Edema

Some of the common signs and symptoms of edema include:

• Swelling: Swelling in edema is due to fluid retention in the tissues. It primarily affects the feet, ankles, and legs, but can also involve other areas such as the face, hands, and abdomen.
• Stretched and shiny skin: The skin above the swollen area may appear stretched and glossy due to excess fluid that pulls the skin.
• Pitting: Poor circulation or the retention of extra fluids are common causes of pitting edema. A dimple in the skin can be created by gently pressing on the swollen area with a finger for at least 5 seconds and then removing the finger.
• Aching body parts: The aching pain can be localized or generalized, depending on the underlying cause of edema. Excess fluid and disturbed cellular activities contribute to the pain experienced in edema.
• Weight gain: Unexplained weight gain may result from fluid retention, causing limbs, hands, feet, face, or abdomen to appear puffy.
• Decreased urine output: If kidney disease is the underlying cause of edema, urine output may be affected. The kidneys are vital organs that help purify blood by eliminating excess fluid, toxins, and waste in the form of urine. In kidney disorders, the kidneys may fail to produce adequate urine, leading to the development of edema.
• Shortness of breath: This occurs due to the lungs' inability to provide enough oxygen to the body. Shortness of breath, also known as dyspnea, typically develops gradually.
• Chest pain: This can be another symptom of pulmonary edema. If the underlying cause is cardiac disease or chest injury, it may present with severe chest pain. Chest pain should not be ignored, as it can be life-threatening and may require immediate attention.

When the small blood arteries (capillaries) leak fluid and fluid collects in the surrounding tissues, it leads to edema. It could be due to a twisted ankle, a bee sting, or a skin infection. This may be beneficial in some instances, such as an infection, where more fluid from your blood vessels fills the enlarged area with infection-fighting white blood cells. However, edema could also indicate serious underlying medical conditions including:

• Congestive heart failure: One or both lower chambers of the heart lose their capacity to pump blood effectively. Blood can back up in the legs, ankles, and feet, creating edema. This disorder can sometimes cause fluid to build up in the lungs (pulmonary edema), resulting in shortness of breath. Worried about your heart health? Read 5 tips by cardiologists to keep your heart healthy.
• Liver cirrhosis: Ascites (fluid accumulation in the abdominal cavity) and fluid accumulation in the legs can occur as a result of liver injury (cirrhosis).
• Kidney disease: Edema can also be caused by kidney or renal disease. Kidney disease may lead to fluid and sodium retention in the body, causing the legs to swell.
• Damage to veins in the legs: The one-way valves in the leg veins are weakened or destroyed, allowing blood to pool and produce swelling. A blood clot (deep vein thrombosis, or DVT) in one of the leg veins can cause sudden swelling in one leg, as well as pain in the calf muscle. In this condition, one must get medical attention immediately.
• Inadequate lymphatic system: The lymphatic system aids in the removal of excess fluid from tissues. If this system is affected, such as in cancer surgery, the lymph nodes and lymph arteries that drain an area may not function properly, resulting in edema.
• Protein deficiency: Albumin and other proteins in the blood behave like sponges, allowing fluid to flow freely through your blood vessels. Over time, a deficiency of protein in the diet might result in fluid accumulation and edema; however, it is rarely the sole cause.
• Allergic reactions: Edema is a common side effect of allergic responses. Nearby blood vessels leak fluid into the affected area in response to the allergen.
• Head trauma: Cerebral edema can be due to low blood sodium, high altitudes, brain tumors, and a blockage in fluid outflow in the brain (hydrocephalus). Headache, disorientation, and unconsciousness are all possible symptoms.
• Critical illness: Burns, life-threatening infections, and other conditions can trigger a response that permits fluid to leak into practically all tissues, resulting in edema throughout the body.
• Emphysema: This lung condition can also cause edema in the legs and feet if the pressure in the lungs and heart becomes elevated.

