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  Edema (Water Retention)  
 
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Contributing risk factors | Other conditions that may be present | Recommendations

 

Edema is swelling due to an accumulation of excess fluid. Your body has set fluid levels and will restore itself to its usual state within 48 hours of taking in extra water under normal circumstances. There are many causes and subtypes of edema including hypertensive, exercise, high altitude, tropical, medication and idiopathic cyclic edema. Idiopathic Cyclic Edema
This is one subtype primarily occurring in young menstruating women in which large amounts of tissue swelling occurs in the legs and abdomen after sitting or standing, and swelling of the face and eyelids upon lying down. It is thought to be a problem of leakage of blood fluids from capillaries into fat and skin tissue especially when gravity (standing up) is added to the pressure in the vascular system. It results in large weight changes from morning to evening. Sometimes the condition is called idiopathic orthostatic (standing upright) edema or just idiopathic edema. Other names include fluid retention syndrome and cyclical edema.

This condition can result in moderate discomfort in any area of excess fluid accumulation. Carpal tunnel syndrome, diffuse aching, morning stiffness and muscle/bone pains as well as headaches often accompany the swelling. It can also masquerade as premenstrual syndrome or make existing premenstrual syndrome worse. It exacerbates the swelling, abdominal bloating and general physical discomfort but it does not usually cause irritability or depressive symptoms as does classic PMS. Sometimes the syndrome can occur in women with eating disorders who are taking diuretics or even laxatives in order to lose weight.

Swelling in both legs can have many other possible causes

  • Prolonged standing or sitting, especially in hot weather, may cause excess fluid accumulation in the feet, ankles and lower legs.
  • Venous insufficiency is a common problem of the weakened valves in the veins of the legs. This leads to varicose veins and build up of fluid.
  • Severe chronic lung disease such as emphysema or chronic bronchitis increase the pressure in the blood vessels to the lungs. This pressure backs up in the right side of the heart and the higher pressure causes swelling in the legs and feet.
  • Congestive heart failure due to decreased pumping action of the heart muscle causes fluid buildup in the lungs and other parts of the body. The swelling is often most visible in the feet and ankles.
  • Pregnancy with leg edema occurs because the pregnant uterus puts pressure on the vena cava, a major blood vessel that returns blood to the heart from the legs. Fluid retention of pregancy also might be caused by a more serious condition called preeclampsia.
  • Low protein levels in the blood that can be seen in malnutrition, kidney and liver disease. The proteins in the blood help hold salt and water inside the blood vessels so fluid does not leak out into the tissues. If albumin (the most abundant blood protein) gets too low, edema occurs especially in the feet, ankles and lower legs.
Diagnosis
To check for edema that is not obvious, you can gently press your thumb over the foot, ankle or leg with slow, steady pressure. If edema is present, an indentation will show on the skin. A professional evaluation to determine the cause of leg swelling is needed. If both legs are swollen, your doctor will inquire about other symptoms and perform a physical examination. A urine test will show whether you are losing protein from the kidneys. Blood tests, a chest X-ray and an electrocardiogram (ECG) may be ordered.

Prevention
Prevention of edema means preventing the cause. Smoking is the No. 1 cause of chronic lung disease. Congestive heart failure most often is due to coronary artery disease and high blood pressure. To avoid leg swelling on long trips or due to long hours at a desk job, stand up and walk around often; ideally you should get up once per hour. If not possible, then exercise your feet and lower legs while sitting. This will help the veins move blood back toward the heart.

When you repeatedly take laxatives, diuretics or vomit, your body will adapt to being constantly dehydrated by learning to retain more fluid than usual. When you stop these behaviors and start to take a normal diet, your body may continue to retain fluids until it learns that adequate fluid will be available, then it will release the extra fluid. People who abuse laxatives or vomit regularly are at the greatest risk for alternating between dehydration and edema.

It may take from 2 to 6 weeks following long term dehydration for your body to get used to being normally hydrated again and flush out the extra fluid it has been retaining.

