Edema

Definition

Edema is a condition of abnormally large fluid volume in the circulatory system or in tissues between the body's cells (interstitial spaces).

Description

Normally the body maintains a balance of fluid in tissues by ensuring that the same amount of water entering the body also leaves it. The circulatory system transports fluid within the body via its network of blood vessels. The fluid, which contains oxygen and nutrients needed by the cells, moves from the walls of the blood vessels into the body's tissues. After its nutrients are used up, fluid moves back into the blood vessels and returns to the heart. The lymphatic system (a network of channels in the body that carry lymph, a colorless fluid containing white blood cells to fight infection) also absorbs and transports this fluid. In edema, either too much fluid moves from the blood vessels into the tissues, or not enough fluid moves from the tissues back into the blood vessels. This fluid imbalance can cause mild to severe swelling in one or more parts of the body.

Causes & symptoms

Many ordinary factors can upset the balance of fluid in the body to cause edema, including:

  • Immobility. The leg muscles normally contract and compress blood vessels to promote blood flow with walking or running. When these muscles are not used, blood can collect in the veins, making it difficult for fluid to move from tissues back into the vessels.
  • Heat. Warm temperatures cause the blood vessels to expand, making it easier for fluid to cross into surrounding tissues. High humidity also aggravates this situation.
  • Medications. Certain drugs, such as steroids, hormone replacements, nonsteroidal anti-inflammatory drugs (NSAIDs), and some blood pressure medications may affect how fast fluid leaves blood vessels.
  • Intake of salty foods. The body needs a constant concentration of salt in its tissues. When excess salt is taken in, the body dilutes it by retaining fluid.
  • Menstruation and pregnancy. The changing levels of hormones affect the rate at which fluid enters and leaves the tissues.

Some medical conditions may also cause edema, including:

  • Heart failure. When the heart is unable to maintain adequate blood flow throughout the circulatory system, the excess fluid pressure within the blood vessels can cause shifts into the interstitial spaces. Left-sided heart failure can cause pulmonary edema, as fluid shifts into the lungs. The patient may develop rapid, shallow respirations, shortness of breath, and a cough. Right-sided heart failure can cause pitting edema, a swelling in the tissue under the skin of the lower legs and feet. Pressing this tissue with a finger tip leads to a noticeable momentary indentation.
  • Kidney disease. The decrease in sodium and water excretion can result in fluid retention and overload.
  • Thyroid or liver disease. These conditions can change the concentration of protein in the blood, affecting fluid movement in and out of the tissues. In advanced liver disease, the liver is enlarged and fluid may build up in the abdomen.
  • Malnutrition. Protein levels are decreased in the blood, and in an effort to maintain a balance of concentrations, fluid shifts out of the vessels and causes edema in tissue spaces.

Some conditions that may cause swelling in just one leg include:

  • Blood clots. Clots can cause pooling of fluid and may be accompanied by discoloration and pain. In some instances, clots may cause no pain.
  • Weakened veins. Varicose veins, or veins whose walls or valves are weak, can allow blood to pool in the legs. This is a common condition.
  • Infection and inflammation. Infection in leg tissues can cause inflammation and increasing blood flow to the area. Inflammatory diseases, such as gout or arthritis, can also result in swelling.
  • Lymphedema. Blocked lymph channels may be caused by infection, scar tissue, or hereditary conditions. Lymph that can't drain properly results in edema. Lymphedema may also occur after cancer treatments, when the lymph system is impaired by surgery, radiation, or chemotherapy.
  • Tumor. Abnormal masses can compress leg vessels and lymph channels, affecting the rate of fluid movement.

Symptoms vary depending on the cause of edema. In general, weight gain, puffy eyelids, and swelling of the legs may occur as a result of excess fluid volume. Pulse rate and blood pressure may be elevated. Hand and neck veins may be observed as fuller.

Gross lymphoedema in the arm of an elderly woman following radiotherapy treatment for breast cancer. (Photograph by Dr. P. Marazzi. Photo Researchers.)

Diagnosis

Edema is a sign of an underlying problem, rather than a disease unto itself. A diagnostic explanation should be sought. Patient history and presenting symptoms, along with laboratory blood studies, if indicated, assist the health professional in determining the cause of the edema.

Treatment

Simple steps to lessen fluid build-up may include:

  • reducing sodium intake
  • maintaining proper weight
  • exercise
  • elevation of the legs
  • use of support stockings
  • massage
  • travel breaks

Nutritional therapy

A naturopath or a nutritionist may recommend the following dietary changes:

  • Reduction of salt intake, including salty foods such as olives, soy sauce, or pickles. Cutting back the amount of sodium eaten may help reduce edema.
  • Limited use of alcohol, caffeine, sugar, and dairy products.
  • Increased consumption of whole grain foods, cucumbers, apples, potatoes, grapes, onions, cabbage, and oranges.
  • Daily vitamin and mineral supplements.

Herbal therapy

Diuretic herbs can also help relieve edema. One of the best herbs for this purpose is dandelion (Taraxacum mongolicum), since, in addition to its diuretic action, it is a rich source of potassium. (Diuretics flush potassium from the body, and it must be replaced to avoid potassium deficiency.)

Hydrotherapy

Hydrotherapy using daily contrast applications of hot and cold (either compresses or immersion) may also be helpful.

Other alternative treatments

Other alternative therapies may also reduce edema. They include traditional Chinese medicine, Ayurveda, juice therapy, and bodywork. Traditional Chinese medicine and acupuncture have an elaborate diagnostic system to determine the pattern causing the edema. Thus treatment, if done correctly, results not only in the removal of fluid, but also with the correction of the problem.

Allopathic treatment

The three "Ds"—diuretics, digitalis, and diet—are frequently prescribed for medical conditions that result in excess fluid volume. Diuretics are medications that promote urination of sodium and water. Digoxin is a digitalis preparation that is sometimes needed to decrease heart rate and increase the strength of the heart's contractions. One dietary recommendation includes less sodium in order to decrease fluid retention. Consideration of adequate protein intake is also made.

For patients with lymphedema, a combination of therapies may prove effective. Combined decongestive therapy includes the use of manual lymph drainage (MLD), compression bandaging, garments and pumps, and physical therapy.

Resources

BOOKS

The Burton Goldberg Group. "Edema." in Alternative Medicine: The Definitive Guide. Tiburon, CA: Future Medicine Publishing, Inc., 1999.

Monahan, Frances D., and Marianne Neighbors. Medical-Surgical Nursing: Foundation for Clinical Practice, 2nd ed. Philadelphia: W. B. Saunders, 1998.

ORGANIZATIONS

Lymphedema and Wound Care Clinic of Austin. 5750 Balcones Dr., Ste. 110, Austin, TX 78731. (512) 453-1930. <www.lymphedema.com>.

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