Edema (Water retention): Symptoms, Causes, Diagnosis & Treatment

Edema is swelling or puffiness of parts of the body. Edema usually happens in the feet, ankles, and legs. It also can affect the face and hands. Pregnant women and older adults often get edema. However, it can happen to anyone.

There are several types of Edema:

  • Peripheral edema – This usually affects the legs, feet, and ankles, but it can also happen in the arms. It could be a sign of problems with the circulatory system, lymph nodes, or kidneys.
  • Pedal edema – This happens when fluid gathers in the feet and lower legs. It’s more common in the older or pregnant population. It can make it harder to move around in parts because of lack of feeling in the feet.
  • Lymphedema – This swelling in the arms and legs is most often caused by damage to the lymph nodes i.e. the tissues that help filter germs and waste from the body. The damage may be the result of cancer treatments like surgery and radiation. The cancer itself can also block lymph nodes and lead to fluid buildup.
  • Pulmonary edema – When fluid collects in the air sacs in the lungs, one may have pulmonary edema. That makes it hard to breathe and worsens when one lays down. You may have a fast heartbeat, feel suffocated, and cough up a foamy spittle.
  • Cerebral edema – This is a very serious condition in which fluid builds up in the brain. It happens if the head is hit hard, a blood vessel gets blocked or bursts, or there is a tumor or an allergic reaction.
  • Macular edema – This happens when fluid builds up in a part of the eye called the macula, which is in the center of the retina i.e. the light-sensitive tissue at the back of the eye. It happens when damaged blood vessels in the retina leak fluid into the area.

Self-diagnosis: The skin over the swollen area may be stretched and shiny. Pushing gently on the swollen area for about 15 seconds will leave a dimple.

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How Does Edema Affect Your Body?

In the body, there are two main compartments between which fluid is exchanged: the intravascular and extravascular compartments. Intravascular compartments include the cardiac chambers and the vascular system itself, whereas the extravascular compartments include everywhere else. Fluid moves easily between these compartments, and the extent of this movement is determined primarily by the balance between hydrostatic and oncotic pressures. Any change in the balance of these pressures that results in a net filtration greater than the lymphatic system, can effectively transport can cause edema.

What Are The Causes of Edema?

Common causes of edema are:

  • Heart failure – If one or both of the lower chambers of the heart cannot pump blood properly, the blood can accumulate in the limbs, causing edema.
  • Kidney disease – Damage to the glomeruli i.e. the capillaries in the kidneys that filter waste and excess fluids from the blood, can result in nephrotic syndrome. One symptom of this is a low level of the albumin protein in the blood. This can lead to edema.
  • Liver disease – Cirrhosis can lead to changes in the secretion of hormones and fluid-regulating chemicals and reduced protein production. This causes the fluid to leak out of blood vessels into surrounding tissue, thus causing edema.
  • Pregnancy – During pregnancy, the body releases hormones that encourage fluid retention, and a woman tends to retain more sodium and water than usual. The face, hands, lower limbs, and feet may swell.
  • Dietary factors – A number of dietary factors can increase the risk of edema. These include:
  1. Consuming too much salt
  2. Malnutrition, where edema can result from low protein levels in the blood
  3. A low consumption of vitamin B 1, B 6, and B 5
  • Conditions affecting the brain – Some causes of swelling in the brain include:
  1. Head injury – A blow to the head may result in an accumulation of fluids in the brain.
  2. Stroke – A major stroke can result in brain swelling.
  3. Brain tumor – A brain tumor will accumulate water around itself, especially as it builds new blood vessels.
  • Allergies – Some foods and insect bites may cause edema of the face or skin in people who are allergic or sensitive to them. Severe swelling can be a sign of anaphylaxis. Swelling in the throat can close a person’s airway and restrict breathing. This is a medical emergency.
  • Problems with the extremities – Any blockage, such as a clot in a vein, can prevent blood from flowing. As pressure increases in the vein, fluids start to leak into the surrounding tissue, causing edema.
  • Varicose veins – These usually occur because valves become damaged. Pressure increases in the veins and they start to bulge. The pressure also increases the risk of fluids leaking into the surrounding tissue.
  • A cyst or tumor – Any lump can cause edema if it presses against a lymph duct or a vein. As pressure builds up, fluids can leak into surrounding tissue.
  • Lymphedema – The lymphatic system helps remove excess fluid from tissues. Any damage to this system, such as surgery, infection, or tumor, can result in edema.
  • Use of certain medications – Some medications increase the risk of developing edema. These include:
  1. Vasodilators, or drugs that open blood vessels
  2. Calcium channel blockers
  3. Non-steroidal anti-inflammatory drugs (NSAIDs)
  4. Estrogens
  5. Some chemotherapy drugs
  6. Some diabetes drugs, such as thiazolidinediones (TZDs)

Other miscellaneous conditions:

  • Prolonged immobility – People who are immobilized for a long time can develop edema in their skin. This can be due both to fluid pooling in gravity-dependent areas and the release of antidiuretic hormone from the pituitary.
  • High altitude – This, combined with physical exertion, can increase the risk of edema. Acute mountain sickness can lead to high-altitude pulmonary edema or high-altitude cerebral edema.
  • Burns and sunburn – The skin reacts to a burn by retaining fluid. This causes localized swelling.
  • Infection or inflammation – Any tissue that is infected or inflamed can become swollen. This is usually most noticeable in the skin.
  • Menstruation and pre-menstruation – Hormone levels fluctuate during the menstrual cycle. During the days before menstrual bleeding, levels of progesterone are lower, and this may cause fluid retention.
  • Use of contraceptive pills – Any medication that includes estrogen can cause fluid retention. It is not uncommon for women to put on weight when they first start using the pill.
  • Menopause – Around menopause, hormone fluctuations can cause fluid retention. Hormone replacement therapy (HRT) can also trigger edema.
  • Thyroid disease – Hormonal imbalances associated with thyroid problems can lead to edema.
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What Are The Risk Factors of Edema?

