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Patient information: Edema (swelling) (Beyond the Basics)

EDEMA OVERVIEW

Edema is the medical term for swelling caused by a collection of fluid in the spaces that surround the body's tissues and organs. Edema can occur nearly anywhere in the body. Some of the most common sites are:

The lower legs or hands (also called peripheral edema)

Abdomen (also called ascites)

Chest (called pulmonary edema if in the lungs, and pleural effusion if in the space surrounding the lungs)

Ascites and peripheral edema can be uncomfortable and can be a sign of a more serious condition. Pulmonary edema, which makes it difficult to breathe and can be life threatening, is a symptom of heart failure and is discussed in more detail separately. (See "Patient information: Heart failure (Beyond the Basics)".)

EDEMA SYMPTOMS

Symptoms of edema depend upon the cause but may include:

Swelling or puffiness of the skin, causing it to appear stretched and shiny. This typically is worse in the areas of the body that are closest to the ground (because of gravity). Therefore, edema is generally the worst in the lower legs (called peripheral edema) after walking about, standing, sitting in a chair for a period of time, or at the end of the day. It accumulates in the lower back (called sacral edema) after being in bed for a long period. Pushing on the swollen area for a few seconds will leave a dimple in the skin (picture 1).

Increased size of the abdomen (with ascites).

Difficulty breathing (with edema in the chest).

CONDITIONS ASSOCIATED WITH EDEMA

A number of different problems can cause edema.

Chronic venous disease — A common cause of edema in the lower legs is chronic venous disease, a condition in which the veins in the legs cannot pump enough blood back up to the heart because the valves in the veins are damaged. This can lead to fluid collecting in the lower legs, thinning of the skin, and, in some cases, development of skin sores (ulcers) (figure 1). (See "Patient information: Chronic venous disease (Beyond the Basics)".)

Edema can also develop as a result of a blood clot in the deep veins of the lower leg (called deep vein thrombosis [DVT]). In this case, the edema is mostly limited to the feet or ankles and usually affects only one side (the left or right); other conditions that cause edema usually cause swelling of both legs. (See "Patient information: Deep vein thrombosis (DVT) (Beyond the Basics)".)

Pregnancy — Pregnant women retain extra fluid. Swelling commonly develops in the hands, feet, and face, especially near the end of a normal pregnancy. Swelling without other symptoms and findings is common and is not usually a sign that a complication, such as preeclampsia (sometimes called toxemia), has developed. (See "Patient information: Preeclampsia (Beyond the Basics)".)

Monthly menstrual periods — Edema in women that occurs in a cyclic pattern (usually once per month) can be the result of hormonal changes related to the menstrual cycle. This type of edema is common but does not require treatment because it resolves on its own.

Drugs — Edema can be a side effect of a variety of medications, including some oral diabetes medications, high blood pressure medications, non-prescription pain relievers (such as ibuprofen), and estrogens.

Kidney disease — The edema of kidney disease can cause swelling in the lower legs and around the eyes. (See "Patient information: Chronic kidney disease (Beyond the Basics)".)

Heart failure — Heart failure, also called congestive heart failure, is due to a weakened heart, which impairs its pumping action. Heart failure can cause swelling in the legs and abdomen, as well as other symptoms. Heart failure can also cause fluid to accumulate in the lungs (pulmonary edema), causing shortness of breath. This can be a very dangerous condition requiring emergency treatment. (See "Patient information: Heart failure (Beyond the Basics)".)

Cirrhosis — Cirrhosis is scarring of the liver from various causes, which can obstruct blood flow through the liver. People with cirrhosis can develop pronounced swelling in the abdomen (ascites) or in the lower legs (peripheral edema). (See "Patient information: Cirrhosis (Beyond the Basics)".)

Travel — Sitting for prolonged periods, such as during air travel, can cause swelling in the lower legs. This is common and is not usually a sign of a problem. The table provides tips to minimize leg swelling during travel (table 1).

If your leg(s) remain swollen or you develop leg pain hours or days after the flight, contact your healthcare provider. Continued swelling and pain can be signs of a blood clot (DVT). (See "Patient information: Deep vein thrombosis (DVT) (Beyond the Basics)".)

Angioedema — Reactions to some medications and some inherited disorders can cause fluid to leak out of the blood vessels into surrounding tissues (angioedema). This can cause rapid swelling in the face, lips, tongue, mouth, throat, voice box, limbs, or genitals. Symptoms may include hoarse voice, throat tightness, and difficulty swallowing. Swelling of the throat can interfere with breathing and may be life threatening.

Sometimes, this type of swelling occurs in the bowel (the intestinal wall) and can result in abdominal pain.

Lymphedema — Surgical removal of lymph nodes for the treatment of cancer (most commonly breast cancer) can cause swelling of a limb or limbs with thickening of the skin on the side of the surgery. Swelling of both legs because of lymph problems can also be an inherited condition that becomes apparent in childhood or young adulthood.

