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Edema: Swelling in My Body

Edema, or swelling of the tissues, is a normal reaction to inflammation and injury. Swelling protects the injured area and promotes tissue repair. If the cause of the swelling is clear, for example a broken ankle or an insect bite, and there are no other symptoms, it will generally resolve on its own within a few days.

Are your ankles swollen or is your face puffy? Edema can also be caused by a wide variety of other conditions, such as sunburn, eating too much salt, standing for a long time, and pregnancy. It is a well-known side-effect to certain medications, such as steroid drugs. Persistent or chronic edema may indicate a more serious underlying cause.

Edema, also known as fluid retention or hydropsy, is swelling that results from excess fluid accumulating in the tissues, but where does this fluid come from?

Fluid circulates throughout the body as plasma surrounding the red blood cells and platelets in our blood vessels, moving through tiny pores in the capillaries as interstitial fluid transporting dissolved gases, nutrients, and electrolytes within the tiny gaps between cells, and returning to the blood through the lymph vessels as lymphatic fluid.


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Plasma, interstitial fluid, and lymphatic fluid are all extracellular fluids—water containing dissolved sugars, salts, fatty acids, amino acids, coenzymes, hormones, neurotransmitters, white blood cells and cell waste-products. The composition of these fluids varies somewhat depending on where they are in the circulatory system.

As the heart pumps, it puts pressure on the circulatory system. Whenever tissues are damaged or inflamed somewhere in the body, fluid can leak into the surrounding tissues causing the area to swell. Excess fluid leakage can also occur when the membranes of the circulatory system are influenced for example by certain hormones or medications and become more permeable.

Main symptoms of edema

Some of the main symptoms are:

  • visual changes in shape or appearance—the affected area looks swollen or larger than usual
  • stretched, shiny looking skin
  • itchiness or warmth in the affected area
  • heaviness or discomfort 
  • stiffness or reduced mobility
  • reduced circulation

Edema resulting from acute inflammation or blunt force trauma may be accompanied by dizziness, nausea, confusion, stiffness, and other symptoms.

Causes of edema

Edema can result from a wide variety of conditions. Some are mild and temporary, while others may be chronic or indicate a serious illness. The most common causes include:

  • Physical trauma, injury
  • Sitting or standing still for long periods of time
  • Allergic reaction to food, insect stings, etc.
  • Sunburn or activities in hot weather
  • Poor diet, specifically too much salt or a lack of B-group vitamins
  • Hormonal changes—birth control pills, hormone replacement therapy, the menstrual cycle (usually the premenstrual phase)
  • Pregnancy
  • Menopause
  • Aging
  • Compromised immunity


Estrogen contributes to fluid balance in the body. Elevated levels of estrogen or estradiol can increase fluid retention and weight gain for some people.

In some cases, a certain type of edema can indicate a more serious health condition such as kidney disease, lung disease, cirrhosis of the liver, varicose veins, thyroid disease, congenital heart failure, or diabetes.


Types of edema

The most common form of edema occurs just beneath the skin—most often in the legs and feet, arms and hands, or face—when the network of tiny capillaries there is under pressure or damaged.

Peripheral edema

Peripheral edema, or swelling in the legs or arms, is very common after standing or sitting still for long periods, wearing tight clothing, sunburn, or eating an excess of salty foods. Peripheral edema is also common during pregnancy and can be a result of hormonal changes during the menstrual cycle. 

Pedal edema

Edema in the feet is known specifically as pedal edema and is extremely common in pregnant women and people over 65.

Pulmonary edema

Pulmonary edema is when fluid collects in the lungs. This can be quite dangerous as it affects your ability to breathe. The symptoms include shortness of breath, greater difficulty breathing at night or when lying down, wheezing, and coughing, and sometimes rapid weight gain. Contact the emergency services immediately if pulmonary edema comes on suddenly or if it is accompanied by sweats, gasping, coughing up blood, heart palpitations, anxiety, and the feeling of drowning.

Macular edema

Macular edema is swelling in the eye, more specifically in the macula— a sensitive area in the centre of the retina at the back the eye responsible for processing central vision and fine detail. If fluid collects here, vision becomes blurry and colour perception can change. Macular edema is sometimes a complication of diabetes.

