Overview

There are many causes and types of edema. Pedal edema causes swelling in the feet while pulmonary edema affects the lungs. This condition starts slowly, but its onset could be sudden. While fluid retention in the legs, feet, arms, and hands is a common problem, it could be a sign of a serious condition.

The following are some key facts about edema:

• Edema happens when excess fluids stay within the tissues of the body.
• There is usually an underlying condition or disease.
• Symptoms depend on the cause.
• Edema normally develops gradually.
• Medications are available to treat edema.

Fluid retention in the legs, feet, arms, and hands, or edema refers to puffiness and swelling in various areas of the body. It most often occurs in the skin, especially on the hands, arms, ankles, legs, and feet. Edema can also affect the muscles, lungs, bowels, brain, and eyes. The condition mainly affects older adults and pregnant women, but anyone can experience edema.

Causes

Fluid retention in the legs, feet, arms, and hands or edema can result from a variety of problems such as infection, circulatory problems, malnutrition, tissue death, total body fluid overload, kidney disease, and electrolyte problems. 

The balance and regulation of fluid in the body are very complex. The cause of edema is the small blood vessels in the body, or capillaries, which leak fluid into the tissues surrounding them. The excess fluid is the cause of the swelling of the tissues.

The cause of fluid leaking into the surrounding tissues could be the result of several mechanisms, including:

1. Too much pressure in the blood vessels
2. An external force in the blood vessel results in the fluid to be drawn out
3. The blood vessel’s wall is damaged and cannot maintain equilibrium, resulting in a fluid loss.

Each of these three mechanisms may be associated with a variety of diseases or conditions including:

Heart failure

If one or both of the lower chambers of the heart cannot properly pump blood, the blood can accumulate in the limbs, causing fluid retention in the legs, feet, arms, and hands or edema.

Kidney damage or kidney disease

An individual with a kidney disorder may be unable to eliminate enough sodium and fluid from the blood, which increases the pressure on the body’s blood vessels, causing a leak out of the liquid. Swelling may also occur around the eyes and legs.

Damage to the glomeruli or capillaries in the kidneys that filter waste and excess fluids from the blood, may result in nephrotic syndrome. One symptom of this syndrome is a low level of the protein albumin in the blood.  This can lead to edema.

Liver disease

Liver diseases such as cirrhosis can affect liver function. They can lead to changes in the liver’s secretion of fluid-regulating chemicals and hormones while also reducing the production of protein. This causes fluid to leak out of blood vessels into the surrounding tissues.

Cirrhosis increases pressure within the portal vein, the large vein carrying blood from the intestines, pancreas, and spleen into the liver. Edema can result in the legs and abdominal cavity.

Certain medications

Some medications may increase the risk of fluid retention in the legs, feet, arms, and hands, including:

• Vasodilators, or drugs that open the blood vessels
• Non-steroidal anti-inflammatory drugs
• Calcium channel blockers
• Some chemotherapy drugs
• Estrogens
• Some diabetes drugs, such as thiazolidinediones

Pregnancy

During pregnancy, the body releases hormones that encourage fluid retention. Pregnant women tend to retain more sodium and water than usual. The face, hands, lower limbs, and feet of a pregnant woman may swell.

When a woman rests in a reclined position during pregnancy, the uterus may press on a vein known – the inferior vena cava, obstructing the femoral veins that may result in edema.

During pregnancy, the blood clots more easily, increasing the risk of deep venous thrombosis, another cause of edema.

Eclampsia, resulting from pregnancy-induced hypertension, can also cause edema.

Dietary factors

Several dietary factors impact a person’s risk of edema, including:

• Consuming too much salt in people who are susceptible to develop edema
• Malnutrition, where edema can result from low protein levels in the blood
• Low consumption of vitamin B1, B6, and B5.

Diabetes

Complications of diabetes include:

• Cardiovascular disease
• Acute liver failure
• Acute renal failure
• Protein-losing enteropathy, an intestinal condition that causes loss of protein

Diabetic macular edema is the swelling of the retina in diabetes.

Allergies

Insect bites and some foods may cause swelling of the skin or face in people who are allergic or sensitive to them. Severe swelling can be a sign of anaphylaxis. Swelling in the throat can close a person’s airway, making him unable to breathe. This is a medical emergency.