DIAGNOSING THE CAUSE OF EDEMA

If you develop new swelling in one or both of your legs, hands, in your abdomen, or around your eyes, you should call your healthcare provider to determine if you need to be evaluated. (See "Clinical manifestations and diagnosis of edema in adults".)

If you develop a sudden onset of swelling in the lips, tongue, or mouth, especially if it affects your ability to talk or breathe, you should go to an emergency department immediately.

EDEMA TREATMENT

Treatment of edema includes several components: treatment of the underlying cause (if possible), reducing the amount of salt (sodium) in your diet, and, in many cases, use of a medication called a diuretic to eliminate excess fluid. Using compression stockings and elevating the legs may also be recommended. (See "General principles of the treatment of edema in adults".)

Not all types of edema require treatment. Edema related to pregnancy or menstrual cycles is not usually treated. Peripheral edema and ascites are usually treated slowly to minimize the side effects of rapid fluid loss (such as low blood pressure).

Reduce salt (sodium) in your diet — Sodium, which is found in table salt and processed foods, can worsen edema. Reducing the amount of salt you consume can help to reduce edema, especially if you also take a diuretic. Guidelines on how to reduce sodium are available separately. (See "Patient information: Low-sodium diet (Beyond the Basics)".)

Diuretics — Diuretics are a type of medication that causes the kidneys to excrete more water and sodium, which can reduce edema. Diuretics must be used with care because removing too much fluid too quickly can lower the blood pressure, cause lightheadedness or fainting, and impair kidney function.

You may have to empty your bladder more frequently after taking a diuretic. However, other side effects are uncommon when diuretics are taken at the recommended dose.

Compression stockings — Leg edema can be prevented and treated with the use of compression stockings. Stockings are available in several heights, including knee-high, thigh-high, and pantyhose. Knee-high stockings are sufficient for most patients. Some stockings can cause skin irritation or pain, although proper measurement and fitting of the stockings can reduce the risk of discomfort. More detailed compression stocking tips are available in the table (table 2 and figure 2A-C).

Effective compression stockings apply the greatest amount of pressure at the ankle and gradually decrease the pressure up the leg. These stockings are available with varying degrees of compression.

Stockings with small amounts of compression can be purchased at pharmacies and surgical supply stores without a prescription.

People with moderate to severe edema, those on their feet a lot, and those with ulcers usually require prescription stockings. A healthcare provider may take measurements for stockings or may write a prescription for stockings and then have a surgical supply or specialty store take the necessary measurements.

The white "antiembolism" stockings commonly given in the hospital do not apply enough pressure at the ankle and are not adequate treatment for edema.

Body positioning — Leg, ankle, and foot edema can be improved by elevating the legs above heart level for 30 minutes three or four times per day. Elevating the legs may be sufficient to reduce or eliminate edema for people with mild venous disease, but more severe cases require other measures. In addition, it may not be practical for those who work to elevate their legs several times per day.

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient information: Chronic kidney disease (The Basics)
Patient information: Swelling (The Basics)
Patient information: Preeclampsia (The Basics)
Patient information: Glomerular disease (The Basics)
Patient information: Growth hormone treatment (The Basics)
Patient information: Tricuspid regurgitation (The Basics)
Patient information: Tricuspid stenosis (The Basics)
Patient information: Diastolic heart failure (The Basics)
Patient information: Systolic heart failure (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient information: Cirrhosis (Beyond the Basics)
Patient information: Heart failure (Beyond the Basics)
Patient information: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (Beyond the Basics)
Patient information: Chronic venous disease (Beyond the Basics)
Patient information: Deep vein thrombosis (DVT) (Beyond the Basics)
Patient information: Preeclampsia (Beyond the Basics)
Patient information: Chronic kidney disease (Beyond the Basics)
Patient information: Low-sodium diet (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Clinical manifestations and diagnosis of edema in adults
Idiopathic edema
Clinical manifestations and diagnosis of lymphedema
Prevention and treatment of lymphedema
Pathophysiology and treatment of edema in patients with the nephrotic syndrome
Mechanism of action of diuretics
Neurogenic pulmonary edema
Overview of heavy proteinuria and the nephrotic syndrome
Pathophysiology and etiology of edema in adults
Treatment of refractory edema in adults
General principles of the treatment of edema in adults

The following organizations also provide reliable health information.

National Library of Medicine

     (www.nlm.nih.gov/medlineplus/edema.html, available in Spanish)

National Institute of Diabetes and Digestive and Kidney Diseases

     (www.niddk.nih.gov)

National Kidney Foundation

     (www.kidney.org)

Literature review current through: Jun 2014. | This topic last updated: Jun 24, 2014.
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