Get answers to frequently asked questions about edema with Meri Sehat. Understand the causes and management of swelling.

Edema FAQs

Swelling is a major symptom of edema. It can affect any body part but usually occurs in the legs and feet.

Introduction

<a href="https://merisehat.pk/disease/edema">Edema</a> is a palpable swelling produced by an accumulation of fluid in the intercellular tissue resulting from an abnormal expansion in interstitial fluid volume. 
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Understanding Frequently Asked Questions about Edema

While swelling can occur in any part of the body, it is most common in the feet, ankles, and legs. 
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Other symptoms of edema include:

<ul>
	<li>Warmth, discoloration, and changes in the texture of the affected area</li>
	<li>Pain and tenderness in the affected area</li>
	<li>The affected area appears bigger than it was a day ago</li>
	<li>The skin covering the swollen area appears to be taut and smooth</li>
	<li>Difficulty walking if the swelling is in the legs, ankles, or feet</li>
	<li>Coughing or having trouble breathing</li>
	<li>A sensation of fullness or tightness in the affected area of the body 
	&nbsp;</li>
</ul>

Edema can occur in various parts of the body. Based on the location and causes, it can be classified into the following types. 
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<ul>
	<li>Peripheral Edema - Generally, the legs, feet, and ankles are affected. However, it can also occur in the arms. This indicates issues with the circulatory system, lymph nodes, or kidneys. 
	&nbsp;</li>
</ul>

<ul>
	<li>Pedal Edema - It affects the feet and lower legs. It&rsquo;s more common in older or pregnant individuals. 
	&nbsp;</li>
	<li>Lymphedema - Swelling in the arms and legs occurs when the lymph nodes are damaged, usually due to cancer treatments. Cancer itself also blocks lymph nodes, resulting in a build-up of fluid. 
	&nbsp;</li>
	<li>Pulmonary Edema - Fluid accumulation in the air sacs in the lungs makes it hard for the individual to breathe. The condition worsens when the person is lying down. They may have a fast heartbeat, feel suffocated, and cough up a foamy spittle, sometimes with blood. Pulmonary edema is a life-threatening condition that requires immediate treatment. 
	&nbsp;</li>
	<li>Cerebral Edema - Hydrocephalus is a serious medical condition caused by an excessive accumulation of fluid in the brain. A head injury, blockage or rupture of blood vessels, tumors, or allergic reactions can all cause cerebral edema. 
	&nbsp;</li>
	<li>Macular Edema - Macular edema occurs when fluid accumulates in the macula, a crucial part of the retina located in the center of the eye, due to fluid leakage from impaired blood vessels in the retina. 
	&nbsp;</li>
</ul>

Edema usually occurs in the skin, particularly in the arms, hands, legs, ankles, and feet. However, it can also affect the muscles, lungs, bowel, eyes, and brain. 
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Edema develops in two steps:

<ol>
	<li>The capillary hydrostatic pressure gradient and the oncotic pressure gradient across the capillary regulate the fluid between the interstitial and intravascular space. When local or systemic conditions change this equilibrium, it leads to greater plasma volume, capillary hydrostatic pressure, and capillary permeability while reducing plasma oncotic pressure.</li>
	<li>The kidneys respond to these changes by retaining sodium and water. 
	&nbsp;</li>
</ol>

The following are the causes of edema:&nbsp;

