Edema is the accumulation of abnormal levels of fluid in the circulatory system and the tissues between the body’s cells (interstitial tissue). This condition often causes tissue underneath the skin to swell, and is common when lymphatic blockage occurs.
Swelling occurs in the blood vessels when an excessive increase in the volume of plasma fluid causes the vessels to dilate.
Eventually, blood vessel walls weaken as they dilate, causing lymph fluid to diffuse into surrounding tissue space.
This excess fluid gets trapped in the body’s tissue in a greater capacity than the lymphatic system can eliminate.
Generally, edema is physically unnoticeable until the interstitial fluid volume is approximately 30% above normal (normal fluid volume is 10%).
Many American’s suffer from edema without knowing what it is, and what causes it. Edema is also referred to as oedema, which was formally labeled dropsy or hydropsy.
Symptoms of Edema
Swelling of the Skin
- Localized or peripheral: swelling is in one specific area. Mainly in one of the legs or arms.
- Generalized: swelling is in particular regions of the body. Such as in the extremities, a portion or all of the face, abdomen, and the feet.
- Organ-specific: swelling in a particular organ such as the brain (cerebral edema), the lungs (pulmonary edema) or the eye’s (periorbital edema).
- Pitting Edema: a severe case of edema which exists if skin retains a dimple after being pressed for 10 to 20 seconds.
The skin may feel tight and stretched. Edema causes the skin to feel tight as a result of being stretched beyond its normal boundaries. In some cases, skin may either feel warm to the touch, or quite cool if there is a blockage in local circulation.
Additional Symptoms to Look For
You may also experience puffiness of the ankles. Boggy ankles are one of the most common signs of peripheral edema; which is characterized by generalized swelling in the extremities.
In addition to ankle swelling, you may also experience swelling of the face or eyes. This can cause the face to become red and swollen. Swelling of the eyes can occur in the cornea of the eye due to glaucoma, conjunctivitis, keratitis, or surgery. Periorbital edema causes puffiness around the eyes, and is most noticeable immediately after waking. Other issues to watch out for are:
- Weight gain: due to increased fluid retention, and lack of elimination.
- Increased localized heat radiating from skin’s surface: is commonly associated with a localized infection.
- Hypertension: or an increase in blood pressure due to blood flow blockage resulting from an influx of fluid levels.
- Stiff joints and aching body parts: are the body’s reactions to pain, signaling that a disorder has occurred.
Causes of Edema
There can be many causes of Edema, such as:
- Physical inactivity
- Genetic predisposition
- Standing or sitting for long periods of time
- Surgery resulting in localized inflammation or impaired organ functionalities
- High Altitudes
- Certain medications
- Excessive salt intake
- Contraceptive Pill
- Poor diet
- Kidney disease/damage
- Heart failure
- Chronic lung disease
- Liver disease
- Thyroid disease
- Brain tumor
- Head injury
Risk Factors for Edema
- Congestive heart failure – blood accumulation in the legs, ankles, or feet due to the hearts inability to pump efficiently.
- Cirrhosis – scarring of the liver that imbalances the secretion of hormones and chemicals regulating fluid levels in the body.
- Kidney disease – cause fluid and sodium retention in the legs and around the eyes.
- Nephrotic syndrome – kidney damage causing low protein levels in the blood to result in an over accumulation of fluid.
- Chronic venous insufficiency (CVI) – weakening of the veins and values in the legs, which causes them to lack the proper pumping abilities needed to push blood back to the heart.
- Deep vein thrombosis – a blood clot which forms in a vein, mainly in the thigh or lower leg.
- Lymphedema – the improper draining of lymph nodes and vessels due to genetic predisposition, or a medical condition such as cancer or an infection.
Tests and Diagnosis
In order to treat edema a doctor has to diagnose what is causing it. However, in cases showing signs of systemic edema (caused by a malfunction of one or more of the systems in the body) or pitting edema, it is wise not to wait to seek the advice of a medical practitioner.
The initial set of test done by a medical professional is a preliminary evaluation. First, a medical history profile is completed. Then, the practitioner performs a physical assessment, comparing patient’s arms and legs for symmetrical edema and other areas of the body for dependent edema. Last, the medical professional palpates the area affected by taking peripheral pulses, by notating areas of the body that are cold to the touch, and by performing a complete cardiac and respiratory assessment.
If edema is confirmed additional test are recommended, correlating to the area of the body in which the edema occurs.
Testing for Localized Edema
Localized Edema can be determined during a patient consultation, which includes health history questionnaires, and physical assessments carried out by a medical professional. Once localized edema is suspected the following test may be done to diagnose the exact cause:
- Impedance phlebography is a noninvasive test that uses electrical monitoring to measure blood flow in veins of the leg. Information from this test helps a doctor to detect deep vein thrombosis (blood clots or thrombophlebitis).
- D-dimer testing is a sensitive indicator for active deep vein thrombophlebitis.
- Cultures of blood or fluids that are available from the site of the lesion should be taken for patients showing symptoms of cellulitis or osteomyelitis.
- X-rays and CT scans should be taken of the involved area.
- Bone scans should be taken for patients thought to have osteomyelitis and bone fractures.
- Lymphangiography is used to determine if lymphedema exists.
- CT scan of the pelvis or abdomen is used when signs of malignant lymph nodes exist.
