Edema

Fluid is everywhere in the body. It is needed to keep cells hydrated for the best function. There is a balance maintained by the body to have a certain amount of fluid in the bloodstream and in the body’s tissue. However, sometimes, there can be an imbalance in the amount of fluid in body tissue. Too much fluid in the tissues can lead to swelling. This is edema.

Edema can be caused by several sources, including diet, injury and infection, medication, normal body functioning, medical issues, and lack of movement. Knowing the source of edema will help you determine the treatment needed to help resolve or control it.

Swelling in an area anywhere on the body can be a sign of edema. This swelling can range from puffiness to an area that is tight with swelling, even with the oozing of thick fluid from the tissue through the skin. In extreme cases of edema, the skin may split open as the body attempts to remove fluid from itself. Skin with edema is prone to pressure injury as the skin becomes tight, not allowing the natural elasticity or stretch to accommodate the tension in it. If the edema is over a joint, movement can be restricted.

Measurement of edema is made by applying a finger to the area for a second. This measure should be done only one time by you or your health professional, not repeated over and over, which increases damage to the swollen tissue below and encourages skin breakdown. Edema is measured in grades from the pressure left by the examiner’s finger.

Grade 1 is rebounding skin with little pitting

Grade 2 is rebounding within 15 seconds and 3-4mm pitting

Grade 3 is rebounding in greater than 15 seconds but less than 60 seconds with 5-6mm pitting

Grade 4 is rebounding in 2-3 minutes with 8 mm pitting

Diet: The types of food you consume can produce edema. This is mostly due to eating salty foods or adding table salt to the foods you eat. Some drink products contain high amounts of salt. Salt will draw fluid out of the body’s cells and into the tissue. Added salt in the diet can lead to puffiness or even larger amounts of edema in the body, usually in the hands and feet but can also be around the mouth, eyes, or face in general. Internally, edema may be occurring that cannot be seen.

Be sure to watch your salt (sodium) intake to reduce your risk of edema from food intake. If you develop edema from eating certain foods, allow yourself only a small amount so as not to affect the fluid balance in your body.

Lack of protein over an extended period of time in the diet has been an issue creating edema in individuals. The human body requires protein to thrive. If you have health issues, you may require an increase in protein until the health concern is resolved. This might include immediately while healing from neurological injury, disease, or healing a pressure injury. Individuals that follow a vegan or vegetarian diet should pay attention to ensure their protein intake from other sources matches their individual needs.

Injury and Infection: When the body is injured, the natural response is to send fluid to the area, which helps cushion it. This added fluid will help prevent further injury while the area repairs itself. In an infection, fluid containing your body’s natural antibodies is sent to the area to fight the invader. This is the same process of protection as with an injury. However, sometimes the injury is severe such as a broken bone. A huge amount of fluid is sent to protect the area that the bone typically holds in place.

If you have an injury, you may need to elevate the area to reduce edema, apply a cool cloth to reduce the fluid collection or both. The same may be a treatment for an infection; however, with an infection, you will need to check with your healthcare professional to see if an antibiotic is needed. Catching and treating an infection early is better treatment for your body than a wait-and-see attitude that allows the infection to flourish.

Medications: Some medicines may have a side effect of edema. Just because you take these medicines does not mean you will have edema. It just means you may be more susceptible to it. Medications that can have edema as a side effect include some high blood pressure medicines, steroids, estrogen, and some diabetes medications. Ironically, nonsteroidal anti-inflammatory (NSAID) medicines that are taken to decrease inflammation can have edema as a side effect. Drugs known to this community that treat nerve pain can lead to edema. These drugs may produce edema that might be seen quickly, but more often, it appears over time. This time lag may make relating the edema to the drug difficult to connect.

If you feel your medication produces edema, check with your healthcare professional, as another brand may not cause the same reaction. Think about the risk/benefit to you. For example, if you can control your edema with secondary measures such as elevation, elastic stockings, or movement, you may not want to give up the benefit of the nerve pain medication.

Normal Body Functions: Edema can occur within your body just due to natural living. Some women have swelling in their bodies during the premenstrual cycle. Edema usually appears and resolves on its own. There are some treatments that can assist with the discomfort, such as medications, a warm towel placed over the abdomen, and elevation of extremities. Although women may not want to move due to discomfort, gentle movement helps resolve the uncomfortable and painful symptoms as it increases circulation to help reduce edema.

Pendulous abdomens in both men and women (including pregnancy) can also restrict circulation. A large abdomen may be from weight gain or from lax muscles in the abdomen due to paralysis. Just because your abdomen is larger than you would like, does not mean you are overweight. If you have paralysis affecting the abdominal muscles, the abdominal contents tend to create a belly. The pressure of the abdomen on the groin blood vessels can hamper blood flow to and from the legs, especially when sitting. This can cause edema to build up in the lower body. Movement typically helps, as does the elevation of your feet and legs. Monitoring your caloric intake may assist with the reduction of your abdominal girth.

Sitting too long can produce edema, especially in the feet and legs. This is typically called dependent edema since arms and legs are dependent or hanging down. Your body requires the movement of muscles to assist with pumping blood through the veins, which takes fluid away from the cells and tissues.

If you sit for prolonged periods of time, have someone move your legs and, if needed, arms through the range of motion, and elevate your legs and arms. For fluid to be removed from your extremities, you need to have your arms or legs raised higher than your heart. That is best accomplished when in bed. You may require using elastic stockings on your extremities during the day. If ace wraps are used, be sure to wrap starting from the point furthest from the heart, wrapping towards the heart. If you can walk, do so every hour to assist with fluid return from the extremities.

Elasticity in the body can become less effective as we age. This can create edema, especially in the legs and feet. Be sure to move your legs and feet or have someone assist you with doing so. Elevate your legs as you can. Elastic stockings will assist with returning blood flow.

Medical Issues: There are many diseases or health conditions that can lead to edema. Some major health issues include cerebral edema, where fluid rushes to the brain or spinal cord, as in brain injury, stroke, or spinal cord injury. That is the natural healing process, but a lack of space in the skull or vertebrae of the spinal cord will apply pressure and collapse neurological tissue. Pulmonary edema occurs in lung tissue making breathing difficult or impossible. Macular edema occurs in the eye(s) from blood vessels in the retina. The lymph nodes can be affected if they are unable to carry fluid away from the body. These are serious issues requiring medical treatment.

Peripheral edema, usually in the extremities, can occur from issues with your heart function, lymph nodes, kidneys, or lack of movement. Pedal edema occurs in the feet and lower legs from lack of movement, aging, or pregnancy.