Edema

Types Of Edema

The various types of edema include:

1. Peripheral edema: Edema of peripheral parts like legs, feet, and ankles.

2. Pedal edema: Edema of the foot.

3. Pulmonary edema: This is characterized by the accumulation of fluids in air spaces of the lungs that may lead to respiratory failure.

4. Cerebral edema: The accumulation of increased water content in the brain that may be caused due to ischemic stroke, cancer, or brain inflammation due to meningitis or encephalitis.

5. Angioedema: It generally occurs on the face and is different from hives where swelling is caused underneath the skin rather than on the surface of the skin.

6. Hereditary angioedema: It is a rare genetic condition that affects the immune system.  This type of swelling generally affects the face, genitals, and abdomen.

7. Papilledema: Swelling of the optic nerve of the eye which is a result of increased intracranial pressure inside the skull and around the brain.

8. Macular edema: This condition occurs when blood vessels leak into a part of the retina called the macula, making it swell.

9. Dependent edema: It is the swelling that occurs in the legs and lower body which is affected by gravity and position.

10. Scrotal lymphedema: It is caused due to enlargement of the scrotum due to fluid accumulation around the testes.

11. Lipedema: It is a disorder of the fatty (adipose) tissue that causes swelling of the legs and hips.

12. Ascites: It is a condition in which fluid collects in spaces within the abdomen.

13. Pleural effusion: It is an abnormal, excessive collection of this fluid in the chest (lung or pleural cavity). The most common cause of the pleural effusion is heart failure.

14. Anasarca: This is a medical condition that leads to general swelling of the entire body.

The condition is also known as extreme generalized edema or massive edema.

15. Idiopathic edema: Accumulation of fluid in tissues with no particular cause.

Edema can also be broadly classified as:

1. Pitting edema: In this condition, depression is seen when pressure is applied to the skin and removed.

2. Non-pitting edema: This is a type of edema in which there is no presence of depression when pressure is applied. 

Symptoms Of Edema

Some of the common signs and symptoms of edema include:

1. Swelling

Swelling in edema is due to fluid retention in the tissues. Swelling affects the feet, ankles, and legs the most, but it can also affect other parts such as the face, hands, and abdomen. 

2. Stretched and shiny skin

In edema, the skin above the swelling area may appear stretched and glossy. The stretching of the skin is due to excess fluid that pulls the skin. 

3. Pitting

Poor circulation or the retention of extra fluids are the most common causes of pitting edema. A dimple in the skin can be created by gently pressing in on the swelling area with the finger for at least 5 seconds and then removing your finger.

4. Aching body parts

The aching pain can be local or general. It depends upon the underlying cause of edema. Excess fluid and disturbed cellular activities are the cause of pain in edema. 

5. Weight gain

Unexplained weight gain could be due to fluid retention. Weight gain can make limbs, hands, feet, face, or abdomen appear puffy. 

6. Decreased urine output

If kidney disease is the underlying cause of edema, urine output could get affected. The kidneys are vital organs that help in blood purification. During this process, the excess fluid along with toxins and waste is eliminated in the form of urine. In kidney disorders, the kidney fails to produce urine in adequate quantities and, as a result, edema develops. 

7. Shortness of breath

Is because of the lung's inability to provide enough oxygen to the body. Shortness of breath also known as dyspnea develops gradually.

8. Chest pain 

Another symptom of pulmonary edema. If the underlying cause of pulmonary edema is a cardiac disease or chest injury it may present with severe chest pain. 

Chest pain is not something to ignore! It can be life-threatening and may need immediate attention. Read about first-aid tips to follow in case of chest pain.
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Causes Of Edema

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. 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:

1. Congestive heart failure

One or both the lower chambers of the heart lose their capacity to pump blood effectively in congestive heart failure. Blood can back up in the legs, ankles, and feet as a result, creating edema.

This disorder can sometimes cause fluid to build up in the lungs (pulmonary edema), resulting in shortness of breath.

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2. Liver cirrhosis 

Ascites (fluid accumulation in the abdominal cavity) and fluid accumulation in the legs can occur as a result of liver injury (cirrhosis).

3. Kidney disease 

Edema can also be caused due to kidney or renal disease. Kidney disease may lead to fluid and sodium retention in the body, causing the legs to swell.

4. 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.

5. Inadequate lymphatic system

The lymphatic system aids in the removal of excess fluid from tissues. If this system gets affected, like in cancer surgery, the lymph nodes and lymph arteries that drain an area may not function properly, resulting in edema.

6. 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 cause.

7. 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.

8. Head trauma

Cerebral edema can be due to low blood sodium, high altitudes, brain tumors, and a block in fluid outflow in the brain (hydrocephalus). Headache, disorientation, and unconsciousness are all possible symptoms.

9. Critical illness

Burns, life-threatening infections, and other conditions can trigger a response that permits fluid to leak into practically all tissues. This can result in edema all over the body.