Treatment
Treatment focuses on correcting the underlying cause of the fluid accumulation. In addition, a low-salt diet and avoiding excess fluid intake usually helps. If you are not short of breath, elevation of the legs above the level of your heart will also keep swelling down. A low dose of a diuretic (water pill) used sparingly might be added in some cases.

For swollen ankles and feet caused by pregnancy from the enlarged uterus pushing on the vena cava, elevation of the legs and not lying on your back (either side) helps blood flow and decreases swelling.

Most patients with mild leg edema due to varicose veins can be treated with periodic leg elevation and support (compression) stockings. Sometimes surgery is needed to improve the flow of blood through the leg veins.

Also, no matter what the underlying cause of edema, any swollen area of the body should be protected from pressure, injury and extreme temperatures. The skin over swollen legs becomes more fragile over time. Cuts, scrapes and burns take much longer to heal and are more prone to infection when skin has edema underneath.

When to seek help
Call your doctor immediately if you have pain, redness or heat in the swollen area, an open sore, shortness of breath or swelling of only one limb. If the swelling has never happened before and it persists for more than a couple days, call your doctor's office for advice.

Prognosis
The prognosis for edema of the legs depends on the cause. For most people with edema, the prognosis is excellent.
 

 
 

Risk factors for Edema (Water Retention):
 
 
Addictions  Alcohol-related Problems
 Excessive alcohol intake can cause edema,

Allergy

  Allergy / Intolerance to Foods (Hidden)

Cell Salts

  Cell Salt, Nat Mur Need

Circulation

  Lymphatic Congestion
 Edema may be due to lymphedema. There are two kinds. Inherited lymphedema, or primary lymphedema, in which you are born lacking lymph vessels and nodes. The swelling usually appears during your adolescence and affects your foot or calf. A rare form of primary lymphedema develops in infancy and is called Milroy’s disease. Acquired lymphedema or secondary lymphedema, in which an injury to your lymphatic system causes lymphedema. It is much more common than primary lymphedema.

Some people develop chronic lymphedema, which can last for the rest of your life. Chronic lymphedema can be a difficult form of lymphedema to treat. Swollen limbs become vulnerable to infection. Any kind of injury to the skin, such as a cut, scratch, insect bite, or even athlete’s foot between your toes can cause a severe infection, which physicians call lymphangitis. Lymphangitis affects the connective tissue under your skin. Repeated infections can cause scarring that makes the tissue vulnerable to more swelling and infection. This leads to the tissue hardening, called fibrosis, which is characteristic of advanced chronic lymphedema.

  Congestive Heart Failure

Diet

  Excess Salt Consumption
 Salt can increase the amount of fluid that you retain in your body.

  Excess Water Consumption
  Protein Deficiency
 When protein (especially albumin) levels in your blood go too low, the colloidal osmotic pressure will decrease and allow fluid to escape from blood vessels into your tissues, resulting in edema or swelling of the hands, feet, ankles, knees and/or belly.

Digestion

  Atrophic Gastritis
 Edema may be due to low levels of circulating proteins from poor protein digestion.

Environment / Toxicity

  Gulf War Illness
  General Detoxification Requirement

Hormones

  Low Progesterone or Estrogen Dominance
 Progesterone has also been used in the treatment of idiopathic edema under the premise that some women with idiopathic edema either do not ovulate or have a luteal phase deficiency.

