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Pitting vs Non Pitting Edema

Pitting vs non-pitting edema - what is the difference?
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Edema is the swelling resulting from fluid accumulation in body tissues. It is most commonly found in the lower extremities (such as feet, ankles, and legs). 

Clinically, there are two different types of edema - pitting and non-pitting. Let’s find out the differences between pitting vs non pitting edema: 

Pitting Edema 

Pitting edema can be demonstrated by applying pressure to the swollen area by depressing the skin with a finger. If this causes an indentation that stays for some time after the release of the pressure, this type of edema is referred to as pitting edema. 

Pressure in any form, such as from the elastic in socks or tight clothing, can induce pitting with this type of edema. Pitting edema may also be caused by systemic diseases that affect the various organ systems of the body, or by local conditions involving the affected extremities. 

Pitting edema is mainly caused by complications of vital organs of the body, such as heart, liver, and kidneys. Malfunctioning of these organs can cause retention of fluid in the body.

Regulation of diet, taking prescribed diuretics, avoiding foods in high sodium and doing exercises might help reduce pitting edema.

Pitting edema is also observed in edema patients with rheumatoid-like diseases such as rheumatoid arthritis and systemic lupus erythematous. It is also the kind of edema present in patients receiving intravenous fluids.

The indentation made on the skin when pressure is applied to a pitting edema is due to the fluid leaking out of the capillaries into the subcutaneous tissue. The extent and duration of the indentation after applying pressure are good indications of the severity of the pitting edema.

Therefore, pitting edemas are graded by this simple examination. The table below explains the four grades of pitting edema.

Assessment of Pitting Edema

Grade 1+ Edema: A pit of 2 mm or less; presents as slight pitting with no distortion. Pitting disappears immediately.

Grade 2+ Edema:  A deeper pit measuring between 2 mm and 4 mm. It will have no easily discernible distortion and the pitting will disappear in 10 – 15 seconds.

Grade 3+ Edema: A noticeably deep pit measuring between 4 mm and 6 mm. The area affected will look distinctly fuller and swollen. The indentation will take as long as 1 minute before it disappears.

Grade 4+ Edema: A very deep pit is seen which will last between 2 to 5 minutes before it disappears. This indentation will measure 6 – 8 mm in depth and the body part affected by the edema will look gross and distorted.


Non-Pitting Edema

This is the type of edema in which the indentation made by a pressure on the affected area does not persist. It is often associated with lymphedema, lipoedema and myxedema.

Since the kinds of edema which causes non-pitting edemas involve more than fluids simply filling up interstitial spaces, it is quite possible that their turgid nature is due to some internal pressure pressing on the swollen area.

In myxedema, for example, the tissues are gradually filled with water-loving molecules such as hyaluronan, a carbohydrate-like molecule. These molecules are responsible for attracting fluid to the tissues.

They absorb water and swell up to cause the edema. The osmotic pressure generated by this action is most likely to be the reason why this type of edema presents as non-pitting edemas. The osmotic pressure would make the affected area appear taut and feel turgid.

A similar mechanism is involved in lymphedema where the lymphatic system breaks down and the lymph nodes swell up.

The osmotic pressure generated by the swollen lymph nodes may be responsible for the constant internal pressure pushing the fluids against the skin even when pressure is applied on the affected area.

Non-pitting edema usually affects the legs or arms. If the pressure applied to the skin does not result in a persistent indentation, this type of edema is referred to as non pitting edema. 

Non-pitting edema may be caused by certain disorders of the lymphatic system such as lymphedema, a condition of the lymphatic circulation which may occur after a congenitally, mastectomy, or lymph node surgery. 

Another cause of non-pitting edema of the legs is known pretibial myxedema, which is a case of swelling over the skin that occurs in patients having hyperthyroidism. 

Sometimes pitting edema and non-pitting edema may occur without any underlying disease and this is known as idiopathic edema. This is common in women who experience it in legs and feet, during their pre-menstrual or pre-menopausal period.

Diagnosis and Treatment 

The diagnosis of pitting and non-pitting edema is determined by their symptoms. The doctor will examine the skin over the swollen area to check whether it is stretched or shiny. He may also apply pressure on the swollen area to see if it leaves an indentation. 

Additional medical examinations such as a blood test, urine test, a chest X-ray, and electrocardiogram (ECG) may also be performed to verify the cause of the edema. 

Treatment of pitting and non-pitting edema depends on the causes of edema and whether it is temporary or permanent. The initial treatment usually focuses on eliminating the condition that causes it. 

The doctor may recommend a dose of diuretics to reduce the swelling and help you expel the excess fluid. You may also consider taking a natural fluid retention remedy such as Capisette to treat edema. It contains herbs such as horse chestnut, gingko biloba, and buchu extracts. 

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