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Edema is swelling due to an accumulation of excess fluid. Your body has set fluid levels and will restore itself to its usual state within 48 hours of taking in extra water under normal circumstances. There are many causes and subtypes of edema including hypertensive, exercise, high altitude, tropical, medication and idiopathic cyclic edema.
Causes & Development
Idiopathic Cyclic Edema is one subtype primarily occurring in young menstruating women in which large amounts of tissue swelling occurs in the legs and abdomen after sitting or standing, and swelling of the face and eyelids upon lying down. It is thought to be a problem of leakage of blood fluids from capillaries into fat and skin tissue especially when gravity (standing up) is added to the pressure in the vascular system. It results in large weight changes from morning to evening. Sometimes the condition is called idiopathic orthostatic (standing upright) edema or just idiopathic edema. Other names include fluid retention syndrome and cyclical edema.
Sometimes the syndrome can occur in women with eating disorders who are taking diuretics or even laxatives in order to lose weight.
Swelling in both legs can have many other possible causes:- Prolonged standing or sitting, especially in hot weather, may cause excess fluid accumulation in the feet, ankles and lower legs.
- Venous insufficiency is a common problem of the weakened valves in the veins of the legs. This leads to varicose veins and build up of fluid.
- Severe chronic lung disease such as emphysema or chronic bronchitis increase the pressure in the blood vessels to the lungs. This pressure backs up in the right side of the heart and the higher pressure causes swelling in the legs and feet.
- Congestive heart failure due to decreased pumping action of the heart muscle causes fluid buildup in the lungs and other parts of the body. The swelling is often most visible in the feet and ankles.
- Pregnancy with leg edema occurs because the pregnant uterus puts pressure on the vena cava, a major blood vessel that returns blood to the heart from the legs. Fluid retention of pregancy also might be caused by a more serious condition called preeclampsia.
- Low protein levels in the blood that can be seen in malnutrition, kidney and liver disease. The proteins in the blood help hold salt and water inside the blood vessels so fluid does not leak out into the tissues. If albumin (the most abundant blood protein) gets too low, edema occurs especially in the feet, ankles and lower legs.
Signs & Symptoms
Idiopathic Cyclic Edema can result in moderate discomfort in any area of excess fluid accumulation. Carpal tunnel syndrome, diffuse aching, morning stiffness and muscle/bone pains as well as headaches often accompany the swelling. It can also masquerade as premenstrual syndrome or make existing premenstrual syndrome worse. It exacerbates the swelling, abdominal bloating and general physical discomfort but it does not usually cause irritability or depressive symptoms as does classic PMS.
Diagnosis & Tests
To check for edema that is not obvious, you can gently press your thumb over the foot, ankle or leg with slow, steady pressure. If edema is present, an indentation will show on the skin. A professional evaluation to determine the cause of leg swelling is needed. If both legs are swollen, your doctor will inquire about other symptoms and perform a physical examination. A urine test will show whether you are losing protein from the kidneys. Blood tests, a chest X-ray and an electrocardiogram (ECG) may be ordered.
Treatment & Prevention
Treatment focuses on correcting the underlying cause of the fluid accumulation. In addition, a low-salt diet and avoiding excess fluid intake usually helps. If you are not short of breath, elevation of the legs above the level of your heart will also keep swelling down. A low dose of a diuretic (water pill) used sparingly might be added in some cases.
For swollen ankles and feet caused by pregnancy from the enlarged uterus pushing on the vena cava, elevation of the legs and not lying on your back (either side) helps blood flow and decreases swelling.
Most patients with mild leg edema due to varicose veins can be treated with periodic leg elevation and support (compression) stockings. Sometimes surgery is needed to improve the flow of blood through the leg veins.
Also, no matter what the underlying cause of edema, any swollen area of the body should be protected from pressure, injury and extreme temperatures. The skin over swollen legs becomes more fragile over time. Cuts, scrapes and burns take much longer to heal and are more prone to infection when skin has edema underneath.
Prevention of edema means preventing the cause. Smoking is the No. 1 cause of chronic lung disease. Congestive heart failure most often is due to coronary artery disease and high blood pressure. To avoid leg swelling on long trips or due to long hours at a desk job, stand up and walk around often; ideally you should get up once per hour. If not possible, then exercise your feet and lower legs while sitting. This will help the veins move blood back toward the heart.