Problems with extremities

• A blood clot – A blockage, such as clotting of the blood in the vein, can prevent the flow of blood. When there is pressure in the vein, fluids may start to leak into the tissues, causing edema.
• A cyst, tumor, or growth – A lump may cause edema if it is pressing against a vein or a lymph duct. With the buildup of pressure, fluids can start leaking into the surrounding tissues.
• Varicose veins – They usually occur when the valves are damaged, with pressure increasing in the veins, causing the veins to bulge. The increased pressure increases also the risk of fluids leaking into the surrounding tissues.
• Lymphedema – The lymphatic system assists in removing excess fluid from the tissues. When the system is damaged, such as those resulting from infection or surgery, can result in edema.

Miscellaneous conditions

• Prolonged immobility – People who are immobilized for an extended period may develop edema in their skin. This can be because of the pooled fluid in gravity-dependent areas and the antidiuretic hormones released from the pituitary.
• High altitude – High altitude, combined with physical exertion, can increase the risk. Mountain sickness may cause high-altitude pulmonary edema or high-altitude cerebral edema.
• Burns and sunburn -The skin reacts to a burn by retaining fluid, causing localized swelling.
• Infection or inflammation – Tissues that are inflamed or infected can become swollen. This is usually very noticeable in the skin.
• Menstruation or pre-menstruation – Hormone levels are fluctuating during the menstrual cycle. Levels of progesterone are lower during the pre-menstrual days, which may cause fluid retention.
• The contraceptive pill – Medications that include estrogen may result in fluid retention. It is common for women to put on weight after starting pills.
• Menopause – Hormone fluctuation around menopause can result in fluid retention. The same may be triggered by hormone replacement therapy.
• Thyroid disease – Thyroid problems may cause hormonal imbalances which can lead to edema.

Diagnosis

To find out the cause of your edema, your doctor will perform first a physical exam and ask you questions about your medical history. The information is often enough to determine the underlying cause of your edema. In some cases, ultrasound exams, X-rays, blood tests and urine tests, and magnetic resonance imaging may be used to find out the cause of your edema.

Treatment

Mild edema typically goes away on its own, or with the help of you raising the affected limb higher than your heart.

More serious cases of edema may be treated with drugs that help the body expel excess fluids in the form of urine – diuretics. Furosemide or Lasix is the most common diuretics.  It is up to your doctor to determine which medication to use based on your personal medical history.

Long-term management of edema focuses on the treatment of the underlying cause of the swelling. In cases where edema is caused by medication use, your doctor may change or adjust your prescription.

Your doctor may also suggest that you:

• Try a low-salt diet – Do not consume more than 2,300 mg of sodium a day.
• Medication – Your doctor may prescribe a water pill or diuretic to help your body get rid of extra sodium and fluid through urination.
• Raise your feet – Lie down with your feet above the level of your heart several times a day to move fluid out of your feet and ankles.
• Wear compression stockings – Special stockings gently squeeze your lower legs to help keep your blood circulate.

Risks of Having Fluid Retention in the Legs, Feet, Arms, and Hands

During pregnancy, the body retains more water and sodium than usual because of the fluid needed by the fetus and placenta. This can increase the risk of developing edema.

The risk of edema may increase when you take certain medications, such as:

• High-blood pressure medications
• Nonsteroidal anti-inflammatory drugs
• Estrogens
• Steroid drugs
• Certain diabetes medications called thiazolidinediones

When to Seek Medical Attention

Fluid retention in the legs, feet, arms, and hands could be a sign of a more serious disorder, such as a blood clot or heart disease. Seek medical care immediately when there is leg swelling for no clear reason or when you have chest pain, difficulty breathing, or other warning signs of a blood clot or a serious heart condition.

Call for emergency medical care if you have leg swelling and any of the following symptoms, which may indicate a blood clot in your lungs or a serious heart condition:

• Chest pain
• Difficulty breathing
• Fainting or dizziness
• Coughing blood
• Shortness of breath with exertion or lying flat in bed.

Nonemergency problems related to swelling need prompt medical care. Call your doctor and schedule an appointment so he could examine you and determine the underlying cause of your swelling.

Sources:

https://www.medicalnewstoday.com/articles/159111.php

https://www.mayoclinic.org/diseases-conditions/edema/symptoms-causes/syc-20366493

https://www.webmd.com/diet/why-am-i-retaining-water#1

https://www.emedicinehealth.com/edema/article_em.htm