Edema

Overview

Getting waterlogged

You stepped on the scale this morning and weighed three pounds more than you did a few days ago. When you looked in the mirror, your stomach seemed to look a little paunchy. Maybe you couldn't squeeze the ring off your finger, or your ankles looked puffy, or your pants were a little bit snug.

These are just a few of the possible signs of edema, the abnormal accumulation of fluids within the body tissues. Edema is not an illness, but rather a symptom of many medical conditions, among them congestive heart failure, pregnancy, cirrhosis, and premenstrual syndrome (PMS). It can also occur from occupations that require long periods of standing in one place. PMS and cirrhosis cause abdominal edema, and a feeling of being bloated. Congestive heart failure and cirrhosis usually cause swelling of the ankles because fluid has a hard time traveling up the legs against the force of gravity. It can also occur from defective valves in the leg veins (or varicose veins).

Based on the kind of edema you have, as well as the accompanying signs and symptoms, you and your doctor can discern its underlying cause. Then you can take adequate measures to treat the underlying cause of the edema. Several self-care strategies can supplement conventional treatments.

Detailed Description

All of your body's cells reside in a pool of water called interstitial fluid. This fluid suspends the cells and provides a medium for them to interact with one another. Small blood vessels called capillaries supply the interstitial fluid with nutrients and oxygen. The capillaries also carry away the cells' waste products, which are floating in the interstitial fluid.

Edema happens when the volume of interstitial fluid is greater than normal. Hormones regulate the amount of interstitial fluid relative to cells in the surrounding area. When there is a hormone imbalance, edema often occurs. It can also happen when the amount of fluid leaving the capillaries is greater than the amount re-entering them. This causes the accumulation of interstitial fluid within the body.

If you are having edema, you should seek the advice of your healthcare provider. Once you discover the cause of your edema, you can get started on a treatment program.

How Common Is Edema?

Edema of the lower extremities (ankles, feet, legs) is not uncommon in individuals with an underlying condition, such as congestive heart failure, and in patients without heart disease as well.

Conventional Treatment

Goals of Treatment

Because edema has so many potential causes, its treatment depends upon the underlying cause. For temporary edema, such as that in women during the premenstrual phase, preventive measures may be all that is needed. However, other underlying causes such as kidney disease, heart failure, and thyroid disorders require medical attention. Your doctor can suggest the treatment goals best suited for the reduction of your edema. Treatment is aimed at reducing swelling if it causes reduced mobility, skin breakdown, infection, or discomfort.

Treatment Options

Drugs most commonly used

Drugs used to treat edema depend greatly on the underlying condition being treated. Below are some common diuretics, a class of drugs used in the treatment of high blood pressure to help clear the body of excess fluid.

Microzide

 On-Label Efficacy

buy Lasix

 On-Label Efficacy

Aldactone

 On-Label Efficacy
Second choice

Bumex

 On-Label Efficacy

Dietary modifications

Avoid foods that are high in sodium. These include french fries, pepperoni pizza, potato chips, and most fast foods. Salad dressings, canned soups, and cereals are also high in sodium. Read the nutritional values labels of foods carefully — you might be surprised at what you find. If you have edema related to kidney disease, your doctor will likely recommend a diet low in fats and proteins. If so, seek the assistance of a nutritionist, who can help you create a balanced diet within certain guidelines. Use alcohol in moderation, and if your edema is related to liver disease, abstain entirely.

Alternative care

Natural diuretics: A number of herbs act as diuretics, including buchu, dandelion, juniper, parsley, and uva ursi. Teas made from these herbs may provide temporary relief; however, they are not a long-term solution because the body eventually compensates for their diuretic action.

Exercise Yoga and tai chi: These gentle forms of exercise can help treat edema.

Self care & Prevention

Preventing Edema

The best treatment for atherosclerosis is prevention. Prevention focuses on eliminating controllable risk factors:

  • Watch the salt — a high-sodium diet causes fluid retention. Fast foods, snack chips, and crackers are particularly high in salt.
  • Get some exercise. The leg muscles play a key role in moving blood from the feet back up to the heart. If the leg muscles weaken or you don't get adequate exercise, fluid from the blood pools in your feet and ankles. Walking, cycling, dancing, and other activities involving the legs keep the leg muscles in shape to move fluid upward.
  • Elevate your feet. Lie with your feet above the level of your heart to help fluid move from the legs back to the heart.