Cerebral edema

Cerebral edema is when fluid builds up in the brain. This typically leads to impaired nerve function, increased pressure within the skull, and potential compression of the brain. Symptoms include headache, nausea, vomiting, seizure, drowsiness, visual or cognitive impairment. Cerebral edema is common with brain injuries but can also result from allergic reaction, high altitude, tumors, and other causes. Always seek medical attention in case of trauma to the head or the heart.

Almost any part of the body can become swollen, including the areas surrounding internal organs, but this happens more rarely and can be difficult to identify without specialist training and equipment.

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Edema grading

A simple pitting test can help determine how much fluid has accumulated in the tissues. Gently press a finger into the swollen area for 5–15 seconds, release pressure, and observe. If an indentation, or pit, remains once the pressure has been released, there is excess fluid in the tissues. The depth of the pit and how long it takes for the skin to bounce back tells you how much fluid there is.

GRADEPIT  DEPTH  REBOUND TIME

1                 2mm      immediate

2                4mm       less than 15 secs

3                6mm      15 to 60 secs

4                8mm       2 to 3 mins


Skin that holds an indentation after being pressed is an indication of edema. This is also known as pitting. The deeper the indentation and the longer it takes for the skin to rebound, the more severe the edema.

How is edema treated?

To relieve swelling or fluid retention in some part of the body, you must first identify the underlying cause, so you take the proper steps to get  relief.

If there is no serious complicating issue, there are various steps you can take to help the healing process. If the cause is overexertion in the heat or overindulgence in salty foods, the swelling will likely go away naturally after a few hours or a good night’s sleep at most.

If swelling is a common problem in your life, lifestyle changes or medications might be needed.

Lifestyle changes

Ensure you are eating a balanced, nutrient-rich diet that includes fresh fruits and vegetables. Reduce salt (sodium) and alcohol intake in your diet and consider quitting smoking if you do smoke. Water follows salt in the body. If there is excess salt in your kidneys, your body will retain water to dilute the concentration and flush it from your system.

Physical activity is an important cornerstone for a healthy body and balanced circulation. Exercise gently to reduce existing swelling. Once the edema has resolved, train more rigorously to prevent future problems.

Elevate your legs (or the affected area) when sitting or lying down to improve fluid circulation. You can do this by resting your feet on a pillow or small stool while working or by laying down with your feet raised and resting on a pillow or against the wall.

Massage and acupuncture can be very helpful for improving the circulation of blood and lymph throughout the vascular system, but if  swelling is present, be sure to stop if the massage becomes painful.

Compression socks or calf sleeves can help equalize the pressure in your body. Socks are best for long-term wear when you want relief from pain and swelling and improved circulation. Calf sleeves also reduce lower leg swelling and are often used by athletes and mountain climbers to combat the effects of demanding physical activity and changes in air pressure. If you are prone to swelling in the feet and ankles, specialized edema shoes are also available.

Medications

Diuretics can provide relief from swelling by helping the body release more sodium into the urine thus removing one cause of water retention—you pee out the extra salt and water. They should only be used as a short-term solution. Diuretics are commonly used to treat swelling caused by congestive heart failure and liver disease.

Swelling is caused by blood clots can be treated with blood thinners.

Antihistamines are often used to relieve swelling and itching caused by allergy.

Summary

Edema is a natural physiological reaction to many different kinds of illness and injury. As the potential causes are so many and varied, effective treatment depends on identifying the cause. Regular moderate exercise, a balanced diet, and elevating the feet and legs are effective treatments for common, everyday swollen feet and puffiness in the face.

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https://www.medicalnewstoday.com/articles/159111
https://www.healthline.com/health/edema
https://www.webmd.com/heart-disease/heart-failure/edema-overview
https://www.nhs.uk/conditions/oedema/
https://medlineplus.gov/edema.html
https://www.ncbi.nlm.nih.gov/books/NBK279409/
https://www.sciencedirect.com/topics/nursing-and-health-professions/edema
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