Ovarian function was investigated in 30 women with postural idiopathic edema by measuring plasma estradiol and progesterone levels between the 21st and 23rd days of the menstrual cycle. Plasma progesterone concentrations were found to be lower than 5ng/ml in 53% of the cases and lower than 10ng/ml in 83%. The ovarian dysfunction most frequently observed was inadequate corpus luteum, i.e. progesterone deficiency with normal plasma estradiol levels. In virtually all patients the initial disorder in capillary permeability, as evaluated by Landis' test, was fully corrected by progesterone administered orally. However, clinical improvement was less marked with treatments of short duration (2-3 consecutive cycles). In view of the complex cause of the disease, combined treatments in which progesterone might well play the major role are usually required. [Presse Med 1983 Dec 10;12(45): pp.2859-62 (translated)]

  Hypothyroidism

Medications

  Birth Control Pill / Contraceptive Issues

Metabolic

  Nephrotic Syndrome (NS)
  Problem Caused By Being Overweight
  Anorexia / Starvation Tendency
 Semi-starvation can cause edema. People with eating disorders may interpret the puffiness of edema or any changes on the scale as weight gain or getting "fat" and may panic and purge or take laxatives even more.

Nutrients

  Hypokalemia / Potassium Need

Organ Health

  Cirrhosis of the Liver
 When the liver loses its ability to make the protein albumin, water accumulates in the legs and abdomen.

  Kidney Weakness / Disease
  Liver Detoxification / Support Requirement

Uro-Genital

  Eclampsia / Preeclampsia
  Premenstrual Syndrome PMS H (Heaviness)
 
 

Edema (Water Retention) suggests the following may be present:
 
 
Cell Salts  Cell Salt, Nat Sulf Need

Environment / Toxicity

  General Detoxification Requirement

Metabolic

  Problem Caused By Being Overweight

Counter-indicators:
  Constitutional Temperature

Organ Health

  Cirrhosis of the Liver
 When the liver loses its ability to make the protein albumin, water accumulates in the legs and abdomen.

Uro-Genital

  Eclampsia / Preeclampsia
 
 

Recommendations for Edema (Water Retention):
 
 
Animal-based  Urea
 Urea is a direct diuretic, meaning it can increase diuresis by boosting the function of the renal epithelia. Urea can be taken internally: 1 to 2gm per day are used as a treatment of water retention and related problems (such as swollen face, swollen fingers in the morning, headaches, premenstrual water retention, watery dreams, etc.).

Botanical

  Ginkgo Biloba
 Idiopathic cyclic edema is characterized by water and sodium retention with secondary hyperaldosteronism (over-production of aldosterone) due to capillary hyperpermeability. This defect is detected and measured by the Landis' labeled albumin test; correcting it is important. Ginkgo biloba extract administered either orally or by intravenous infusion provided full correction of this biological anomaly in 10 cases in which the Landis' test was performed before and after oral treatment, and in 5 cases treated by intravenous infusion. [Presse Med 1986 Sep 25;15(31): pp.1550-3 (translated)]

  Grape Seed Extract / Resveratrol
 One month of treatment with Pycnogenol (360mg per day reduced lower limb circumference and improved subjective symptoms better than horse chestnut seed extract in a study of 40 patients with diagnosed chronic venous insufficiency. [Phytother Res 2002;16(2): pp.1-5]

A double-blind placebo-controlled study of 71 subjects with venous insufficiency found that grape seed OPCs, taken at a dose of 100mg 3 times daily, significantly improved major symptoms, including heaviness, swelling, and leg discomfort. [La Revue de Medecine. Aug/Sept.1981;no.27–28: pp.1793-1802]

A study published in the October 2006 journal of Clinical and Applied Thrombosis/Hemostasis shows Pycnogenol® (pic-noj-en-all), an antioxidant plant extract from the bark of the French maritime pine tree reduced edema, a typical side-effect of antihypertensive medications, by 36 percent in patients taking these medications.

According to Dr. Gianni Belcaro, lead researcher of the study, more than 35 percent of patients taking antihypertensive medications are believed to suffer from edema as a side-effect. This happens because the antihypertensive medications cause blood vessels to dilate, which allows easier blood flow and thus lowers blood pressure. However, as a side-effect this causes blood to pool in the vessels of the lower legs. In result they stretch and liquid seeps into tissue causing swelling (edema). Hypertension is a serious risk factor for developing severe cardiovascular incidents some time in the future and thus the necessity for treatment justifies the development of edema as a side-effect.