- Thyroid profile detects pretibial myxedema as a result of thyrotoxicosis.
Testing for Generalized Edema
Generalized Edema is systematic. Therefore, endocrine testing is one of the primary components used to make a diagnosis.
- Venogram is used to test edema in the upper extremities caused by increased venous pressure.
- Doppler or ultrasound study is also used to test venous obstruction of the upper extremities as well.
- Computed Tomography (CT) if thorastic outlet syndrome is present. Other options include Magnetic resonance imaging (MRI) or plain films.
- Chest X-ray (CXR) study and ECG are done to detect edema in the arms and legs.
- Liver function test are done if cirrhosis is suspected.
- Urinalysis and sediment evaluations are done if renal causes of edema are expected.
Organ Specific Edema Test
Organ Specific Edema test vary depending on the organ affected. However, general testing procedures still apply which include.
- Complete blood count (CBC)
- Chest films
- Electrocardiogram (ECG)
- Biochemical screening which include albumin, total protein, liver function tests, total cholesterol, and thyroid function tests
Testing for Pitting Edema
Press and hold the skin for 10-20 seconds. If the dimple impression remains when released then pitting edema may exists. If pitting edema exists for more than 3 months, low serum protein levels may be an underlying factor.
At home treatments often times recommended by doctors include:
- Walk regularly when traveling by car, train, boat or plane
- Wear support stockings or compression bandaging
- Do regular exercise
- Decreasing salt intake
- If overweight, loss weight
- Raise legs when sleeping & several times daily
- Do not stand or sit for long periods at a time
- Limit the use of alcohol, sugar, caffeine, and dairy products.
Before determining a treatment plan for edema, a doctor must first determine the underline cause for the swelling, and determine if it is localized to a specific area of the body, or if it is generalized in different regions of the body.
In cases which edema is found to be present, the initial recommendation is to lower sodium intake in foods consumed; or to prescribe diuretics. Bed rest and elevation of the swollen area is also recommended. And, in some situations, elastic stockings are advised as well.
In more severe cases of edema (such as edema associated with heart failure), doctors may prescribe other drugs along with diuretics in order to regulate the circulatory system.
Pharmaceutical drugs such as antiangiogenesis drugs are sometimes prescribed to help control blood vessel growth. Some antiangiogenesis drugs as well as other prescriptions for edema are as follows:
- Aqua-Ban with Pamabrom
- Aquazide H
- Diamox Sequels
- Diuril Sodium
- Sodium Edecrin
Surgery is usually the final option if medications prescribed are ineffective. Edema should never be treated until the underline cause has been properly diagnosed and addressed. Although, edema is sometimes a result of surgery, there are surgical procedures done to treat the edema itself.
- Brain Surgery: In medical patients with severe traumatic brain injury and malignant middle cerebral artery infarction, doctors sometimes recommend opening the skull (decompressive craniectomy) to reduce intracranial pressure.
- Testicular Transposition: Is a new treatment used for the treatment of chronic lymphedema following inguinal lymph node dissection.
- Charles Procedure, Buck’s Fascia, Homans-miller Procedure, Kondoleon Procedure, Sisktrunk Procedure, Thompson Procedure, Lymphedema Microsurgery, Dermal Flap, Miller Sistrunk Procedure, Surgical Therapy: Each of these surgical techniques generally involves stripping out the subcutaneous regions filled with lymph fluid.
- Thompsons Procedure: Is a surgical procedure done to build an alternative route or bypass for the lymph system.
- SinEcch™: an oral homeopathic preparation used for more than 10 years, by thousands of surgeons, as an adjuvant treatment for post-surgery edema and ecchymosis.
- Dandelion: is a diuretic herb that is rich in potassium. However, the diuretic action can also eliminate potassium from the system, so it is good to consume foods and vitamins high in potassium in addition to taking dandelion.
- Ginkgo: helps to enhance the circulatory system, thereby improving blood flow.
- Horse Chestnut: acts as an anti-inflammatory by reducing fluid leakage from the capillaries. Subsequently improving overall circulatory health.
- Increase overall consumption of whole grain foods, potatoes, grapes, apples, onions, cabbage, oranges, and cucumbers.
- Increase daily use of vitamins and mineral supplements that act as diuretics to regulate fluid retention.
- Juice Therapy from organic fruit and vegetables.
- Hydrotherapy is used by alternating hot and cold compressions daily, and by full body immersion in warm water with Epsom salt.
- Gamma Linolenic Acid (GLA) or Omega-6 fatty acid helps to reduce fluid retention and other symptoms associated with premenstrual syndrome (PMS).
- Magnesium helps with edema associated with symptoms of PMS.
Alternative Health Care Remedies
- Acupuncture: helps to determine the cause of edema and in some cases it helps to reduce the inflammation.
- Massage Therapy: by a qualified therapist. The pressure must be light to moderate, and movements must flow in the direction of the heart. Massage is a contraindication for systemic and pitting edema, but it is highly recommended for less severe edema.
- Ayurveda: oils are massaged into the skin to reduce localized swelling in specific areas of the body.
- Oxygen Therapy: administering oxygen as a medical treatment is good to help assist the body with efficient cell metabolism, and normal physiological functioning through tissue oxygenation. It is very effective in cases where pulmonary edema is present.