Oedema
Question Received:
Response:
I have experienced swelling (especially of the ankles/feet) for the past 2 years. My doctor prescribed a diuretic, then later added a potassium pill. I seldom take either, and as a matter of fact the potassium seems to negate the good the diuretic does.
However, the swelling seems to be getting worse - all over the body - and it makes me so uncomfortable with pain and something like anxiety, I guess, I can hardly sit here! I have a sedentary job, am 61 years old, and at 5'5" weigh 135 lbs (I think - my weight fluctuates wildly between 133-143). I feel so well when the swelling goes down! Any suggestions?
21st April 2004
The swelling that you are experiencing is due to the accumulation of additional fluid between the cells forming your soft tissues. This condition is called oedema (also spelt ‘edema’). Oedema usually affects the lower parts of the body first due to the effect of gravity, and now in your case is becoming more generalised. Oedema can be uncomfortable and painful, it interferes with normal blood circulation, impairs wound healing, and increases the likelihood of skin infections. It is a sign that something is wrong, and the next important step is to find out the underlying cause. We are not in a position to advise you on this - your doctor is the best person to identify the cause and determine the best treatment. What we can do is give you some background information that may make it easier for you to discuss this problem with your doctor or a nurse specialising in oedema care.
Oedema has many possible causes. Here are some of the more common ones:
Prolonged standing or sitting, especially in a very warm environment, can cause excess fluid to accumulate in the feet, ankles and lower legs.
Swelling of the feet is quite a common experience for people on long-haul flights
If the valves in leg veins become inefficient, the return of blood to the heart becomes less effective and blood and fluid accumulate in the feet and legs
Severe chronic lung diseases such as emphysema and bronchitis increase the pressure in the pulmonary blood vessels that lead from the heart to the lungs. This pressure acts back on the right side of the heart and the veins returning blood to it, causing swelling in the legs and feet
If the heart is no longer pumping efficiently, fluid builds up in the lungs and other parts of the body, particularly the feet and ankles. This is called congestive heart failure
If protein levels in the blood become low, perhaps because of a poor diet, liver disease or kidney disease, oedema can develop. The proteins in the blood, for example albumen, help to draw fluid back from the tissues into the blood.
The steps taken in treatment of oedema are usually as follows:
Firstly, identify and treat the underlying cause
Decrease sodium and water intake
Increase the excretion of sodium and water by the use of a diuretic. Diuretics help to improve the situation in the short term but are not a cure, and should be used with care. Several types of diuretics are available and they have different sites of action, potencies, and side effects. In view of your age, begin with a low dose to minimise unwanted side effects. Some diuretics lower the amount of potassium in the body, and that is why supplementary potassium may be required while the diuretic is being taken.
Here are some of the things you can try for yourself to see if they help to reduce the swelling:
Reduce the amount of salt that you take with your food, and avoid processed foods which are often high in salt
While sitting for prolonged periods at your desk, try contracting and relaxing the muscles of your legs, for example by rocking your feet onto your toes and heels every few minutes. Every hour or so get up and walk around for a while. These activities will improve the circulation in your legs and help fluid return
Reduce your weight if you feel it is appropriate
Gradually reduce your fluid intake
When the swelling is worse than usual, try resting on a bed with your head and legs slightly elevated, perhaps using elasticated stockings designed to reduce swelling of the legs
Gradually increase your physical activity - a walk followed by elevation of the legs will help to disperse fluid that has accumulated in the feet and ankles
Ensure good skincare over swollen regions to prevent skin breakdown and infection
Avoid prolonged hot baths that may aggravate the condition.