Antihypertensive medications reduce pressure by inhibiting constriction of blood vessels. "The larger the blood vessel diameter, the easier blood will flow with less pressure," said Dr. Belcaro. "In order to avoid blood pooling in the lower legs and feet (edema), blood vessel diameters must adjust when a person changes positions from laying down to standing up. Results of this study show Pycnogenol to improve blood circulation, avoiding blood pools and reducing edema."

  Stephania tetrandra

Diet

  Therapeutic Fasting
 Fasting promotes the drying up of abnormal fluid accumulations, such as edema in the ankles and legs and swelling in the abdomen.


Not recommended:
  Increased Water Consumption
 Excessive water consumption should be avoided until edema has been resolved.

Drug

  Conventional Drugs / Information
 There is no single, accepted gold standard treatment for idiopathic cyclic edema. Several different treatments have been reported. An agent used for treating high blood pressure called Captopril has also been used with success. It works against the kidney hormone aldosterone which is elevated in this condition and causes excess salt and water retention.

Sometimes a mild diuretic will help reduce fluid retention but can worsen the edema of idiopathic cyclic edema. While one would think that taking a "water pill" or diuretic would improve this edematous condition, it turns out that in most cases this is the wrong long term treatment. In fact, chronic diuretic use will increase the secretion of aldosterone which in turn produces more edema. If the chronic use of diuretics is discontinued, the cyclical swelling disappears in most cases within about 3 weeks.

Patients experiencing a disturbance in their ability to normally excrete salt may need to either be placed on a diet limited in salt and/or given diuretic medications. In the past, patients with diseases associated with edema were placed on diets that were very restricted in salt intake. With the development of new and very potent diuretic agents (water pills), this marked restriction in dietary salt intake is generally no longer necessary. These diuretics work by blocking the reabsorption and retention of salt by the kidneys, thereby increasing the amount of salt and water that is eliminated in the urine.

Habits

  Aerobic Exercise
 Edema can be caused by a sedentary lifestyle - in other words, long periods of standing or sitting. If this is the case for you, regular exercise (not necessarily prolonged or strenuous) should help.

Lab Tests/Rule-Outs

  Test for Food Allergies
 Food sensitivities should be ruled out in cases of edema of unknown cause. "I often recommend an empirical elimination diet in which common allergens (wheat, milk, eggs, corn, coffee, tea, alcohol, yeast, citrus and sugar) are removed for several weeks. Although edema is usually not their primary complaint, many patients report a pronounced diuresis and loss of edema fluid during the first several days of the diet. Foods that cause a return of a patient's presenting symptoms often cause fluid retention as well". [Gaby, AR. Idiopathic edema: Letter. Hospital Practice Feb. 15, 1986, p. 21]

Edema is a very reliable and accurate index in detecting a food reaction that may cause the body to suddenly retain as much as 4% of its body weight as edema fluid. This weight is gained within 6-8 hours of ingesting the guilty food and lost within 18-24 hours after the food has been removed from the diet. [Brenerman, JC. Basics of Food Allergy. Springfield, IL, Charles C. Thomas, 1978]

Mineral

  Salt Intake Reduction
 Generalized edema implies that salt (sodium chloride) intake has been greater than excretion for some time in the recent past, so that the extracellular fluid (ECF) volume is now greater than normal. To develop clinical edema, one needs to retain in excess of three liters of ECF. In normal people, a very high salt intake does not result in edema. The problem often arises with normal salt intake when renal salt excretion is reduced, producing salt retention by the kidneys. Salt intake should be reduced to help remove this ECF. Diuretics are used to increase salt elimination by the kidneys.


Not recommended:
  Increased Salt Consumption

Physical Medicine

  Physical Supports
 The use of compression stockings is by far the most common first treatment step beyond simply elevating the feet. These elastic stockings help keep the veins from getting distended by simply squeezing the legs and feet a little. Compression stockings vary from over the counter styles which provide mild compression to high compression styles requiring a doctor’s prescription. Compression stockings can be difficult to put on and unless you have strong hands and arms, you will probably need help getting them on. One useful tip to make it easier to put them on is to wear Playtex style rubber gloves.