Numerous factors can increase the risk of edema. They include:

• Pregnancy: The fetus and placenta require more fluid, leading the body to retain more sodium and water, making one more susceptible to edema.
• Taking certain medications: The following medications increase the risk of edema:
  • Blood-pressure lowering medications
  • Nonsteroidal anti-inflammatory medications (NSAIDs)
  • Estrogens
  • Thiazolidinediones (oral antidiabetic medication)
  • Corticosteroids (e.g., prednisone and methylprednisolone)
• Prolonged sitting or standing: This can cause edema, especially in hot weather, leading to excess fluid accumulation in the feet, ankles, and lower legs.
• Excessive sodium consumption: Consuming too much salt (sodium) can cause swelling in the fingers and around the ankles due to excessive fluid build-up in the body's tissues.
• Obesity: Several studies have demonstrated that an increased body mass index is widely acknowledged as a risk factor for the development of edema.
• Uncontrolled diabetes: Diabetes can affect blood circulation and cause fluid to build up in the lower extremities. Individuals with diabetes frequently present with lower extremity edema.
• Premenstrual hormonal changes: Edema is observed in 92% of women, predominantly in the second phase of the menstrual cycle due to the hormone progesterone, which causes water retention.

If you experience any symptoms of edema such as swelling or puffiness, stretched skin, weight gain, or a change in urine output, it is wise to consult a doctor.

Your doctor might conduct a physical examination and ask questions related to your medical history. The physical examination generally includes inspecting the skin over the swollen area. The doctor may also press gently over the swollen part for about 15 to 20 seconds to see if it leaves a dimple. The doctor might request additional tests to diagnose the cause:

• X-ray of the chest: A chest X-ray can help confirm the diagnosis of pulmonary edema and rule out other causes of shortness of breath.
• Urine routine microscopy: A urine sample is analyzed to check for the presence of protein in urine. Proteins are reabsorbed and not eliminated in urine. In kidney diseases, the kidneys fail to function properly, resulting in protein and albumin being excreted in the urine. Simultaneously, fluid containing toxins is retained, leading to edema.
• Ultrasound: This test helps check the distribution of edema. The intensity and spread of edema can be determined by ultrasound.
• Echocardiography (ECG): This test can identify any cardiac causes of edema.
• Magnetic resonance imaging (MRI): This test can help identify any damage in the bone marrow that may result in the development of edema.
• Blood test: A complete blood count (CBC) along with kidney function test, lipid profile, and liver function test is useful in diagnosing causes of edema.

In some cases, allergic tests, tests for viral or bacterial infections, or toxicity tests are recommended. Additional serological tests may be conducted based on the condition.

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Here are a few simple tips that can help you manage and prevent edema:

1. Physical activity: Try to be physically active. Sitting or standing for long periods without moving is not recommended. Moving helps activate the muscles in the affected body area, particularly the legs, which may assist in pumping excess fluid back to the heart. While traveling, get up and stroll about, especially if you are flying.
2. Eat a low sodium diet: Avoid consuming too much sodium in your diet. A low-salt diet helps regulate high blood pressure and edema.
3. Elevate your legs: Raising the legs above heart level for 30 minutes three or four times a day can help with leg, ankle, and foot edema. For those with minor venous illnesses, elevating the legs may be sufficient to eliminate edema.
4. Drinking water: Although fluid retention causes swelling, drinking water can help lessen edema. To minimize swelling, drink 8-10 glasses of water every day. When the body is dehydrated, it retains the fluids it already has, resulting in edema.
5. Avoid alcohol: Avoid consuming alcoholic beverages. If drinking alcohol produces recurring swelling, it could indicate a problem with the kidneys, liver, or heart.
6. Magnesium-rich foods: Magnesium deficiency leads to water retention in the body. Eating magnesium-rich foods like tofu, spinach, cashews, almonds, dark chocolate, broccoli, and avocados can help prevent edema.
7. Foot massage: Massage is an effective approach to relieve swollen feet. It helps drain fluids and minimize edema. It is advisable to massage your feet after exercise, long hours of standing, and long journeys.
8. Increase potassium-rich foods: High blood pressure and water retention are symptoms of potassium insufficiency. Potassium-rich foods including sweet potatoes, bananas, salmon, chicken, and white beans should be consumed. In case of kidney problems, consult your doctor before increasing your potassium intake.
9. Sleep on the lateral sides: Sleep on your side if possible. Sleeping on your left side can relieve strain on the vein that transports blood from the lower body to the heart, aiding in the reduction of edema.
10. Swimming: Take a dip in the pool. Try standing or walking in the water. Water pressure can help decrease swelling in your feet and ankles by compressing tissue in your legs.