10. Emphysema

It is a lung condition that can also cause edema in the legs and feet if the pressure in the lungs and heart gets elevated.

Risk Factors For Edema

Numerous factors can up your risk of edema. They include:

1. Pregnancy: The fetus and placenta require more fluid, hence the body retains more sodium and water, making one more susceptible to edema.

2. Taking certain medicines: The following medicines increase the risk of edema:

• Blood-pressure lowering medications

• Nonsteroidal anti-inflammatory medicines (NSAIDs) 

• Estrogens

• Thiazolidinediones (oral antidiabetic medicine)

• Corticosteroids (like prednisone and methylprednisolone)

3. Prolonged sitting or standing: This can cause edema, especially in hot weather, leading to excess fluid accumulating in the feet, ankles, and lower legs. 

4. Excessive sodium consumption: Consuming too much salt (sodium) can cause swelling on the fingers and around the ankles due to excessive fluid build-up in the body's tissues.

5. Obesity: Several studies have demonstrated an increased body mass index is widely acknowledged as a risk factor involved in the development of edema.

6. Uncontrolled diabetes: Diabetes can affect your blood circulation and cause fluid to build up in the lower extremities. Persons with diabetes frequently present with lower extremity (LE) edema. 

7. Premenstrual hormonal changes: Edema is seen in 92% of women, predominantly in the second phase of the menstrual cycle due to the hormone progesterone that causes water retention.

Diagnosis Of Edema

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

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

1. 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.

2. Urine routine microscopy: Urine sample is analyzed to check for the presence of protein in urine. Proteins are reabsorbed and not eliminated in the urine. In kidney diseases, the kidneys fail to function properly, and as a result, protein and albumin are excreted in the urine. At the same time, the fluid having toxins is retained, which gets accumulated and gives rise to edema. 

3. Ultrasound: It is a test that helps to check the distribution of edema. The intensity and spread of edema can be determined by ultrasound.

4. Echocardiography (ECG): This test can be used to determine any cardiac causes of edema.

5. Magnetic resonance imaging (MRI): The test can help identify any damage in the bone marrow that may result in the development of edema.

6. 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 infection, or toxicity tests are recommended. Additional serological tests could be done based on the condition.

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Prevention Of Edema

Here are a few simple tips that can help you to 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 in activating the muscles in the affected body area, particularly the legs. This may assist in pumping the excess fluid back to the heart. While traveling, get up and stroll about, especially if you are flying.

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2. Eat a low sodium diet

Avoid consuming too much sodium in your diet. A low-salt diet helps to 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 enough to eliminate edema.

4. Drinking water 

Although fluid retention causes swelling, drinking water can help to lessen edema. To minimize swelling, drink 8-10 glasses of water every day. When the body is dehydrated, it maintains the fluids it already has. This results 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 retention of water in the body. Eating magnesium-rich foods like Tofu, spinach, cashews, almonds, dark chocolate, broccoli, and avocados are helpful in preventing edema.

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7. Foot massage

Massage is an effective approach to relieve swollen feet. It helps to 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, talk to your doctor before increasing your potassium consumption. 

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9. Sleep on the lateral sides

Sleep on your side if possible. Sleep on your left side if possible to relieve strain on the vein that transports blood from the bottom of your body to your heart. This may aid in the reduction of edema.

10. Swimming 

Take a dip in the pool. In the pool, try standing or walking. Water pressure can help decrease swelling in your feet and ankles by compressing tissue in your legs.

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Specialist To Visit

The symptoms of edema may not always be resolved due to lifestyle changes.

It could be due to some serious underlying disease involving the heart, lungs, or kidneys. 

If you experience severe chest pain or breathlessness or a change in urine output, then consult a doctor. 

Specialists that can help to manage edema depending on the body parts involved include:

• General physician

• Urologist

• Nephrologist 

• Pulmonologist 

• Cardiologist 

• Oncologist 

• Gastroenterologist 

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Treatment Of Edema

Mild edema normally clears up on its own, especially if you speed things up by elevating the affected limb above your heart.

The drugs that are used to treat edema either stop the accumulation of fluid in cellular space or help to eliminate them. Based on their action mechanism, these drugs are: 

1. Diuretics

Diuretics, often known as water pills, aid in the removal of excess salt (sodium) and water from the body. This helps to clear up edema. They include:

• Acetazolamide 

• Theophylline

• Furosemide (Lasix) 

• Chlorthalidone (Hygroton)

• Hydrochlorothiazide (Esidrix)

• Amiloride (Midamor)

2. Corticosteroids

Although it may seem contradictory, corticosteroids have a role in the treatment of edema in some advanced cancer patients. Treatment with corticosteroids is thought to minimize peritumoral edema and relieve constriction of the venous and lymphatic systems, resulting in less edema. The corticosteroids used in treating edema are:

• Dexamethasone 

• Betamethasone

• Methylprednisolone

Corticosteroids are used to manage potentially life-threatening illnesses such as autoimmune disorders and cancer. But, here are a few dos and don’ts you need to follow while taking these medications. 
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3.  Benzopyrones

The use of benzopyrones, such as coumarin and oxerutins, in the treatment of chronic edema caused by lymphatic and venous illness, has piqued interest. 

