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THIS May be Causing Your Edema

Edema can be the sign or presentation of a serious medical condition. It commonly affects the legs, ankles and feet, causing pain and restricting movement. Therefore, it needs quick relief. However, without knowing the specific causes, treating edema may prove difficult. This article discusses the many possible causes of edema and how to identify them.
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Edema is the medical term used to describe the accumulation of fluid in the interstitial spaces beneath the skin. It is also referred to as dropsy or swelling. The degree of an edematous swelling depends on the extent of fluid leakage into the interstitial spaces and/or the rate at which this fluid is drained into the lymphatic system.

Edema can affect different parts of the body but the most common forms of this medical condition affect the limbs, especially the lower limbs.

Therefore, swollen feet, legs and ankles are the most common presentations of edema.

There are different ways to classify edema. One classification is by the site of the swelling. When classified by this factor, edema can be generalized or specific to an organ.

Organ-specific edema include cerebral edema, pulmonary edema, pedal edema, corneal edema, periorbital edema, lymphedema and cutaneous edema caused by insect bites and contact dermatitis.

Edema can also be classified by grades. Grade + edema is a mild form of the condition and it usually affects feet or ankles of both legs. Grade ++ edema is moderate edema that affects the feet, lower legs and may even extend to the hands and lower arms.

Grade +++ edema is the most severe form of edema. It is generalized edema and it affects all limbs and even the face.

Basically, all forms of edema follow a given pattern that ends with the fluids collecting in the interstitial spaces leak from the blood vessels supplying the area.

The progression of edematous swelling follows these steps:

  • Increased hydrostatic (water) pressure in the surrounding area
  • Reduced oncotic (protein) pressure in the blood vessels
  • Increased  oncotic pressure in the tissues surrounding these vessels
  • Increased permeability of the walls of the blood vessels due to factors such as inflammation
  • Blockage of the lymphatic system which prevents the draining of the fluids in the area
  • Increased water-retaining properties of the tissues surrounding the area

These steps translates to an increased water pressure in the tissues of the area affected. Coupled with the increased porosity of the blood vessels, more fluids move out these vessels to reduce the high water pressure in the tissues.

There are different factors that may cause edema swelling to appear. These factors include underlying medical conditions, physiological states, nutritional deficiencies, medications, diet and restricted movement.

Diet

A diet with high salt content is the classic cause of edema.

The table salt used in cooking is sodium chloride. When ingested in high quantities and for a long time, it raises the level of sodium ions in the body. When the amount of sodium increases in the body, the kidney responds by reabsorbing more fluids to dilute the rising concentration of sodium ions.

Unfortunately, the reabsorption of fluids from the kidneys is tied to the reabsorption of more sodium ions that should have been lost in urine.

Salt-driven edema is associated with congestive heart failure, high blood pressure and liver diseases.

To prevent the retention of fluids and the swelling that follows, sodium-restricted diet is commonly prescribed for those affected.

Malnutrition can also cause edema. A diet low in B vitamins especially vitamins B1, B5 and B6 can contribute to edema swelling.

Lastly, low albumin level has been associated with edema. This can be caused by nutritional deficiencies or kidney disease.

Albumin and other proteins found in the blood provide oncotic pressure by acting as a sponge retaining fluids in blood vessels. When the levels of these blood proteins are low, oncotic pressure falls and fluids can leak out of blood vessels.

Underlying Medical Conditions

A number of medical conditions can cause or be caused by edema. Some of these conditions directly affect the legs while others do not.

Foot and Ankle Injuries

A direct injury to the foot or ankle can cause local swelling. The swelling represents the body’s normal response to the damage. Usually, getting off the injured limb can help.

You can also reduce this kind of swelling by applying ice packs on it, wrapping it in compression bandages and raising up the affected limb to allow gravity to pull back the pooled fluid.

Other kinds of leg injuries that can cause swelling include open, infected wound; bursitis (fluid-filled sacs that appear at joints); tearing of the tendon or ligament; osteoarthritis, rheumatoid arthritis and gout arthritis.

Venous Insufficiency

Venous insufficiency is the result of an inefficient return of blood flow to the heart by veins in the legs.

This is caused by damaged or weakened valves in these veins. These defective valves cannot keep the flow of blood in one direction (up towards the heart). Instead, the blood in these veins can flow back through the veins. This results in reduced pressure and the pooling of blood in the lower limbs.

When blood pools in these veins, there is an increased chance that fluids will leak out into the surrounding tissues. Therefore, venous insufficiency can cause swelling in the ankles and feet.

Edema due to chronic venous insufficiency can be recognized by the ulcers and color changes in the skin of the lower leg.

Blood Clot and Tumors

Blot clot in the leg can also impede the proper flow of blood back to the heart.

Blood clots can form in the veins close to the skin surface and cause superficial swelling.  However, when the blood clot is found in one of the deeper, bigger veins (deep vein thrombosis), the resulting edema affects the ankles and feet.

