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Edema What You Should Know

Everything you need to know about edema

Edema What You Should Know

Edema is swelling caused by excess fluid trapped in your body’s tissues. Although edema can affect any part of your body, you may notice it more in your hands, arms, feet, ankles and legs.

Edema can be the result of medication, pregnancy or an underlying disease — often congestive heart failure, kidney disease or cirrhosis of the liver.

“Edema” is the medical term for swelling. Body parts swell from injury or inflammation. It can affect a small area or the entire body. Medications, pregnancy, infections, and many other medical problems can cause edema.

Edema happens when your small blood vessels leak fluid into nearby tissues. That extra fluid builds up, which makes the tissue swell. It can happen almost anywhere in the body.

Edema means swelling. The condition called edema arises when part of the body becomes swollen because fluid gathers in the tissue. It most commonly affects the arms and legs. That is called peripheral edema.

Common early signs of peripheral edema include the following:

An arm or leg starts feeling full or heavy.

The arm or leg starts to look swollen.

When you press the swelling, it leaves a dent.

Your clothing or jewelry starts to feel tight and uncomfortable.

The skin near the edema feels tight or warm.

It becomes harder to move any joints that are affected.

There is a sensation of tautness or even pain in the surrounding area.

Edema is an accumulation of fluid in the interstitial space that occurs as the capillary filtration exceeds the limits of lymphatic drainage, producing noticeable clinical signs and symptoms. The rapid development of generalized pitting edema associated with systemic disease requires timely diagnosis and management. The chronic accumulation of edema in one or both lower extremities often indicates venous insufficiency, especially in the presence of dependent edema and hemosiderin deposition. Skin care is crucial in preventing skin breakdown and venous ulcers

Eczematous (stasis) dermatitis can be managed with emollients and topical steroid creams. Patients who have had deep venous thrombosis should wear compression stockings to prevent postthrombotic syndrome. If clinical suspicion for deep venous thrombosis remains high after negative results are noted on duplex ultrasonography, further investigation may include magnetic resonance venography to rule out pelvic or thigh proximal venous thrombosis or compression.

Obstructive sleep apnea may cause bilateral leg edema even in the absence of pulmonary hypertension. Brawny, nonpitting skin with edema characterizes lymphedema, which can present in one or both lower extremities. Possible secondary causes of lymphedema include tumor, trauma, previous pelvic surgery, inguinal lymphadenectomy, and previous radiation therapy. Use of pneumatic compression devices or compression stockings may be helpful in these cases.

What is Edema?

Edema is swelling of both legs from a buildup of extra fluid. Edema has many possible causes:

Prolonged standing or sitting, especially in hot weather, can cause excess fluid to accumulate in the feet, ankles and lower legs.

Tiny valves inside the veins of the legs can become weakened, causing a common problem called venous insufficiency. This problem makes it more difficult for the veins to pump blood back to the heart, and leads to varicose veins and buildup of fluid.

Severe chronic (long-term) lung diseases, including emphysema and chronic bronchitis, increase pressure in the blood vessels that lead from the heart to the lungs. This pressure backs up in the heart. The higher pressure causes swelling in the legs and feet.

Congestive heart failure, a condition in which the heart can no longer pump efficiently, causes fluid buildup in the lungs and other parts of the body. Swelling is often most visible in the feet and ankles.

Pregnancy can cause edema in the legs as the uterus puts pressure on the vena cava, a major blood vessel that returns blood to the heart from the legs. Fluid retention during pregnancy also can be caused by a more serious condition called preeclampsia.

Low protein levels in the blood caused by malnutrition, kidney and liver disease can cause edema. The proteins help to hold salt and water inside the blood vessels so fluid does not leak out into the tissues. If a blood protein, called albumin, gets too low, fluid is retained and edema occurs, especially in the feet, ankles and lower legs.

What Are The Types Of Edema?

The information provided here is about edema on the legs and feet (pitting or peripheral edema); however, other forms of edema are typically named depending on what part of the body is affected.

Cerebral edema is an accumulation of excess fluid in the brain.

Angioedema is swelling underneath the skin. Unlike hives, which affect the surface of the skin, angioedema affects the deeper layers of the skin and often occurs on the face.

Hereditary angioedema is a rare genetic condition that causes the capillaries to release fluids into surrounding tissue, which results in edema.

Papilledema is swelling of the optic nerve of the eye that is a result of pressure inside the skull and around the brain (intracranial pressure).

Macular edema is a swelling of the portion of the eye that perceives central, detailed vision (the macula).

Dependent edema usually is edema of the legs and lower body, which is affected by gravity and is dependent on a person’s position. This edema usually occurs in the legs when a person is standing, and in the buttocks and hands if a person is lying down.

Scrotal lymphedema is an enlargement of the scrotum due to fluid accumulation around the testes.

Lipedema is a disorder of the fatty (adipose) tissue that causes swelling of the legs and hips, and can lead to lymphedema

Causes of Edema

Things like a twisted ankle, a bee sting, or a skin infection will cause edema. In some cases, like an infection, this may be helpful. More fluid from your blood vessels puts more infection-fighting white blood cells in the swollen area.

