Edema is caused by an accumulation of liquids of various kinds in the interstices of the tissues and in the intercellular spaces

It manifests itself with swelling in the affected area which may be accompanied by pain, a feeling of warmth and redness in the affected area.

It can be limited to a single part of the body, defined as local edema, or occur in a uniform and widespread manner in the case of generalized edema.

The causes of edema and the treatments to be used vary according to the patient and the pathology causing the edema itself.

Taking drugs to reduce and reabsorb excess fluid in the tissues, or reducing or completely eliminating salt from the diet often alleviate the problem; however in some cases it is a symptom of an underlying pathology, which must be treated adequately.

What is edema

Edema is swelling caused by an accumulation of fluid in the interstitial tissues.

It can manifest throughout the body as generalized swelling, or affect a small area, such as a leg or arm.

In the case of generalized edema, before this is clearly visible, a sufficient amount of fluid must accumulate, which is why weight gain can be one of the first indications of this problem.

When the edema extends throughout the body, it is referred to as anasarca.

Although edema can appear in any part of the body, including the brain, the areas most affected are the hands, feet, ankles and legs.

What are the causes?

Edema occurs when capillaries, the smallest blood vessels in the body, leak the fluids they contain and these build up in the surrounding tissues causing swelling.

Mild cases of edema can also derive from a sedentary lifestyle, a diet with too salty foods, pregnancy or the need to maintain the same position for a long time.

Pregnancy in particular represents a risk factor for the development of edema as, during pregnancy, the body retains more sodium and water than normal, since the fetus and placenta need more fluids.

In addition, edema can be a side effect of some drugs, including: drugs for the treatment of high blood pressure, non-steroidal anti-inflammatory drugs (NSAIDs), steroid drugs, estrogens and some diabetes drugs (thiazolidinediones).

However, in some cases, edema is a symptom of a much more serious underlying condition such as congestive heart failure, cirrhosis, kidney disease, or severe protein deficiency that persists over a long period of time.

Symptoms and complications of edema

As mentioned above, the most obvious symptom in patients prone to edema is swelling, due to fluid accumulation.

Then add the inflammation of the affected area, the sense of heaviness, tiredness and / or a state of general weakness.

The swollen area also, if pressed with a finger, maintains a small dimple (sign of the fovea) for a few minutes.

To prevent the condition from degenerating, it is very important to intervene promptly in treating both the edema and any triggering pathologies; if it is not treated adequately, in fact, edema can have a series of even serious complications.

Among these, the most common are:

• difficulty walking;
• infection;
• degeneration of swelling with increased pain;
• decreased blood circulation;
• skin ulcers.

Types of edema

Generalized edema

As seen earlier, generalized edema can affect the entire body, and is often caused by liver failure, heart failure, or kidney disease.

One of the most common renal pathologies involving generalized edema is nephrotic syndrome, which manifests itself with uniform and widespread edema, particularly in the legs, combined with pallor.

Heart failure edema, on the other hand, is more evident in the ankle area, if the patient is walking, or in the sacral region, if he is bedridden.

This type of edema usually worsens towards the evening, while with rest it tends to disappear or at least lessen.

When significant weight loss and decrease in muscle mass are associated with generalized edema, the cause may be malabsorption.

Malabsorption syndrome involves impaired absorption of nutrients from the intestine.

In this case, therefore, the abundant accumulation of liquids is the result of the altered ability of the intestinal mucosa to absorb the necessary nutrients.

The malabsorption syndrome can be caused by genetic factors or due to side effects of a therapy that the patient has undergone previously.

Generalized edema can also be due to hormonal alterations that involve water retention, as in the case of premenstrual syndrome.

Then there are some drugs that can cause excessive fluid accumulation, such as non-steroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers and estrogens.

Other risk factors are: obesity, chronic venous insufficiency, dysfunction of the lymphatic channels (lymphoedema), prolonged bed rest or a diet too rich in salt.

Localized edema

As for localized edema, it most frequently affects the lower limbs, but also often occurs on the face and hands.

It can be caused by venous or lymphatic stasis, inflammatory processes, infections or allergies.

Edema caused by inflammation presents, in addition to swelling, redness, pain, heat sensation and functional deficit of the affected area.

Edema caused by an allergic form generally presents with a pink or red swelling, together with a sensation of itching and dry skin.

In venous stasis, fluid builds up in the area of the legs, feet, and ankles. Normally, this pathology is associated with a feeling of heaviness in the lower limbs and heat.

Localized lymphatic edema is associated, however, with signs of inflammation of the lymphatic vessels, lymphangitis, with redness and enlargement of the lymph nodes.

Localized edema can also result from side effects or damage following radiotherapy or surgery.

Warning signs and when to see a doctor

When, upon initial examination, the skin is swollen, tense and shiny, combined with a slight sensation of pain, it is advisable to consult a specialized doctor to identify the precise causes of the disorder; in the case of edema, a further indication of an excessive accumulation of liquids can be found when the affected area remains sunken after a slight pressure with the finger (fovea sign).

When other more serious symptoms are added to these first warning signs, you should immediately contact a specialist.

Other symptoms associated with this condition can be shortness of breath, difficulty breathing and chest pain: these, in fact, may be signs of pulmonary edema that must be treated immediately.

In addition, it is necessary to consult a specialist if after sitting for some time you notice persistent pain and swelling in your legs, which does not relieve even after several hours: in this case it is possible that it is a blood clot in one of the leg veins, which can lead to a venous thrombosis.

Diagnosis

To investigate the causes of edema, the doctor will first perform a physical examination and then ask the patient questions about his medical history, carefully examine the medical history and evaluate whether any current drug therapies can interfere with the correct liquid absorption.

Usually this information is sufficient to understand the cause of the edema, but in some cases further tests such as X-rays, MRI, ultrasound, blood or urine tests may be necessary.

Treatment

In the case of patients subject to a mild form of edema, it is usually not necessary to intervene therapeutically with drugs, as the accumulation of excess fluids will be reabsorbed autonomously.

More serious edema, on the other hand, must be treated promptly with diuretic drugs, which help the body expel excess fluids in the form of urine.

However, before being able to establish the most correct therapy, it is necessary to identify the underlying pathology of the edema.

If, on the other hand, edema occurs following the use of certain drugs, the therapy must be stopped immediately and the doctor will prescribe an alternative drug that does not cause undesirable effects for the patient.

Alternatively, for less severe cases, there are some techniques and home methods that can help reduce the swelling or prevent it from happening again.

These are procedures that should always be performed under strict medical supervision to avoid further worsening the condition.

First of all, physical activity, through muscle contraction, can promote correct venous circulation, preventing blood from stagnating and causing edema in the limbs, especially the lower ones.

The doctor will indicate which are the most suitable exercises based on the specific situation of each subject.

Another method is to hold the swollen area above heart level several times a day.

There are also compression stockings, sleeves and gloves, to prevent further swelling: these garments maintain pressure on the limbs to prevent fluid from collecting and causing swelling but must be prescribed under careful medical supervision.

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