The veins in your legs are one of the hardest working parts of your circulatory system. From your feet, deoxygenated blood is then returned to your heart, where it is forced to fight gravity along the way. This process puts a great deal of stress on the veins of your legs. Because of this, many people are at risk of having problems with their veins later in life.

Support stockings assist the natural function of your veins by offering a mild graduated compression. This compression provides a "massaging effect" that, when combined with the muscle pump effect of the calf, helps to constrict the veins, and reduce swelling. Constriction of the veins by compression stockings, enables more efficient function of the vein valves, improving the return of blood to the heart.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Weakly counter-indicative
May do some good
Likely to help
Highly recommended
May have adverse consequences
Reasonably likely to cause problems







GLOSSARY

Bronchitis:  Inflammation of the mucous membrane of the bronchial tubes, frequently accompanied by cough, hypersecretion of mucus, and expectoration of sputum. Acute bronchitis is usually caused by an infectious agent and of short duration. Chronic bronchitis, generally the result of smoking, may also be known as Chronic Obstructive Pulmonary Disease (COPD) or Emphysema.

Capillary:  Any of the smallest blood vessels connecting arterioles with venules and forming networks throughout the body.

Carpal Tunnel Syndrome:  A common, painful defect of the wrist and hand. It is caused by pressure on the middle nerve in the carpal tunnel. The syndrome is seen more often in women, especially in pregnant and in menopausal women. Symptoms may result from a blow, swelling, a tumor, rheumatoid arthritis, or a small carpal tunnel that squeezes the nerve. Pain may be infrequent or constant and is often most intense at night.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Congestive:  Pertaining to accumulation of blood or fluid within a vessel or organ.

Corpus Luteum:  Yellow endocrine body formed in the ovary that secretes estrogen.

Diuretic:  An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.

Edema:  Abnormal accumulation of fluids within tissues resulting in swelling.

Electrocardiogram:  A test that shows a tracing of the electrical conduction of the heart.

Idiopathic:  Arising spontaneously or from an obscure or unknown cause.

Laxative:  A substance (food, herb, chemical) that stimulates evacuation of the bowels. Examples include cascara sagrada, senna, castor oil, aloe vera, bisacodyl, phenolphthalein and many others.

Lymph:  A clear fluid that flows through lymph vessels and is collected from the tissues throughout the body. Its function is to nourish tissue cells and return waste matter to the bloodstream. The lymph system eventually connects with and adds to venous circulation.

Lymphatic System:  A network of vessels which collect fluid from the tissues of the body and return it to the blood. Lymphatic fluid (also called lymph) is rich in white blood cells that fight infection and an important part of the body's immune system.

ng:  Nanogram: 0.000000001 or a billionth of a gram.

Preeclampsia:  A toxic condition developing in the last 4 or 5 months of pregnancy that is characterized by a sudden rise in blood pressure, excessive weight gain, generalized edema (especially hands, ankles, feet and face), albuminuria, severe headache, and visual disturbances. It used to be called toxemia of pregnancy. Some rise in blood pressure is normal during pregnancy, but in preeclampsia the rise is dramatic and is accompanied by other changes. The most notable of these are high concentrations of protein in the urine and a tendency to swell up, especially in the face and hands. This can cause women with preeclampsia to put on several pounds in a few days.

Premenstrual Syndrome:  PMS consists of various physical and/or emotional symptoms that occur in the second half of the menstrual cycle, after ovulation. The symptoms begin about midcycle, are generally the most intense during the last seven days before menstruation and include: acne; backache; bloating; fatigue; headache; sore breasts; changes in sexual desire; depression; difficulty concentrating; difficulty handling stress; irritability; tearfulness.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

Varicose Veins:  Twisted, widened veins with incompetent valves.