Swelling

Considerations

Slight swelling (edema) of the lower legs is common in warm summer months, especially if a person has been standing or walking a lot.

General swelling, or massive edema (also called anasarca), is a common sign in people who are very sick. Although slight edema may be hard to detect, a large amount of swelling is very obvious.

Edema is described as pitting or non-pitting.

• Pitting edema leaves a dent in the skin after you press the area with a finger for about 5 seconds. The dent will slowly fill back in.
• Non-pitting edema does not leave this type of dent when pressing on the swollen area.

Causes

• Acute glomerulonephritis
• Burns, including sunburn
• Chronic kidney disease
• Heart failure
• Liver failure from cirrhosis
• Nephrotic syndrome
• Poor nutrition
• Pregnancy
• Thyroid disease
• Too little albumin in the blood (hypoalbuminemia)
• Too much salt or sodium
• Use of certain drugs, including
  • Androgenic and anabolic steroids
  • Calcium channel blockers
  • Certain blood pressure medicines
  • Corticosteroids such as prednisone
  • Diabetes medicines called thiazolidinediones
  • Estrogen
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

Home Care

Follow your doctor's treatment recommendations. If you have long-term swelling, ask your doctor about the options to prevent skin breakdown, such as:

• Flotation ring
• Lamb's wool pad
• Pressure-reducing mattress

Continue with your everyday activities. When lying down, keep your arms and legs above your heart level, if possible, so the fluid can drain. However, do not do this if you get shortness of breath. See your doctor instead.

When to Contact a Medical Professional

If you notice any unexplained swelling, contact your health care provider.

What to Expect at Your Office Visit

Except in emergency situations (such as cardiac failure or pulmonary congestion), your health care provider will take your medical history and will perform a physical examination.

Medical history questions may include:

• Time pattern
  • When did you first notice this?
  • Do you have it all the time?
  • Does it come and go?
• Quality
  • How much swelling is there?
  • When you poke the area with a finger, does the dent stay?
• Location
  • Is it overall or in one area (localized)?
  • If swelling is in a specific area, what is that area?
• Other
  • What seems to make the swelling better?
  • What seems to make the swelling worse?
  • What other symptoms do you have?

Tests that may be done include:

• Albumin blood test
• Blood electrolyte levels
• Echocardiography
• ECG
• Kidney function tests
• Liver function tests
• Urinalysis
• X-rays

Treatment may include avoiding salt, diuretics, or water pills. Your fluid intake and output should be monitored, and you should be weighed daily.

Avoid alcohol if liver disease (such as cirrhosis or hepatitis) is causing the problem. Support hose may be recommended.

Alternative Names

Edema; Anasarca

References

Mitchell RN. Hemodynamic disorders, thromboembolic disease, and shock. In: Kumar V, Abbas AK, Fausto N, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 8th ed. Philadelphia, Pa:Saunders Elsevier;2009:chap 4.

Clein LJ. Edema. In: Walsh D, Caraceni AT, Fainsinger R, et al, eds. Palliative Medicine. 1st ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 160.

Update Date: 10/28/2010

Updated by: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.