Mild edema normally clears up on its own, especially if you expedite recovery by elevating the affected limb above your heart. The drugs used to treat edema either prevent the accumulation of fluid in cellular spaces or assist in eliminating them. Based on their mechanism of action, these drugs include:

1. Diuretics

Diuretics, commonly referred to as water pills, help remove excess salt (sodium) and water from the body, aiding in the resolution of edema. They include:

• Acetazolamide
• Theophylline
• Furosemide (Lasix)
• Chlorthalidone (Hygroton)
• Hydrochlorothiazide (Esidrix)
• Amiloride (Midamor)

2. Corticosteroids

Although it may seem contradictory, corticosteroids play a role in the treatment of edema in some advanced cancer patients. Treatment with corticosteroids is believed to reduce peritumoral edema and alleviate constriction of the venous and lymphatic systems, resulting in decreased edema. The corticosteroids used in treating edema include:

• Dexamethasone
• Betamethasone
• Methylprednisolone

Corticosteroids are utilized to manage potentially life-threatening conditions such as autoimmune disorders and cancer. However, there are important dos and don’ts to follow while taking these medications.

3. Benzopyrones

The use of benzopyrones, such as coumarin and oxerutins, in the treatment of chronic edema caused by lymphatic and venous diseases has garnered interest. Read how to effectively manage venous disease.

Diet and lifestyle changes play a key role in the management and treatment of edema. Here are some tips to help keep edema under control:

• Be active: Moving and activating the muscles, particularly in your legs, can help pump excess fluid back toward your heart.
• Avoid prolonged positions: Do not stay in one position for too long, as it can interfere with venous drainage and lead to edema. Avoid prolonged standing or sitting without support, as gravity can cause fluid to accumulate in your legs and feet, resulting in swelling and pain. It is important to get up and move around at regular intervals.
• Wear compression stockings: If you have edema in one of your limbs, consider wearing compression stockings, sleeves, or gloves to prevent further swelling. Consult your doctor before using them.
• Soak your legs: Soaking your legs for 15 to 20 minutes in a cool Epsom salt bath can be beneficial, as Epsom salt (magnesium sulfate) has the potential to relieve edema and inflammation.
• Try massage: Massaging the affected area with firm, but not painful pressure toward your heart may assist in shifting excess fluid out of that area.
• Eat right: Consuming asparagus, parsley, beets, grapes, green beans, leafy greens, pineapple, pumpkin, onion, leeks, and garlic can be beneficial, as these are all natural diuretic foods.
• Consume foods rich in antioxidants: Blueberries, cherries, tomatoes, squash, and bell peppers are high in antioxidants.
• Stay hydrated: Water is the best natural remedy for edema. Aim to consume approximately 7-8 glasses (2-3 liters) of water every day.
• Increase potassium intake: Water retention can be caused by a potassium deficit. If you do not have any dietary restrictions, consider eating potassium-rich foods such as sweet potatoes, white beans, bananas, salmon, pistachios, and chicken.
• Reduce consumption of salt and refined foods: Salt can exacerbate edema by increasing fluid retention, and refined foods such as white bread, pasta, and sugar should also be avoided.

Edema, if left untreated, can lead to the following:

• Painful edema: If the cause of the swelling is not treated timely, the pain becomes increasingly unpleasant and could turn unbearable.
• Difficult walking: Edema can cause pain while walking.
• Infection: The risk of infection is higher in the swollen area. The slightest injury or abrasion of the swollen part can become infectious. The infection can also lead to skin ulcers.
• Angiosarcoma: It is a rare cancer that develops in the inner lining of blood vessels and lymph vessels. There is a 10% risk of developing angiosarcoma in patients with chronic edema lasting over 10 years.