When you repeatedly take laxatives, diuretics or vomit, your body will adapt to being constantly dehydrated by learning to retain more fluid than usual. When you stop these behaviors and start to take a normal diet, your body may continue to retain fluids until it learns that adequate fluid will be available, then it will release the extra fluid. People who abuse laxatives or vomit regularly are at the greatest risk for alternating between dehydration and edema.
Prognosis; Seek medical attention if
The prognosis for edema of the legs depends on the cause. For most people with edema, the prognosis is excellent. It may take from 2 to 6 weeks following long term dehydration for your body to get used to being normally hydrated again and flush out the extra fluid it has been retaining.
Call your doctor immediately if you have pain, redness or heat in the swollen area, an open sore, shortness of breath or swelling of only one limb. If the swelling has never happened before and it persists for more than a couple days, call your doctor's office for advice.
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Signs, symptoms & indicators of Edema (Water Retention):
Risk factors for Edema (Water Retention): | | | | | Addictions |  Alcohol-related Problems | Excessive alcohol intake can cause edema, |
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Allergy |
Allergy to Foods (Hidden) |
Cell Salts |
 Nat Mur Cell Salt Need
Nat Sulf Cell Salt Need |
Circulation |
Congestive Heart Failure |
Diet |
 Excess Salt Consumption| | Salt can increase the amount of fluid that you retain in your body. |
Excess Water Consumption
Protein Deficiency| | When protein (especially albumin) levels in your blood go too low, the colloidal osmotic pressure will decrease and allow fluid to escape from blood vessels into your tissues, resulting in edema or swelling of the hands, feet, ankles, knees and/or belly. |
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Digestion |
Atrophic Gastritis |
Hormones |
Progesterone Low or Estrogen Dominance| | Progesterone has also been used in the treatment of idiopathic edema under the premise that some women with idiopathic edema either do not ovulate or have a luteal phase deficiency.
Ovarian function was investigated in 30 women with postural idiopathic edema by measuring plasma estradiol and progesterone levels between the 21st and 23rd days of the menstrual cycle. Plasma progesterone concentrations were found to be lower than 5ng/ml in 53% of the cases and lower than 10ng/ml in 83%. The ovarian dysfunction most frequently observed was inadequate corpus luteum, i.e. progesterone deficiency with normal plasma estradiol levels. In virtually all patients the initial disorder in capillary permeability, as evaluated by Landis' test, was fully corrected by progesterone administered orally. However, clinical improvement was less marked with treatments of short duration (2-3 consecutive cycles). In view of the complex cause of the disease, combined treatments in which progesterone might well play the major role are usually required. [Presse Med 1983 Dec 10;12(45): pp.2859-62 (translated)] |
Hypothyroidism |
Metabolic |
Anorexia / Starvation Tendency| | Semi-starvation can cause edema. People with eating disorders may interpret the puffiness of edema or any changes on the scale as weight gain or getting "fat" and may panic and purge or take laxatives even more. |
Aspartame Side-Effects| | Angioedema or swelling of the eyelids, lips, hands or feet are listed as possible reactions to aspartame. |
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Organ Health |
Cirrhosis of the Liver| | When the liver loses its ability to make the protein albumin, water accumulates in the legs and abdomen. |
Kidney Disease
Liver Detoxification / Support Requirement |
Uro-Genital |
Eclampsia / Preeclampsia
Premenstrual Syndrome PMS H (Headache) |
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Edema (Water Retention) suggests the following may be present:
Recommendations and treatments for Edema (Water Retention): | | | | | Botanical |  Ginkgo Biloba| | Idiopathic cyclic edema is characterized by water and sodium retention with secondary hyperaldosteronism (over-production of aldosterone) due to capillary hyperpermeability. This defect is detected and measured by the Landis' labeled albumin test; correcting it is important. Ginkgo biloba extract administered either orally or by intravenous infusion provided full correction of this biological anomaly in 10 cases in which the Landis' test was performed before and after oral treatment, and in 5 cases treated by intravenous infusion. [Presse Med 1986 Sep 25;15(31): pp.1550-3 (translated)] |
 Grape Seed Extract (Pycnogenol)| | One month of treatment with Pycnogenol (360mg per day) reduced lower limb circumference and improved subjective symptoms better than horse chestnut seed extract in a study of 40 patients with diagnosed chronic venous insufficiency. [Phytother Res 2002;16(2): pp.1-5] |
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Diet |
 Therapeutic Fasting| | Fasting promotes the drying up of abnormal fluid accumulations, such as edema in the ankles and legs and swelling in the abdomen. |
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Drug |
Conventional Drug Use| | There is no single, accepted gold standard treatment for idiopathic cyclic edema. Several different treatments have been reported. An agent used for treating high blood pressure called Captopril has also been used with success. It works against the kidney hormone aldosterone which is elevated in this condition and causes excess salt and water retention.
