Why is fluid retained in tissues?
Normally, fluid continuously leaves the capillaries into the tissues and returns back, and the excess is carried away by the lymphatic system. Edema occurs when this balance is disturbed: pressure in the veins increases, protein levels in the blood decrease, vascular permeability increases, or the outflow of lymph is disrupted. Understanding the mechanism explains a variety of causes. With venous insufficiency, swelling increases in the evening and decreases after a night's rest. In heart failure, the edema is symmetrical, dense, combined with shortness of breath. With kidney disease, the face and eyelids are often the first to swell in the morning.
- Increased pressure in the veins
- Decreased protein in the blood
- Sodium and water retention in kidney disease
- Disruption of lymph outflow
- Increased vascular permeability during inflammation
- Effect of drugs
Common reasons
The most common cause of bilateral edema in adults is chronic venous insufficiency, in which the vein valves fail and blood stagnates in the legs. Next come heart failure, kidney disease with protein loss, liver disease, as well as taking medications: some blood pressure medications, hormonal drugs, painkillers. Swelling often appears in the heat, during prolonged standing or sitting, during pregnancy and before menstruation. Unilateral edema has its own range of causes, among which deep vein thrombosis comes first.
- Chronic venous insufficiency and varicose veins
- Heart failure
- Protein-losing kidney disease
- Liver cirrhosis and low albumin
- Taking certain medications
- Heat, prolonged standing and sedentary work
- Pregnancy
- Deep vein thrombosis with unilateral edema
- Erysipelas and lymphedema
How to distinguish dangerous edema
Swelling that develops over hours on one leg, accompanied by bursting pain in the calf, increased skin temperature and increased venous pattern, is suspicious for deep vein thrombosis. Its main danger is the rupture of a blood clot that enters the pulmonary artery, therefore, with such edema, urgent diagnosis is needed, and massage, warming ointments and tight bandaging before examination are unacceptable. Another dangerous option is swelling with bright redness, a clear border and high body temperature: this may be erysipelas, requiring antibiotics. Swelling combined with shortness of breath when lying down indicates heart failure.
- Rapid development on one leg
- Calf pain and bloating
- Redness and local fever
- Shortness of breath and chest pain
- Shortness of breath when lying down
- Swelling of the face and eyelids in the morning
- Decreased urine output
Survey
The examination plan depends on the picture. In case of unilateral edema, an ultrasound examination of the veins with Doppler sonography is performed first to rule out thrombosis. For bilateral edema, the heart is assessed using echocardiography and ECG, the kidneys are checked using urine and creatinine analysis, albumin levels and liver function indicators are determined. Be sure to measure your blood pressure and evaluate your weight over time: a rapid increase indicates fluid retention. An important part remains the revision of medications taken, since drug-induced edema is common.
- Ultrasound of the veins of the lower extremities with Dopplerography
- EchoCG and ECG
- General urine test
- Creatinine and kidney function calculation
- Albumin and total protein
- Liver enzymes
- Blood pressure measurement and weight control
- Review of medications taken
Treatment and measures at home
Treatment is always aimed at the cause: in case of heart failure, therapy is selected, in case of kidney disease, the underlying disease is treated, in case of venous insufficiency, compression hosiery of the required class remains the main remedy. Diuretics should not be taken independently: they do not help with venous and medicinal edema, but cause potassium loss, dehydration and deterioration of kidney function. Simple measures help in everyday life: elevated position of the legs during rest, regular walking, working the calf muscles during sedentary work, limiting salt and losing weight.
- Treatment of the underlying disease
- Compression hosiery as prescribed by a doctor
- Elevated leg position while resting
- Regular walking and foot exercises
- Breaks during standing and sedentary work
- Limiting salt
- Losing excess weight
- Diuretics only as prescribed by a doctor
