In brief: Causes and signs of edema

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Edema (or "oedema") means swelling. It arises when part of the body becomes swollen because fluid gathers in the tissue. It is most common in the arms and legs. That is called peripheral edema.

Common early signs of peripheral edema include the following:

  • An arm or leg feels heavy and puffy.
  • The arm or leg looks swollen.
  • When you press the swelling, it leaves a dent.
  • Your clothing or jewelry feels tight and uncomfortable.
  • The skin around the edema feels warm and tight.
  • It becomes harder to move any joints that are affected.
  • The affected area starts to feel tight and may be painful.

Causes and forms

Edema can have various causes. To make sure it’s treated properly, it’s important to see a doctor and find out what is causing it. Edema can be:

  • a mild and harmless water retention problem that goes away by itself, in just one part of the body,
  • a symptom of a serious disease that needs treatment,
  • a condition that could become chronic and severe (like lymphedema after cancer treatment or edema in one leg following deep vein thrombosis), or
  • a side effect of medication or part of an allergic reaction.

Slight swelling caused by water retention

Signs of this kind of edema include puffiness of the hands, feet and/or face. This kind of edema goes away without treatment. It can be caused by standing or sitting for too long – for instance, after a long flight or in people who have to stand for a long time at work.

Many women experience edema before or during their period (menstruation) or during pregnancy. Edema in pregnant women is usually harmless, although it can be a sign of other problems – for instance, if their blood pressure is also too high.

Edema caused by diseases

A lot of diseases can cause edema. Then the edema itself is usually not a serious problem, but it may be a sign of one. Here are some examples:

Venous insufficiency can cause edema in the feet, lower legs and ankles. This is because the veins can’t transport enough blood all the way down to the feet and back up to the heart. As a result, the blood builds up in the legs, and fluid is forced out of the blood vessels into the surrounding tissue. Edema can also be caused by varicose veins.

Heart failure (cardiac insufficiency) can cause edema in the arms and legs (peripheral edema) as well as in the abdomen (ascites). This is because the heart is too weak to pump blood around the body properly, so the blood gathers in front of the heart. As a result, and due to the increased blood pressure in the veins, fluid seeps out into the surrounding tissue. This may cause swelling in the legs or a build-up of fluid in the abdomen.

If the person spends a lot of time lying down, the edema might occur on his or her back (called sacral edema).

Heart failure can also cause edema in the lungs (pulmonary edema). This is not very common, but it is life-threatening. The lungs fill with fluid because the heart is too weak to pump out the blood it gets from the lungs. The blood gathers in the blood vessels of the lungs, and fluid seeps out into the lung tissue. The signs of pulmonary edema include shortness of breath and rapid, shallow breathing or coughing.

Kidney disease can cause edema in the legs and around the eyes. This is because the pressure in the blood vessels starts building up if the kidneys don’t remove enough sodium and water from the body, and that can lead to edema.

Low protein levels in the blood: If there’s a lack of the protein albumin in the blood, fluid can leak out of blood vessels more easily. This lack of protein can be caused by extreme malnutrition. It can also be caused by kidney and liver diseases where the body loses too much protein or produces too little protein.

Liver diseases: Scarring of liver tissue (liver cirrhosis) – for instance, due to long-term alcohol abuse or a liver inflammation – can cause edema in the abdomen (called ascites). This is because cirrhosis leads to a lack of proteins and a build-up of blood in the liver, which can increase the pressure in the blood vessels. As a result, fluid seeps out into the abdomen.

Severe lung diseases like emphysema can also cause edema in the legs and feet because the pressure in the lungs increases a lot. Blood builds up in the heart and veins.

Lymphedema

This is caused by damage to the lymphatic system. It usually affects only one part of the body, like an arm. The most common cause of lymphedema in industrialized countries is cancer treatment that involves removing or destroying lymph nodes. It sometimes lasts only a short while after cancer surgery, but it can also develop into a chronic condition with severe symptoms.

Sources

  • Brandes R, Lang F, Schmidt R. Physiologie des Menschen: mit Pathophysiologie. Berlin: Springer; 2019.

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