<ul>
	<li>Low Albumin: Also known as hypoalbuminemia, the lack of albumin (a type of protein in the blood) can lead to edema. This is because albumin acts like sponges to retain the fluid in the blood vessels. 
	&nbsp;</li>
	<li>Allergic Reactions: Allergic reactions also cause edema. Blood vessels release fluid into the affected region when the skin is exposed to an allergen. This results in swelling. 
	&nbsp;</li>
	<li>Obstruction Of Flow: Fluid can accumulate if fluid drainage from any body part is obstructed. Blood clots or tumors obstruct the normal flow of blood or lymph and cause edema in the affected area. 
	&nbsp;</li>
	<li>Critical Illness: A condition, like severe burns or severe infection, can result in fluid leakage into tissues throughout the body, leading to generalized edema. 
	&nbsp;</li>
	<li>Congestive Heart Failure: When the heart weakens and pumps blood less effectively, it causes fluid to build up slowly in the legs. If the buildup is rapid, fluid can accumulate in the lungs. In the case of right-sided heart failure, it can cause fluid buildup in the abdomen. 
	&nbsp;</li>
	<li>Liver Disease: Severe liver disease, such as cirrhosis, causes fluid retention. It also decreases the albumin level and other proteins in the blood. The accumulation of fluid in the abdomen leads to edema in the legs. 
	&nbsp;</li>
	<li>Kidney Disease: Nephrotic syndrome, a medical condition affecting the kidneys, can cause pronounced edema in the legs and, in severe cases, generalized edema throughout the body. 
	&nbsp;</li>
	<li>Pregnancy: Mild leg edema is common during pregnancy. Severe conditions like deep vein thrombosis and preeclampsia during pregnancy can also cause edema. 
	&nbsp;</li>
	<li>Head Trauma: Cerebral edema can be caused by several factors, such as low blood sodium levels (hyponatremia), exposure to high altitudes, the presence of brain tumors, and obstruction in the drainage of fluid from the brain (hydrocephalus). It can lead to headaches, confusion, unconsciousness, and coma. 
	&nbsp;</li>
</ul>

Medications, Including:

<ul>
	<li>High blood pressure medications such as calcium channel blockers</li>
	<li>Pain drugs such as NSAIDs, pregabalin, and gabapentin</li>
	<li>Diabetes medications such as pioglitazone</li>
	<li>Inflammation medications such as steroids 
	&nbsp;</li>
</ul>

Twisted ankles, a bee sting, or a skin infection can also cause edema. In some cases, like an infection, edema can be helpful because it increases the number of white blood cells in the affected area that fight off infections<a href="#accordion">[4]</a>. 
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Edema can showcase in multiple forms, including unilateral (one-sided), bilateral (both sides of the body), localized (specific region of the body), or generalized (throughout the body) edema.

The doctor will begin by taking note of the patient&#39;s history, including the timing of the edema, changes of edema with position, and medication usage.

They may perform a physical exam to diagnose edema. They will examine the affected areas for swelling, especially where the skin looks shiny or stretched, employing volume measurements (with a water volumeter), girth measurements (with a tape measure, including the circumferential method and the figure-of-eight method), and pitting edema assessment (based on the depth and duration of the indentation).

This is followed by further diagnostic tests aimed at determining the root cause. This includes liver tests, complete blood count, blood urea nitrogen, serum electrolytes, serum protein, creatinine, and urinalysis.

The doctor may also order a chest X-ray, EKG, D-dimer (for suspected pulmonary embolism), and brain natriuretic peptide (for suspected heart failure). 
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A medical professional will perform a pitting test to check for edema. They apply gentle pressure with their finger to the swollen part for 5-15 seconds. After the pressure is released, a dimple or pit will form in the skin if there is fluid buildup in the tissues.

<ul>
	<li>Grade 0: No clinical edema</li>
	<li>Grade 1: 2 mm pit that rebounds immediately</li>
	<li>Grade 2: 4 mm pit with no readily detectable distortion that rebounds in fewer than 15 seconds</li>
	<li>Grade 3: 6 mm pit that rebounds in less than 30 seconds</li>
	<li>Grade 4: 8 mm pit that takes more than 30 seconds to rebound 
	&nbsp;</li>
</ul>