Sometimes a mild diuretic will help reduce fluid retention but can worsen the edema of idiopathic cyclic edema. While one would think that taking a "water pill" or diuretic would improve this edematous condition, it turns out that in most cases this is the wrong long term treatment. In fact, chronic diuretic use will increase the secretion of aldosterone which in turn produces more edema. If the chronic use of diuretics is discontinued, the cyclical swelling disappears in most cases within about 3 weeks. |
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Habits |
Aerobic Exercise| | Edema can be caused by a sedentary lifestyle - in other words, long periods of standing or sitting. If this is the case for you, regular exercise (not necessarily prolonged or strenuous) should help. |
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Lab Tests/Rule-Outs |
Test for Food Allergies| | Food sensitivities should be ruled out in cases of edema of unknown cause. "I often recommend an empirical elimination diet in which common allergens (wheat, milk, eggs, corn, coffee, tea, alcohol, yeast, citrus and sugar) are removed for several weeks. Although edema is usually not their primary complaint, many patients report a pronounced diuresis and loss of edema fluid during the first several days of the diet. Foods that cause a return of a patient's presenting symptoms often cause fluid retention as well". [Gaby, AR. Idiopathic edema: Letter. Hospital Practice Feb. 15, 1986, p. 21]
Edema is a very reliable and accurate index in detecting a food reaction that may cause the body to suddenly retain as much as 4% of its body weight as edema fluid. This weight is gained within 6-8 hours of ingesting the guilty food and lost within 18-24 hours after the food has been removed from the diet. [Brenerman, JC. Basics of Food Allergy. Springfield, IL, Charles C. Thomas, 1978] |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link |  | | Weakly counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Aldosterone
A steroid hormone secreted by the adrenal cortex that helps the kidneys regulate the amount of salt and water in your body and, thus, regulate your blood pressure. When aldosterone levels drop too low, your kidneys cannot keep your salt and water levels in balance, and your blood volume and blood pressure drop.
Allergen (Allergens)
A substance that is capable of producing an allergic response in the body.
Allergy (Allergies)
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Angioedema
Recurring attacks of transient, subcutaneous edema (water retention/swelling of tissue), often due to an allergic reaction.
Arterial (Arteries, Artery)
Blood that leaves the heart. When it leaves the right ventricle, it is venous blood; and when it leaves the left ventricle, through the aorta, it is fresh and oxygenated. After it has passed out to the capillaries and started to return, it is venous blood.
Aspartame
A low-calorie sweetener used in a variety of foods and drinks and as a tabletop sweetener. It is about 200 times sweeter than sugar and is commonly known by names such as NutraSweet, Equal, Spoonful or Equal-Measure.
Bronchitis
Inflammation of the mucous membrane of the bronchial tubes, frequently accompanied by cough, hypersecretion of mucus, and expectoration of sputum. Acute bronchitis is usually caused by an infectious agent and of short duration. Chronic bronchitis, generally the result of smoking, may also be known as Chronic Obstructive Pulmonary Disease (COPD) or Emphysema.
Capillary
Any of the smallest blood vessels connecting arterioles with venules and forming networks throughout the body.
Carpal Tunnel Syndrome
A common, painful defect of the wrist and hand. It is caused by pressure on the middle nerve in the carpal tunnel. The syndrome is seen more often in women, especially in pregnant and in menopausal women. Symptoms may result from a blow, swelling, a tumor, rheumatoid arthritis, or a small carpal tunnel that squeezes the nerve. Pain may be infrequent or constant and is often most intense at night.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Congestive
Pertaining to accumulation of blood or fluid within a vessel or organ.