Deep vein thrombosis can cause more harm than just pedal edema. When the blood clot breaks off, it may travel to the heart or lungs where it can cause serious and potentially life-threatening complications.

Deep clots blocking major veins in the leg can be identified by the pain, fever and the skin color change accompanying the swelling.

Tumors can also block blood flow in the veins of the legs. When a tissue mass gets large enough, it can press on veins and gradually increase the pressure within the blood vessels. This results in the leakage of fluid into the surrounding tissues.

In addition, the lymphatic system draining the area can respond to the tumor and swell up.

Lymphedema

The lymphatic system is responsible for draining the fluids in various sites of the body. The lymph vessels drain to the lymph nodes where foreign bodies such as bacteria are trapped and destroyed.

However, it is possible that the lymph vessels are blocked or damaged. When this happens, the protein-rich lymph fluid can build up and cause edema.

Lymphedema commonly affects cancer patients. It can be triggered by radiotherapy and deliberate surgical removal of the lymph nodes. Any other factor that blocks the lymphatic system can also cause lymphedema.

Heart, Liver and Kidney Diseases

Congestive heart failure can cause swelling in the legs, ankles and feet because it affects blood flow from the lower limbs.

During congestive heart failure, the lower chambers of the heart cannot effectively pump blood. Therefore, the venous return from the lower part of the body is affected. This means that blood flow stagnates in the legs, ankles and feet, and therefore, the chance of fluid leakage into the surrounding tissue increases.

Liver diseases especially liver cirrhosis reduces the efficiency of the liver. This affects the release of hormones and other natural compounds that regulate the amount of water in the body.

In addition, liver cirrhosis increases the pressure in the veins draining the pancreas, intestines and spleen. This rise in pressure can cause the accumulation of fluids in the abdominal cavity (ascites) and in the lower limbs (pedal edema).

The kidney is chiefly responsible for the loss of fluid in the body. The body passes fluids through the kidneys and, depending on the current needs of the body, some fluid may be reabsorbed or else lost in urine. Therefore, kidney diseases can cause the accumulation of fluids in the body.

The edema associated with kidney problems usually affects the eyes and legs.

In addition, liver diseases also cause blood albumin levels to fall. This can also lead to swelling in the legs, ankles and feet.

Other Diseases

Other diseases that can cause or worsen edema include diabetes (due to complications such as kidney failure, liver failure and loss of proteins), arthritis (due to inflammation in the joint caused by the rupture of the synovial membrane), hypothyroidism (due to slow metabolism) and chronic lung disease.

Physiological States

Certain normal physiological states may also cause edema. Although these are not diseased states, they can still cause significant changes in the body that promote water retention.

Pregnancy

Pedal edema during pregnancy is common. It results from the increased fluid buildup in the body required to properly care for mother and child.

In addition, pregnant women retain sodium, and thus water, more easily. Furthermore, when reclined, the uterus can block veins leading to the legs. Lastly, blood clots more easily in pregnant women and deep vein thrombosis can result in edema.

Mild edema during pregnancy is harmless and it can be relieved by avoiding prolonged standing or sitting, by avoiding tight-fitting shoes and clothes, by wearing compression stockings, and by (paradoxically) drinking more water.

However, severe edema during pregnancy is an early sign of preeclampsia and it should be promptly reported to a physician.

Menstruation and Menopause

Menstruation causes wide fluctuations in hormonal levels. For example, the levels of progesterone is reduced during the menstrual cycle and the low level of this hormone can cause fluid retention in the body.

In the same way, menopause can cause hormonal fluctuations that trigger edema. Strangely, hormone replacement therapy, which is aimed at replacing lost hormones, can also cause edema.

All of these show that it is the wide fluctuation rather than specific hormones that causes edema.

Medications

Some medications can also cause swelling in the legs. These drugs mostly affect the water balance in the body or cause blood vessels to leak fluids.

Medications that can cause edema include:

  • Vasodilators, because they promote the widening of blood vessels. This dilation also increases the porosity of the vessels and cause the leakage of fluid
  • NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen
  • Corticosteroids such as prednisone
  • Steroids, both androgenic and anabolic
  • Calcium channel blockers such as nifedipine and amlodipine
  • Drugs for diabetes especially thiazolidinediones such as pioglitazone and rosiglitazone
  • Estrogens and birth control pills and replacement hormones containing estrogen-like hormones
  • MAOI (monoamine oxidase inhibitor) and tricyclic antidepressants

Restricted Movements

Periods of prolonged restricted movement can also cause edema especially swelling in the feet, ankles and legs.

The kinds of restricted movement that can cause edema include standing or sitting too long, lack of exercise, prolonged hospital stay and long flights.

Edema caused by all of these instances of physical activity can get worse when the weather is hot.

Sources


http://www.whattoexpect.com/pregnancy/symptoms-and-solutions/edema.aspx

http://www.nlm.nih.gov/medlineplus/ency/article/003104.htm

http://www.mayoclinic.com/health/leg-swelling/my00592/dsection=causes

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