Edema: Cause, Symptoms and Treatment

Edema refers to swelling occurring anywhere in the body due to the accumulation of fluid in the soft tissue. Edema is seen most commonly in the feet and ankles, but can also occur in the hands, arms, and face. This is a common presenting symptom seen with several diseases and therefore requires attention and medical evaluation.

Causes of Edema

• Pregnancy: mild edema in pregnancy involving the ankles is normal. This occurs from an increased volume of circulating blood and increased pressure in the lower limbs during pregnancy. Edema involving the face and extensive swelling of the legs should be evaluated.
• Medications: Several drugs, including blood pressure medication and steroids, can cause swelling of the legs.
• Prolonged sitting: long plane rides, car journeys cause pooling of blood in the legs
• Heart Failure: A decrease in the capacity of the heart to pump blood leads to pooling of blood in the lower legs. This causes fluid to move from the circulation into the soft tissue of the feet and ankles during the day, causing edema. The swelling may decrease while lying down.
• Kidney disease: Poorly functioning kidneys cause the body to retain fluid, which moves to the soft tissue. This is characteristically noted as edema or puffiness around the eyes upon waking up in the morning.
• Liver disease: Abnormal liver function also leads to fluid retention and increased pressure in blood vessels in the abdomen and lower limbs. There is swelling of the feet and also of the belly, due to the accumulation of fluid in the abdomen, called ascites.
• High salt diet: Salt retains fluid by preventing its excretion by the kidney. This leads to edema.
• Infection and inflammation: This leads to enlargement of blood vessels in the area leading to localized swelling along with warmth. This is noted in the case of inflammation of the skin and joints.
• Damage to the veins in the body: damaged valves in veins hinder the proper movement of blood leading to pooling of blood in the lower limbs with edema and swollen veins (varicose veins). Clots in the veins, as in deep vein thrombosis, can also cause edema.

Symptoms of Edema

• Swelling of the feet and ankles
• Puffiness around the eyes
• Enlargement of the abdomen termed ascites
• Stretched or shiny skin
• Dimpling of the skin upon being pressed hard (pitting)
• Difficulty breathing from fluid accumulation in the lungs

Evaluation of Edema

Edema can represent a wide variety of underlying conditions. A careful history and physical examination along with appropriate laboratory investigations will help your doctor diagnose the underlying problem.

• History: The duration and progression of the edema along with symptoms like shortness of breath and past history will be asked. Long term and recent medications are also enquired.
• Physical Examination: A general examination and a thorough examination of the swollen area is performed. In addition, an examination of the heart, lungs, and abdomen are done.
• There are many investigations that may be done for evaluating edema. Your physician may perform some of these when considered appropriate.
• Blood investigations:
  • Complete blood count
  • Kidney function tests
  • Liver function tests
• Urine routine examination and microscopy
• Imaging:
  • Chest X-ray
  • Echocardiogram: An ultrasound examination of the heart to evaluate the function
  • Ultrasound of the abdomen to look for fluid and to look at the kidney and bladder
  • Doppler ultrasound of the limbs to look at the blood vessels

Treatment of Edema

Mild edema occurring from prolonged sitting and normal pregnancy usually resolve on their own with no treatment. Edema due to underlying disease requires specific management of the condition itself. The following are some options for general management of edema

• Raising of the affected body part: when limbs are affected, propping them up can decrease the swelling
• Medications: Diuretics are drugs that increase urine production which helps to excrete excess fluid from the body. Lasix (furosemide) is one of the most common diuretics used for this purpose, especially in heart failure.
• Reducing salt intake

References

1. Longo DL, et al., eds. Edema. In: Harrison’s Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015.
2. Smith C, et al. Clinical manifestations and diagnosis of edema in adults. https://www.uptodate.com/contents/search. Accessed May 14, 2019.
3. Sterns R, et al. General principles of the treatment of edema in adults. https://www.uptodate.com/contents/search. Accessed May 14, 2019.