Some other complications include:

• Scarring between tissue layers
• Reduced blood circulation
• Reduced artery, vein, joint, and muscle flexibility

Here are a few quick fixes on how to control and get relief from edema.

1. Ayurveda

• Rock salt (Sendha namak): To relieve inflammation and swelling, soak your feet in a bucket of lukewarm water with rock salt. Make sure to use only rock salt, which is considered a pure form of salt.
• Grapefruit essential oil (Angur ka tel): Known for its antioxidant and diuretic properties, adding a few drops of grapefruit oil to a bucket of warm water can help relieve swelling.
• Cucumber and lemon water (Kheera and Nimbu pani): Both cucumber and lemon contain antioxidants. The nutrients in these ingredients act as a natural diuretic, helping to eliminate excess water while retaining essential nutrients and hydration.
• Watermelon (Tarbuj): Watermelon, composed of 92% water, is a natural diuretic that stimulates urination, thereby reducing water retention and swelling.
• Coriander seeds (Dhaniya ke beej): With anti-inflammatory properties, coriander seeds can help reduce edema. Add 2-3 spoons of coriander seeds to a cup of water, boil until reduced by half, strain, and let it cool. Repeat twice a day for optimal results.
• Dandelion: The dandelion leaf acts as a diuretic and can help relieve edema, but it should not be taken alongside diuretic medications.

2. Yoga

Yoga may help reduce edema by increasing blood flow. Some simple yoga asanas that can assist in reducing edema include:

• Tadasana
• Urdhahastottasana
• Parsvakonasana
• Viparita Karani
• Sarvangasana
• Halasana
• Setu bandha asana
• Ashwa Sanchalan
• Katichakrasana
• Surya Namaskar

Note: Practicing yoga, especially mountain pose, combats edema in the limbs. Tadasana stretches the muscles and nerves in the legs, enhancing blood circulation and reducing water retention. It is one of the few yoga poses that stretches all muscles, from your toes to your head.

3. Acupressure

Acupressure involves pressing acupuncture points to facilitate the free flow of energy. This alternative technique can help manage edema by enhancing blood flow and reducing swelling in the feet and legs.

If you experience edema occasionally, it can be managed with a few lifestyle and posture changes. Remember, edema can also indicate underlying kidney, heart, or pulmonary problems such as renal failure, congestive heart disease, or COPD. Hence, if edema arises from these chronic conditions, in addition to diet and lifestyle changes, you may also require medications and proper medical supervision. Here are some diet and lifestyle changes that can help in the management of edema:

• Avoid standing or sitting in one place for long hours.
• Keep moving your limbs to ensure smooth circulation.
• Wear compression stockings, sleeves, or gloves to prevent further swelling.
• Avoid foods that can trigger and worsen symptoms of edema, such as carbonated drinks, deep-fried foods, fat-rich dairy, alcohol, and meat.
• Avoid eating trans fatty acids, which are found in baked items.
• Increase intake of foods rich in antioxidants, such as blueberries, cherries, tomatoes, squash, and bell peppers.
• Consume potassium-rich foods if you have no dietary restrictions.
• Reduce your salt consumption.
• Avoid refined foods, such as white bread, pasta, and sugar.

Edema in Pregnancy

Swelling in the ankles and feet can occur during pregnancy due to additional fluid in the body and pressure from the expanding uterus. As a woman's due date approaches, the swelling tends to worsen, especially near the end of the term. While sudden swelling of the face or hands can indicate preeclampsia (sudden high blood pressure during pregnancy), modest swelling of the ankles and feet is usually not a cause for concern. Try these simple techniques to help lessen and/or prevent swollen ankles:

• Avoid long periods of standing.
• When sitting for extended periods, stretch frequently.
• When sleeping, lie on your left side.
• Before getting out of bed in the morning, wear maternity support stockings that reach your waist.
• Ensure you drink plenty of water.
• In humid or hot weather, try to stay cool and hydrated.