Read how to effectively manage venous disease.
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Home-Care for Edema

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

Be active: Moving and activating the muscles, particularly your legs, can help in pumping the excess fluid back toward your heart.

Do not stay in a certain position for long: As it could interfere with venous drainage leading to edema. 

Avoid prolonged standing or sitting without support! Gravity can drag fluid down into your legs and feet at times. This can lead to swelling and pain. It is necessary to get up and move about at regular intervals.

Read about 5 natural remedies to relieve pain.
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Wear compression stockings: If you have edema in one of your limbs, you can wear compression stockings, sleeves, or gloves to prevent further swelling. Do consult your doctor before using them.

Soak your legs: Soaking legs for 15 to 20 minutes in a cool epsom salt bath can be very beneficials 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 the excess fluid out of that area.

Eat right: Consuming asparagus, parsley, beets, grapes, green beans, leafy greens, pineapple, pumpkin, onion, leeks, and garlic could 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. You must aim to consume close to 7-8 glasses (2-3 liters) of water every day.

Increase potassium intake: Water retention can be caused by a potassium deficit. Consider eating potassium-rich foods if you don't have any dietary limitations. Sweet potatoes, white beans, bananas, salmon, pistachios, and chicken are all rich in potassium.

Reduce consumption of salt and refined foods: Salt can aggravate edema by increasing fluid retention and refined foods such as white bread, pasta, and sugar should also be avoided.

Complications Of Edema

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 10% risk of developing angiosarcoma in patients with chronic edema lasting >10 years. 

Some other complications include:

• Scarring between tissue layers

• Reduced blood circulation

• Reduced artery, vein, joint, and muscle flexibility.

Alternative Therapies For Edema

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 you only use rock salt, which is thought to be a pure kind of salt. 

• Grapefruit essential oil (Angur ka tel): Grapefruit oil is known for its antioxidant and diuretic properties. Adding a few drops of grapefruit oil to a bucket with warm water can relieve swelling.

• Cucumber and lemon water (Kheera and Nimbu pani): Cucumber and lemon both contain antioxidants. The nutrients present in lemons and cucumbers help as a natural diuretic. It helps to get rid of excess water while retaining essential nutrients and hydration. 

• Watermelon (Tarbuj): Watermelon is a natural diuretic with 92% water. It stimulates urination and hence, reduces water retention and swelling.

• Coriander seeds (Dhaniya ke beej): Coriander seeds have anti-inflammatory properties and are widely used for reducing edema. Add 2-3 spoons of coriander seeds to a cup of water. Boil it till the quantity reduces to half. Strain and let it cool. Repeat twice a day for better results. 

• Dandelion: As the dandelion leaf is a diuretic, it can be helpful in relieving edema, but it should not be taken along with diuretic drugs. 

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2. Yoga 

Yoga may help to reduce edema by increasing the flow of blood. Some of the simple yoga asanas that can help reduce 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. By stretching the muscles and nerves in the legs, Tadasana helps to enhance blood circulation and reduce water retention. It's one of the few yoga poses that stretch all of your muscles, even the tiniest ones, from your toes to your head.

Read about 12 health benefits of yoga.
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3. Acupressure

Acupressure consists of pressing the acupuncture points in an attempt to help the free flow of energy. It is an alternate technique to manage edema which helps to enhance blood flow and reduce swelling in the feet and legs. 

Living With Edema

If you experience edema once in a while, it can be managed with a few lifestyle changes and posture changes. Remember, edema can also indicate underlying kidney or heart or pulmonary problems such as renal failure, congestive heart disease, or COPD. Hence, if edema appears as a result of these chronic conditions, then in addition to diet and lifestyle changes, you may also need medications and proper medical supervision.

Here are a few diet and lifestyle changes that can help in 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 like carbonated drinks, deep-fried food, fat-rich dairy, alcohol, and meat. 

• Avoid eating trans fatty acids, which are found in baked items.

• Increase food rich in antioxidants. Blueberries, cherries, tomatoes, squash, and bell peppers are high in antioxidants. 

• Consume potassium-rich foods if you don't have any dietary limitations.

• 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 those pesky swollen ankles:

• Long periods of standing should be avoided.

• When sitting for long periods, stretch frequently.

• When sleeping, sleep on your left side.

• Before getting out of bed in the morning, put on maternity support stockings that reach your waist.

• Make sure you drink plenty of water. 

• In humid or hot weather, try to stay cool and hydrated.