Water makes up about 60% of our human body and serves vital roles in all parts of our body, including our bones. This means that staying hydrated is important for our everyday health. However, excess retention of fluids in our body can cause edema, which can affect our daily life or even be deadly.
Edema can be a mild, momentary or commonplace occurrence for some, but it could also be a sign of more serious medical conditions such as congestive heart failure and kidney damage.
What is Edema (Water Retention)?
Edema, or water retention, occurs when the balance of water in our body is disrupted, causing fluids to leak out of our blood vessels and accumulate in the surrounding tissues. This leads to bloating, swelling, and puffiness in various parts of our body. Apart from visible swelling, you may also feel heavier, less agile, or pain when experiencing edema. Edema is commonly observed in the legs and arms, but can also occur in the brain, eyes, lungs, and abdomen, where they may be severe and life-threatening.
What Causes Edema?
The abnormal retention of fluids could be caused by external environmental effects, diet, and certain types of medication. These extrinsic factors include:
- Pressure change during a flight
- Remaining stationary for prolonged periods
- High sodium intake
- Low protein intake
- Some medication for diabetes, high blood pressure, and chemotherapy
- Some anti-depressants, painkillers, and anti-inflammatory drugs
- Some hormone drugs (e.g. steroids and estrogen)
- Surgery or traumatic injury
Internal health conditions can also influence our body’s ability to regulate excess fluids or cause blood vessels to leak fluid into surrounding tissues. These intrinsic factors include:
- Menstrual cycle or changes in hormone levels
- Deep vein thrombosis
- Diabetic disorders
- Cardiac disorders
- Kidney disorders
- Lymphatic system disorders
- Liver cirrhosis
Types of Edema
Edema can be classified based on the location of fluid retention in the different parts of our body. Different types of edema can be related to, or even diagnostic, for specific conditions.
Pedal edema refers to fluid retention and swelling in the legs, including the thighs, knees, calves, ankles, and feet. This is a common type of edema that is largely non-life-threatening. Pedal edema is sometimes related to dependent edema, which is characterized by water retention in various parts of the body due to gravity, such as the legs when standing or sitting for prolonged periods. Other benign causes include menopause and side effects of medications. However, pedal edema could also be a symptom of a more serious condition such as deep vein thrombosis, congestive heart failure, or liver cirrhosis.
Also known as puffy eyes, periorbital edema is caused by fluid retention around the eyes. Similar to pedal edema, periorbital edema can be related to dependent edema, where gravitational forces cause water to accumulate around the eyes when in a lying position. This is a common condition that is experienced after waking up and dissipates after a short while. Infections, injuries, and allergies may also cause periorbital edema.
Cerebral edema is the retention of fluid in the brain and can develop as a result of head trauma, stroke, hypoxia (lack of oxygen), brain tumours, infections, surgery, and a serious complication of diabetes known as diabetic ketoacidosis. Heavy swelling in the brain leads to the obstruction of blood vessels that deliver oxygen and nutrients to parts of the brain. If left untreated, this will result in the permanent damage of brain tissues and death.
In our eyes, the macula lies in the centre of the retina and is responsible for straight-ahead vision. Fluid retention in the macula disrupts its shape, affecting the sharpness and colour sensitivity of vision. Blurry vision, especially in the centre of the field of vision, faded colours, or significant vision loss are symptoms of macular edema. Macular edema is caused by the leakage of fluid from blood vessels near the macula, possibly attributed to inflammation in the eyes, eye surgery, age-related macular degeneration, or diabetic retinopathy, which is a severe complication of diabetes that may cause irreversible blindness.
Pulmonary edema refers to fluid retention in the tissues and air spaces of the lungs. This can be caused by heart disorders, altitude sickness, chest trauma, and pneumonia. Pulmonary edema usually shows up as a dry cough and difficulty breathing (dyspnea) that may worsen when lying down (orthopnea). Chronic pulmonary edema can be non-life-threatening but uncomfortable as shortness of breath, restlessness, and fatigue is experienced in daily life. An acute (sudden) pulmonary edema can be deadly and will require urgent medical intervention.
Fluid retention in the abdominal spaces (peritoneal cavity) is known as ascites. Ascites is the most common complication of liver cirrhosis and can also be a complication of cancer, heart disease, protein deficiency, and dialysis. Symptoms of ascites include a bloated abdomen, sense of fullness, nausea, indigestion, and weight gain. Prolonged ascites can cause discomfort, pain, increase the risk of infections and hernias in the abdomen, as well as spread to the legs and chest areas.
In almost all cases of anasarca, the body’s ability to regulate water balance, or osmotic pressure, across vessels and tissues is greatly impaired or lost. Along with the co-occurrence of multiple types of edema, fluids are also retained in the subcutaneous tissue of the skin, resulting in a generalized massive edema throughout the whole body. This is the most severe form of edema and a dangerous condition that occurs in critical disease states such as iron deficiency anemia, heart, kidney, or liver failure. Anasarca could also arise from the over-administration of intravenous fluids or as a side effect of steroids and high blood pressure medications such as amlodipine.
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Diagnosis for Edema
Fluid retention in the extremities and surface of the body can also be observed by gently pressing the skin and observing an indentation that remains for some time. If you experience mild swelling that persists, make an appointment to seek a professional diagnosis. Seek medical attention immediately if you experience a sudden onset of heaviness, swelling, shortness of breath coupled with chest or abdominal discomfort, as these may be signs of more severe types of edema.
