach acid production, and can cause mucosal cell damage, all of which interfere with the body's repair mechanisms.

Signs of an infected ulcer include increased pain, redness and swelling around the wound, a foul odor, and pus or drainage. If you notice these symptoms, a healthcare professional should evaluate and treat it.

While stress does not directly cause ulcers, it can worsen symptoms and delay the healing process. Chronic stress can increase stomach acid production and weaken the immune system's ability to fight infection.

While no single 'ulcer diet' exists, a nutritious diet rich in fiber, fruits, and vegetables can support healing. Probiotic-rich foods may also help balance gut bacteria. Avoiding triggers like spicy, acidic, fatty foods, and alcohol is often recommended.

Treatment for a non-healing vascular ulcer focuses on addressing the underlying circulatory problem. This may involve improving blood flow with medications or surgery, managing swelling with compression therapy, and using advanced wound care techniques like debridement or hyperbaric oxygen therapy.

An ulcer can recur if the original cause was not fully resolved. For example, if an H. pylori infection was not completely eradicated or if NSAID use continued. For leg ulcers, underlying chronic issues like vascular disease can cause recurrence without proper management.