Additional Preventive Measures

Many other cases of edema are caused by long-term deterioration of the body. The best preventive measure against these diseases is healthy living. A good diet and plenty of exercise are important in maintaining whole-body fitness. And though many edema-causing conditions are age-related, it is never too late to get in shape and improve your overall health.

When to Call the Doctor

  • You have difficulty breathing or shortness of breath
  • Swelling in your legs persists for more than one week and the skin indents when you poke it
  • You are pregnant and suddenly have swelling in your leg or another part of the body
  • You have a new, general feeling of tiredness
Edema

Last updated 8 November 2011

Synonyms

  • Water retention
  • Swelling
  • Ascites

Pronunciation

Ed-EE-muh


Causes

Possible Underlying Causes

Edema usually occurs when our bodies have more salt (sodium) than normal. This causes water from within the cells to travel outside the cells in order to dilute the sodium concentration there. When we eat salty foods, we usually become thirsty and drink more fluids than normal, thus worsening the problem.

Women are especially susceptible to edema due to the hormonal fluctuation of their menstrual cycle. The monthly increase in the production of estrogen causes a secondary increase in the hormone aldosterone. Aldosterone causes the kidney to retain fluids, making some women temporarily gain a few pounds each month. Estrogen replacement therapy causes similar hormonal fluctuation in postmenopausal women.

Edema can also happen when the heart, kidney, liver, or thyroid malfunctions. Fluid accumulates in the spaces between cells when the vital organs collect more fluid within the body than they are able to eliminate. Because of gravity, edema is most common in the ankles, feet, and legs.

Triggers of Edema

  • Premenstrual phase or other hormonal fluctuations in women
  • Intake of large amounts of fluid
  • Heart or kidney failure

Diagnosing the Underlying Cause

Edema may be a symptom of an underlying disorder. Some of these disorders have certain characteristic symptoms in addition to leg or ankle swelling, while some have no symptoms, at least in the early stages.

The following conditions may include edema among their symptoms, but edema by itself should not lead you to conclude that you have a more serious disorder. You should not attempt to diagnose yourself with a medical condition, even if your symptoms match those characteristic of a certain disorder. If you have edema, the best thing to do is to seek medical advice. To understand your symptoms and reach a diagnosis, your healthcare provider will consider your medical history, what symptoms you have, and the results of a physical examination and laboratory tests.

Swelling without other symptoms:

  • Cirrhosis: damage to the liver over a long period. It has no symptoms in its early stages, but can eventually result in loss of weight and appetite, nausea, swollen legs, ankles, and abdomen; itching; jaundice (yellow skin and whites of the eyes); and more severe symptoms as the disease progresses.
  • Eczema: also called stasis dermatitis. Inflammation of the skin causing itchiness and patches of thickened skin. Eczema can cause rashes in infants. Edema would be localized.
  • Excessive salt intake: accumulation of fluids in the space outside cells in response to increased sodium in the diet, usually in conjunction with an underlying condition.
  • Infections: any infection or irritation of your soft tissue can cause localized edema.
  • Gout: a condition of the joints, especially in the big toe, causing red, swollen, warm, and very painful joints.
  • Renal failure: severe kidney failure that may be characterized initially by decreased urination, weight gain, swelling due to edema, loss of appetite, and nausea/vomiting. Requires medical attention.
  • Varicose veins: bluish-purple, knotted veins, usually in the legs, that cause itchiness or discomfort and possibly swollen feet and ankles.
  • Hormonal fluctuation: accumulation of fluid due to a change in hormones. Examples include the swelling that occurs during pregnancy as well as the premenstrual phase of a woman's monthly cycle.
  • Lymphedema: accumulation of fluid in cancer patients related to the removal of lymph nodes.

Swelling with shortness of breath or difficulty breathing:

  • Congestive heart failure: shortness of breath, fatigue, weakness, cough, and swelling of the legs due to accumulation of fluids.
  • Cardiomyopathy: a disease of the heart that reduces its ability to pump fluids, resulting in shortness of breath, swelling of the extremities, fatigue, chest pain, wheezing, and cough.
  • Heart valve disease: usually does not have symptoms, but may cause fatigue, weakness, dizziness, chest pain, shortness of breath, and swelling, depending upon the valve malfunctioning.
  • Amyloidosis: a rare disease characterized by the collection of starch-like proteins within tissues; it may cause shortness of breath, swelling, and diarrhea, depending upon the area afflicted.

Diagnostic Procedures

If your physician believes that the edema you are having may be related to another condition, you can expect a diagnosis of the underlying disorder through a physical exam and/or various procedures such as blood tests and X-ray studies.