Common risk factors of edema are:

  • Staying in one position (sitting, standing or supine) for too long
  • Increased sodium intake
  • Hormonal changes due to menstruation
  • Pregnancy
  • Taking certain medicines like vasodilators, calcium channel blockers, estrogen-based medication, non-steroidal anti-inflammatory drugs (NSAIDs) and certain diabetic medications
  • As a symptom of diseases like congestive heart failure, cirrhosis, kidney disease, chronic venous insufficiency, and chronic lung diseases
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What Are The Symptoms of Edema?

Common symptoms of edema are:

  • Swollen, stretched, and shiny skin
  • Skin that retains a dimple after being pressed for a few seconds
  • Puffiness of the ankles, face, or eyes
  • Aching body parts and stiff joints
  • Weight gain or loss
  • Fuller hand and neck veins
  • Higher pulse rate and blood pressure
  • A headache
  • Abdominal pain
  • Changes in bowel habits
  • Nausea and vomiting
  • Confusion and lethargy
  • Visual abnormalities
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How is Edema Diagnosed?

To understand what might be causing the edema, the doctor will first perform a physical exam and ask questions about the medical history. This information is often enough to determine the underlying cause of the edema. In some cases, X-rays, ultrasound exams, magnetic resonance imaging, blood tests or urine analysis may be necessary.

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How To Prevent & Control Edema?

If the edema is caused by health problems, such as congestive heart failure, liver disease, or kidney disease, it can only be managed, not prevented. If the edema is caused by eating too much salt, it can be prevented by reducing the salt intake.

Treatment of Edema

  • Mild edema – It usually goes away on its own, particularly if the affected limb is raised higher than the heart.
  • Severe edema – It may be treated with drugs that help the body expel excess fluid in the form of urine (diuretics). One of the most common diuretics is furosemide (Lasix). However, the doctor will determine whether these types of medications are a good option, based on personal medical history.
  • Long-term management of edema – This method focuses on treating the underlying cause of the swelling. If edema occurs as a result of medication use, the doctor may adjust the prescription or check for an alternative medication that doesn’t cause edema.
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Edema- Lifestyle Tips

To alleviate edema, these lifestyle tips should be followed:

  • Elevate the legs while sitting or lying down.
  • In the case of edema of the legs, wear support stockings.
  • Do not sit or stand for long periods of time without moving around.
  • Limit salt intake.

What Are The Recommended Exercises For a Person With Edema?

Following yoga asanas are proved to be very helpful for edema patients:

  • Tadasana Mountain pose
  • Warrior pose
  • Urdhahastottasana
  • Parshavkonasana
  • Viparit Karni
  • Sarvangasana
  • Halasana
  • Setu bandha asana
  • Asvasanchalan
  • Surya Namaskar (Sun Salutation)
  • Katichakrasana
  • Trikonasana
  • Bhujangasana

Edema And Pregnancy – Things to Know

When a woman is pregnant, her body produces 50% more blood and other body fluids than usual, to support the developing fetus. This causes edema of the hands, face, legs, ankles, and feet, and is a normal part of pregnancy. Swelling can also be pronounced in the legs and feet because of the enlarged womb (uterus) taking up space in the abdomen and inhibiting the return of fluids from the legs.

During pregnancy, edema can happen any time through gestation. However, edema is usually experienced in the fifth month, and may worsen in the third trimester.

Mild swelling is common, but sudden swelling of the hands or face can be a sign of preeclampsia, a complication of pregnancy. The obstetrician must be consultedin the case of facial edema, leg edema, or any sudden or severe swelling while pregnant.

Edema may continue even after delivery. In most cases, postpartum edema gradually resolves within a week or so after giving birth and is generally not a serious condition. However, if the postpartum swelling does not resolve within about a week, and there are signs of headaches or pain in the legs, the doctor must be consulted as these symptoms may be a sign of high blood pressure and preeclampsia.

Common Complications Related to Edema

If left unchecked, edema can result in the stretching of the overlying skin, infections, or ulcers. Also, decreased blood circulation can lead to blood clots in the deep veins of the body. This is also known as deep vein thrombosis.

Other FAQs About Edema

Q. Is edema fatal?

A. Brain swelling can be very difficult to treat. It can also cause irreversible damage. The swelling can occur throughout the brain or in certain areas. If left untreated, cerebral edema can be fatal.

Q. What doctor treats edema?

A. Because edema is multifactorial (many possible causes), several doctors will likely be involved in its care. This includes a primary care physician (PCP) or internist, a nephrologist (kidney specialist), cardiologist (heart specialist), or gastroenterologist (digestive tract or liver specialist).

Q. Can High BP cause edema?

A. Due to the increased blood pressure in the veins, the fluid seeps out into the surrounding tissue. This may cause swelling in the legs or a build-up of fluid in the abdomen. A congestive heart failure can also cause edema in the lungs (pulmonary edema).

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