Mild edema usually goes away naturally with some lifestyle modifications. In case of more severe edema, the doctor may prescribe medications, such as diuretics. Diuretics or water pills help increase urine formation to excrete surplus fluid. However, diuretics may not be effective when edema arises due to medication. 
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Several self-care techniques can help reduce the risk of edema or provide relief from its symptoms<a href="#accordion">[3][7]</a>: 
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<ul>
	<li>Avoid tobacco and alcohol.</li>
	<li>Wear compression (support) stockings, sleeves, or gloves, usually after the swelling has gone down, to prevent the recurrence of the condition. These garments keep pressure on the limbs to prevent fluid from building up. For pregnant women, support stockings worn during air travel can be beneficial.</li>
	<li>Avoid packaged and processed foods with a high salt content. Salt can increase fluid buildup and worsen edema.</li>
	<li>Elevate the affected body part above the heart level, especially while lying, as it helps improve circulation.</li>
	<li>Maintain a healthy weight.</li>
	<li>Engage in physical activity and move the muscles of the affected area, particularly the legs. It is imperative to avoid remaining in a static position for long periods and instead take breaks to move around. Even while traveling, it&#39;s recommended to stand up and walk periodically.</li>
	<li>Massage the affected area using firm, non-painful pressure in a direction toward the heart. This technique can facilitate the movement of fluid out of the region.</li>
	<li>Always wear socks or shoes on the feet if that&#39;s where the swelling usually is. Protect the swollen region from harm by ensuring it is clean and injury-free. Applying lotion or cream can help avoid dry and cracked skin, which otherwise increases the risk of cuts, scrapes, and infections. 
	&nbsp;</li>
</ul>

Diuretics are frequently used to treat edema. They help remove excess fluid by increasing urine production. Furosemide (Lasix) is the most commonly used diuretic.

Note: Medications should only be used as per the doctor&rsquo;s instructions. Do not adjust the dosage or abruptly stop any medication without the doctor&rsquo;s advice. 
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If not treated completely, edema may cause several complications, including:

<ul>
	<li>Increased swelling</li>
	<li>Decreased mobility</li>
	<li>Overly-stretched, itchy skin</li>
	<li>Decreased blood circulation to the area 
	&nbsp;</li>
</ul>

If you develop any of the following signs and symptoms, contact a healthcare professional immediately:

<ul>
	<li>Shortness of breath, especially when lying down.</li>
	<li>Chest pain.</li>
	<li>Fast or irregular heart rate.</li>
	<li>Coughing up pink, foamy sputum. 
	&nbsp;</li>
</ul>

The following factors can increase the risk of edema:

<ul>
	<li>A poor diet, especially a diet that contains too much salt, can cause mild edema. A poor diet combined with other conditions can also make edema worse.</li>
	<li>Malnutrition with a low-protein intake can also lead to hypoalbuminemia, which in turn can lead to edema.</li>
	<li>Prolonged sitting and standing can also cause edema, especially in hot weather and long-duration travel.</li>
	<li>Obesity</li>
	<li>Pregnancy 
	&nbsp;</li>
</ul>

Conclusion

The healthcare provider may suggest regular physical activity and minimizing sodium intake to prevent edema.

If edema is due to underlying health conditions, like congestive heart failure, liver disease, or kidney disease, the swelling can only be controlled and managed rather than completely cured. Treating any underlying disease or condition helps prevent it from worsening. 
&nbsp;

Key Takeaways

<ul>
	<li>Edema is swelling caused by too much fluid trapped in the tissues.</li>
	<li>Edema can be due to an underlying disease, certain medicines, or pregnancy.</li>
	<li>Lifestyle changes, such as reducing salt intake and wearing compression garments, can help relieve edema. However, any underlying disease needs to be treated as well.</li>
</ul>

[1] Lent-Schochet D, Jialal I. Physiology, Edema. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

[2] Edema: Types, causes, symptoms, and treatment. WebMD.

[3] Causes, symptoms, treatments, and prevention of edema (swelling). Novus Spine & Pain Center.

[4] Heitz D. What you should know about edema. Healthline.

[5] Besharat, S., Grol-Prokopczyk, H., Gao, S., Feng, C., Akwaa, F., & Gewandter, J. S. (2021). Peripheral edema: A common and persistent health problem for older Americans. PloS one, 16(12), e0260742.

[6] Edema: Causes, symptoms & treatment. Cleveland Clinic.

[7] Edema. Mayo Clinic.

[8] Deshmukh KP, Rahmani Dabbagh S, Jiang N, Tasoglu S, Yetisen AK. Recent technological developments in the diagnosis and treatment of cerebral edema. Advanced NanoBiomed Research. 2021;1(11):2100001. doi:10.1002/anbr.202100001.