Edema can also come from other conditions or from when the balance of substances in your blood is off. For example:

Low albumin. Your doctor may call this hypoalbuminemia. Albumin and other proteins in the blood act like sponges to keep fluid in your blood vessels. Low albumin may contribute to edema, but it’s not usually the only cause.

Allergic reactions. Edema is a part of most allergic reactions. In response to the allergen, nearby blood vessels leak fluid into the affected area.

Obstruction of flow. If drainage of fluid from a part of your body is blocked, fluid can back up. A blood clot in the deep veins of your leg can cause leg edema. A tumor blocking the flow of blood or another fluid called lymph can cause edema.

Critical illness.Burns, life-threatening infections, or other critical illnesses can cause a reaction that allows fluid to leak into tissues almost everywhere. This can cause edema all over your body.

Congestive heart failure. When the heart weakens and pumps blood less effectively, fluid can slowly build up, creating leg edema. If fluid builds up quickly, you can get fluid in the lungs. If your heart failure is on the right side of your heart, edema can develop in the abdomen.

Liverdisease. Severe liver disease, such as cirrhosis, causes you to retain fluid. Cirrhosis also leads to low levels of albumin and other proteins in your blood. Fluid leaks into the abdomen and can also cause leg edema.

Kidney disease. A kidney condition called nephrotic syndrome can cause severe leg edema and sometimes whole-body edema.

Pregnancy. Mild leg edema is common during pregnancy. But serious complications of pregnancy like deep vein thrombosis and preeclampsia can also cause edema.

Head trauma, low blood sodium (called hyponatremia), high altitudes, brain tumors, and a block in fluid drainage in the brain (known as hydrocephalus) can cause cerebral edema. So can headaches, confusion, unconsciousness, and coma.

Medications. Many medicines can cause edema, including:

  • NSAIDs (such as ibuprofen and naproxen)
  • Calcium channel blockers
  • Corticosteroids (like prednisone and methylprednisolone)
  • Pioglitazone and rosiglitazone
  • Pramipexole

When they cause swelling, usually it’s mild leg edema.

What Are the Symptoms of Edema? What Does It Look Like?

Symptoms will depend on the cause of edema.

Peripheral edema

Symptoms of peripheral edema include swelling of the affected area(s), which causes the surrounding skin to “tighten.” The swelling from peripheral edema is gravity-dependent (it will increase or decrease with changes in body position). For example, if a person is lying on their back (supine), the swelling will not appear in the legs, but will appear in the area around the sacrum. The skin over the swollen area appears tight and shiny, and often when pressure is applied to the area with a finger, an indentation appears. This is called pitting edema

Pulmonary Edema

In the case of pulmonary edema, there is often no evidence of fluid retention or noticeable swelling on examination of the patient’s extremities. This is because the fluid is backing up into the lungs. Signs and symptoms of pulmonary edema include:

  • shortness of breath,
  • difficulty breathing when lying flat,
  • waking up breathless, and
  • requiring multiple pillows to raise the head at night for a comfortable sleep.

Treatment

To treat edema, you often must treat its underlying cause. For example, you might take allergy medications to treat swelling from allergies.

Edema from a block in fluid drainage can sometimes be treated by getting the drainage flowing again. A blood clot in the leg is treated with blood thinners. They break down the clot and get drainage back to normal. A tumor that blocks blood or lymph can sometimes be shrunk or removed with surgery, chemotherapy, or radiation.

Leg edema related to congestive heart failure or liver disease can be treated with a diuretic (sometimes called a ”water pill”) like furosemide (Lasix). When you can pee more, fluid from the legs can flow back into the blood. Limiting how much sodium you eat can also help.

The ultimate goal with edema treatment is to rid the excess fluid that has accumulated in the surrounding tissues in the body. The most common treatment is a diuretic. Diuretics make the kidneys excrete excess fluid from the body; which reduces the general fluid volume in the body. Diuretics should be used with caution as dehydration can be a side effect. There are many different types of diuretics that have different mechanisms of action and different potencies.

Depending on the cause of edema, follow-up may be as easy as wearing support hose when standing for prolonged periods, or it may require the input of cardiologists, nephrologists, and/or other subspecialists. It is important to keep the primary physician abreast of any treatment.

Prevention

Some self-care techniques can help reduce or prevent edema.

These include:

  • reducing salt intake
  • losing weight, if appropriate
  • getting regular exercise
  • raising the legs when possible to improve circulation
  • wearing supporting stockings, which are available to purchase online
  • not sitting or standing still for too long
  • getting up and walking about regularly when traveling
  • avoiding extremes of temperature, such as hot baths, showers, and saunas
  • dressing warmly in cold weather

A masseuse or physical therapist may help remove the fluid by stroking firmly in the direction of the heart.

Oxygen may be useful for treating some types of edema. For example, an individual with cardiogenic pulmonary edema may need additional oxygen if they have difficulty taking in enough.

Oxygen delivered through the nose may improve poor vision associated with diabetic macular edema, according to older research from 2004.

However, some research suggests that hyperbaric oxygen therapy can increase the risk of pulmonary edema.

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