Wise Words – Edema and Swelling

Submitted by Dr Becky Wise

Edema is swelling caused by excess water trapped in your body’s tissue, usually in the hands, arms, feet, ankles and legs. It occurs when tiny blood vessels in your body (capillaries) leak fluid. The fluid builds up in surrounding tissues, leading to swelling and can be the result of medication, pregnancy or an underlying disease such as heart failure, kidney disease or cirrhosis of the liver. Taking medication to remove excess fluid and reducing the amount of salt in your food often relieves edema. When edema is a sign of an underlying disease, the disease itself requires separate treatment.

Signs and symptoms of edema include:
Swelling or puffiness of the tissue directly under your skin
Stretched or shiny skin
Skin that retains a dimple after being pressed for several seconds (“pitting”)
Increased abdominal size
Seek immediate medical attention if you experience:
Shortness of breath
Difficulty breathing
Chest pain
*These symptoms can be a sign of pulmonary edema, which requires prompt treatment.

compression-stockings-WEB If you’ve been sitting for a prolonged period, such as on a long car ride or airplane flight, and you develop swelling and pain in a leg that won’t go away, call your doctor immediately. Persistent leg pain and swelling can be a sign of a blood clot in your veins (deep vein thrombosis, or DVT).

It can be a side effect of some medications, including:

High blood pressure medications (especially calcium channel blockers like Norvasc/amlodipine, Cardizem/diltiazem, Procardia/nifedipine)
Nonsteroidal anti-inflammatory drugs (Ibuprofen, Mobic/meloxicam, Celebrex/celecoxib)
Steroid drugs (like Prednisone)
Estrogens (birth-control pills, Premarin)
Certain diabetes medications called thiazolidinediones (Actos/pioglitazone or Avandia/rosiglitazone)

Diseases and conditions that may cause edema include:

Congestive heart failure. When one or both of your heart’s lower chambers lose their ability to pump blood effectively the blood can back up in your legs, ankles and feet. Heart failure can also cause swelling in your abdomen. Sometimes it can cause fluid to accumulate in your lungs (pulmonary edema), which can lead to shortness of breath.

Cirrhosis. Fluid may accumulate in your abdominal cavity (ascites) and in your legs as a result of liver damage (cirrhosis).
Kidney disease. When you have kidney disease, extra fluid and sodium in your circulation may cause edema. The edema associated with kidney disease usually occurs in your legs and around your eyes.

Kidney damage. Damage to the tiny, filtering blood vessels in your kidneys can result in nephrotic syndrome. In nephrotic syndrome, declining levels of protein (albumin) in your blood can lead to fluid accumulation and edema.

Weakness or damage to veins in your legs. Chronic venous insufficiency, in which the one-way valves in your leg veins are weakened or damaged, allows blood to pool in the leg veins and cause swelling. Abrupt onset of swelling in one leg accompanied by pain in your calf can be due to a clot in one of your leg veins. Seek medical help promptly.

Inadequate lymphatic system. Your body’s lymphatic system helps clear excess fluid from tissues. If this system is damaged — for example, by cancer surgery — the lymph nodes and lymph vessels draining an area may not work correctly and edema results.
Surgery can sometimes obstruct a lymph node, leading to swelling in an arm or leg, usually on just one side.

If left untreated, edema can cause:
Increasingly painful swelling
Difficulty walking
Stiffness
Stretched skin, which can become itchy and uncomfortable
Increased risk of infection in the swollen area
Scarring between layers of tissue
Decreased blood circulation
Decreased elasticity of arteries, veins, joints and muscles
Increased risk of skin ulcers

Mild edema usually goes away on its own, particularly if you help things along by raising the affected limb higher than your heart.
More severe edema may be treated with drugs that help your body expel excess fluid in the form of urine (diuretics). One of the most common diuretics is furosemide (Lasix).

Long-term management typically focuses on treating the underlying cause of the swelling. If edema occurs as a result of medication use, your doctor may adjust your prescription or check for an alternative medication that doesn’t cause edema

The following may help decrease edema and keep it from coming back. Before trying these self-care techniques, talk to your doctor about which ones are right for you.

Movement. Moving and using the muscles in the part of your body affected by edema may help pump the excess fluid back to your heart. Ask your doctor about exercises you can do that may reduce swelling.

Elevation. Hold the swollen part of your body above the level of your heart several times a day. In some cases, elevating the affected body part while you sleep may be helpful.

Massage. Stroking the affected area toward your heart using firm, but not painful, pressure may help move the excess fluid out of that area.

Compression. If one of your limbs is affected by edema, your doctor may recommend you wear compression stockings, sleeves or gloves. These garments keep pressure on your limbs to prevent fluid from collecting in the tissue.

Protection. Keep the affected area clean, moisturized and free from injury. Dry, cracked skin is more prone to scrapes, cuts and infection. Always wear protection on your feet if that’s where the swelling typically occurs.

Reduce salt intake. Follow your doctor’s suggestions about limiting how much salt you consume. Salt can increase fluid retention and worsen edema.

If you think you are experiencing edema or swelling, notify your physician so you can discuss a plan of action.

Be Well, Be Wise,
Dr.Becky

******************************************************************************************************

Dr. Rebecca Wise

Wise Words…. is a general medical information column from Dr Rebecca Wise. Dr. Wise has a master’s degree in education as well as her doctorate in pharmacy. She is an assistant professor and ambulatory care specialist at a Medication Therapy Management (MTM) clinic in Erie, PA.

******************************************************************************************************

You must be logged in to post a comment Login