A doctor will first assess your medical history and conduct a physical examination. Edema in various parts of the body can be detected using ultrasound, computer tomography (CT) scan, and magnetic resonance imaging (MRI). Ensuing fluid sampling, such as urine and blood tests, may be carried out to check for signs of an underlying condition such as infections, organ dysfunction, or cancer.
Treatment for Edema
Mild edema, mainly caused by gravity, pressure, or hormonal changes, will often dissipate after some time without the need for medical treatment.
In the case of edema which causes serious discomfort or is persistent, a doctor may prescribe various medications to reduce water retention.
Diuretics are a commonly prescribed type of medication that help the body expel excess fluids as urine. For edema caused by protein deficiency, albumin may be prescribed to restore water-protein levels, or oncotic pressure, in the bloodstream to reduce the leakage of fluids into surrounding tissues. Edema due to allergic reactions or side effects of medications can be alleviated by treating the reaction with steroids and discontinuing the exposure to the allergen or medication.
Lifestyle changes may also be recommended to help your body decrease water retention. These changes generally involve monitoring fluid consumption and reducing salt intake according to a doctor’s advice.
Persistent or severe edema is likely a symptom for underlying poor health conditions and long-term treatment should be sought to alleviate the root cause along with the management of edema.
How To Prevent Water Retention
Most of us have experienced mild water retention in our daily life. You may have felt that your face was puffier after waking up in the morning, or you could have experienced swelling in your legs and a sense of heaviness during a long-haul flight.
Some people may be more predisposed to encountering frequent episodes of edema due to genetics and underlying conditions, but our lifestyle and diet play an important role in our susceptibility to edema as well. Here are some habits we can adopt or avoid to minimise excess water retention in our body.
Regular Movement and Elevation
Dependent edema occurs when gravity causes fluids to accumulate in the parts of your body that are closest to the ground. The most common of which is pedal edema that is frequently experienced after we sit or stand for long periods of time without moving.
To prevent dependent edema from developing, we can simply avoid staying in the same position for too long. For example, if you have to sit at a desk throughout a long work day, you could set a reminder to stand up to stretch and pace around at regular intervals. You could also place a small stool under your desk to elevate your feet.
Activating your muscles promotes blood circulation around your body, while elevation reduces the effect of gravity and prevents fluids from accumulating in a small area, which would cause edema.
Achieving a healthy level of fitness and strong circulatory system from regular exercise will also reduce your chances of developing an edema.
Massage and Compression
Applying gentle pressure when massaging from various parts of your body towards the direction of your heart can help to push fluids back towards your heart. This will generally improve your entire body’s circulation and prevent fluids from accumulating in any one area.
Another way to apply pressure is through the use of compression garments, such as compression stockings or support hose. This is especially useful when taking long-haul flights, usually with a duration of more than seven hours.
When seated during the flight, pressure changes coupled with the lack of mobility can put a strain on and increase the pressure in our vessels, causing fluids to leak out of our vessels more easily and accumulate in our legs and buttocks. Wearing compression garments provides constant support and reduces the difference in pressure between our blood vessels and our muscles, making it less likely for an edema to form in those areas.
Watch Your Diet
Vulnerability to edema increases when organs related to water regulation are not functioning well. These include:
- The heart, which controls the circulation of blood throughout our body
- The liver, which controls the balance of chemicals in our blood, and
- The kidneys, which removes excess water as urine and produces hormones that regulate blood pressure
Taking good care of these organs will improve our body’s capability of maintaining a healthy osmotic balance and prevent edema. One way you can do so is by watching your diet.
Over-consumption of alcohol and smoking are strongly correlated to the damage and failure of many organs. Avoiding these will reduce the risk of poor organ function and resultant edema.
Reducing salt intake and consuming an adequate amount of protein in our diet is important in ensuring an optimal osmotic balance between our blood and tissues. Salt in our body increases water retention and should be consumed sparingly by people that are prone to edema. Dietary protein is required for our body to produce albumin, a protein in our blood that “attracts” water and prevents it from escaping into and accumulating in the surrounding tissues. Malnourished children usually have a bloated belly, which is a form of edema in the abdomen, due to severe protein deficiency. This disorder is known as Kwashiorkor.
As the saying goes, too much of anything is bad. While cow’s milk is usually an important source of calcium for growing children, taking them in excess can lead to iron deficiency anemia, which may also cause a syndrome known as protein-losing enteropathy and result in anasarca. Hence, it’s important to take them in moderation.
Supplements with micronutrients and vitamins can also support optimal organ function and prevent deficiencies. For example, zinc is a micronutrient that is required for protein synthesis to maintain healthy albumin levels in our blood, but our body is unable to store nor produce zinc. People without access to zinc-rich foods are at risk of zinc deficiency and associated edema. Additionally, a study has shown that magnesium and vitamin B6 can alleviate the symptoms of premenstrual syndrome in women, including water retention.
People often question the effectiveness of supplements and if it is necessary to take them. Regardless, you should always consult a doctor before taking supplements, as some supplements may not be effective, contain harmful substances such as ephedra alkaloids, or even cause edema.
If you suspect that edema is causing a disturbance to your daily life, simply consult our doctors at Homage for a professional diagnosis online or in the comfort of your own home. For patients suffering from prolonged edema, possibly due to chronic conditions, Homage offers home nursing services for a range of chronic conditions, as well as home therapy with personalized exercises to alleviate water retention and associated discomfort.
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