Corpus Luteum
Yellow endocrine body formed in the ovary that secretes estrogen.
Diuresis
Excessive discharge of urine.
Diuretic (Diuretics)
An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.
Edema
Abnormal accumulation of fluids within tissues resulting in swelling.
Electrocardiogram (ECG, EKG)
A test that shows a tracing of the electrical conduction of the heart.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Idiopathic
Arising spontaneously or from an obscure or unknown cause.
Intravenous Infusion (IV)
A small needle placed in the vein to assist in fluid replacement or the giving of medication.
Kidneys (Kidney, Renal)
Bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage. The kidneys are sophisticated reprocessing machines, each day handling about 50 gallons of blood to sift out about half a gallon of waste products and extra water. The waste and extra water become urine, which flows to the bladder through tubes called ureters. The actual filtering occurs in tiny units inside the kidneys called nephrons. Every kidney has about a million nephrons. In a nephron, a glomerulus -- which is a tiny blood vessel, or capillary -- intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system. The kidneys recycle chemicals such as sodium, phosphorus, and potassium and thus regulate their levels. Renal: Pertaining to the kidneys.
Laxative (Laxatives)
A substance (food, herb, chemical) that stimulates evacuation of the bowels. Examples include cascara sagrada, senna, castor oil, aloe vera, bisacodyl, phenolphthalein and many others.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Lung (Lungs, Pulmonary)
Organ of the body, located in the chest cavity which is designed to bring oxygen from the air into the blood stream, while also expelling carbon dioxide and other waste gases out of the body. Pulmonary: Related to the lungs.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Milliliter (mL)
0.001 or one thousandth of a liter.
Nanogram (ng)
0.000000001 or a billionth of a gram.
Preeclampsia (Toxemia Of Pregnancy)
A toxic condition developing in the last 4 or 5 months of pregnancy that is characterized by a sudden rise in blood pressure, excessive weight gain, generalized edema (especially hands, ankles, feet and face), albuminuria, severe headache, and visual disturbances. It used to be called toxemia of pregnancy.
Some rise in blood pressure is normal during pregnancy, but in preeclampsia the rise is dramatic and is accompanied by other changes. The most notable of these are high concentrations of protein in the urine and a tendency to swell up, especially in the face and hands. This can cause women with preeclampsia to put on several pounds in a few days.
Premenstrual Syndrome (PMS)
PMS consists of various physical and/or emotional symptoms that occur in the second half of the menstrual cycle, after ovulation. The symptoms begin about midcycle, are generally the most intense during the last seven days before menstruation and include: acne; backache; bloating; fatigue; headache; sore breasts; changes in sexual desire; depression; difficulty concentrating; difficulty handling stress; irritability; tearfulness.
Progesterone
This is the hormone secreted after ovulation by the corpus luteum. It is a steroid (similar to a cholesterol), enters receptive cells to stimulate their growth, and acts as an anabolic agent. Estrogen should be viewed as the primary coat underneath all the cycles during a woman's reproductive years, with progesterone, its antagonist, surging for ten or twelve days in ovulatory months. Most of the actions of progesterone cannot occur without estrogen having previously induced the growth of progesterone-receptive binding sites.
Prognosis
A prediction (estimate) of the future course and outcome of a disease and an indication of the likelihood of recovery from that disease.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Pycnogenol
A trademark for specific bioflavonoids extracted from pine bark.
Sodium
An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Tropics (Tropical)
The region of the earth's surface lying between 23°27 North of the equator and 23°27 South of the equator.
Uterus (Uterine)
The part of the female reproductive system specialized to allow the implantation, growth and nourishment of a fetus during pregnancy.
Varicose Veins
Twisted, widened veins with incompetent valves.
Vascular
Relating to the blood vessels of the body. The blood vessels of the body, as a group, are referred to as the vascular system. They are composed of arteries, veins and capillaries - arteries that pass oxygen-rich blood to the tissues of the body; veins which return oxygen-depleted blood from the tissues to the lungs for oxygen; and the capillaries that are the tiniest vessels and are between the arteries and veins.
Venous
Pertaining to the veins.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Yeast
A single-cell organism that may cause infection in the mouth, vagina, gastrointestinal tract, and any or all bodily parts. Common yeast infections include candidiasis and thrush.
Last updated: Apr 13, 2008
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