LEG SWELLINGS
Leg swelling is very common, especially as people get older. Heart failure (which means the heart cannot function well enough to meet the body's needs), is certainly on the list of serious causes. However, people usually experience other symptoms such as shortness of breath and fatigue by the time the heart failure becomes serious enough to cause leg swelling.
This symptom, called edema, and it occurs when the heart does not have enough pumping power to force blood back up from the lower parts of the body. The swelling is often most noticeable in the ankles however, it can spread up the legs and even to the lower abdomen. More serious cases can cause what's known as pitting edema (i.e. if a finger is pressed into the swollen area, it briefly leaves an indentation or pit).
Occasionally, heart valves that leaks (especially the tricuspid valve, located between the right upper and lower chambers of the heart) can cause some swelling of the legs.
A more common cause of swollen legs is venous insufficiency, which also comes more prevalent with age. People who have had blood clots in their legs and women who have been pregnant are more prone to this problem. It occurs when the walls of the veins deep inside the legs weaken, and the one-way valves that help propel blood back to the heart are damaged. As a result, some blood flows backward and the veins stay filled with blood, especially after long periods of standing.
Elevating the legs when sitting and putting a pillow under the legs when sleeping can reduce swelling. So can wearing appropriate stockings from a medical supply store, but those that leave marks on the legs must be avoided as they may be too tight.
If just one leg suddenly becomes swollen, red, and warm to touch for no apparent cause, keep a close eye on it and better still, call a doctor for advice. One possibility is a skin infection known as cellulitis. But these symptoms can also signal a blood clot deep inside the leg known as deep-vein thrombosis. If the clot breaks loose and travels to the lung, it can cause a pulmonary embolism, which is very serious and can be fatal.
TYPES OF EDEMA
Even though the information provided here is about edema on the legs and feet (pitting or peripheral edema), other forms of edema are typically named depending on what part of the body is affected.
Cerebral edema – An accumulation of excess fluid in the brain.
Angioedema - Swelling underneath the skin. Unlike hives, which affect the surface of the skin, angioedema affects the deeper layers of the skin and often occurs on the face.
Hereditary angioedema - A genetic condition though rare, that causes the capillaries to release fluids into surrounding tissue, which results in edema.
Papilledema – The swelling of the optic nerve of the eye as a result of pressure inside the skull and around the brain (intracranial pressure).
Macular edema - is a swelling of the portion of the eye that perceives central, detailed vision (the macula).
Dependent edema - Edema of the legs and lower body, which is affected by gravity and is dependent on a person's position. This edema usually occurs in the legs when a person is standing, and in the buttocks and hands if a person is lying down.
Scrotal lymphedema - An enlargement of the scrotum due to fluid accumulation around the testes.
Lip edema - is a disorder of the fatty tissue that causes swelling of the legs and hips, and can lead to lymphedema.
CAUSES OF LEG SWELLING
- Injury to the foot or ankle
One of the most common causes of injuries to this area is a sprained ankle. An injury to the foot or ankle could cause swelling in the ankle and lower leg. A sprained ankle can occur as a result of a simple misstep, or an exercise injury. It happens when the ligaments that connect the ankle to the foot and leg are stretched out of alignment.
Treatment
The most common treatment for foot or ankle injuries is the RICE procedure. RICE is an acronym which stands for:
Rest: Resting the affected foot helps to prevent further damage.
Ice: Applying ice to the injury helps to numb pain and reduce swelling. People should wrap ice in a towel before applying it to the skin. Ideally, people should apply the ice pack for 10-20 minutes, three or more times per day.
Compression: Wearing a compression bandage will help to reduce swelling.
Elevation: Elevating the foot or ankle above heart level will help reduce swelling.
- Infection
An infection in the feet, ankles, and lower legs can cause swelling in this area.
People who have diabetes are at increased risk of developing an infection in their feet. They should, therefore, inspect their feet regularly for bruising, cuts, and scrapes.
Studies reveal that people who have diabetes and an untreated infection in the foot or legs can develop gangrene. Gangrene is where body tissues die as a result of severe infection or reduced blood supply.
Treatment
The treatment for a foot infection depends on its severity. In most cases, a doctor will prescribe antibiotics to treat the bacterial infection but if the infection has resulted in gangrene, surgery may be required to remove the damaged toes or foot.
- Lymphedema
Lymphedema is a condition in which excess fluid accumulates in the body's tissues, causing swelling. This condition occurs when a person's lymph nodes become damaged or are absent due to surgical removal.
The lymph nodes are glands that forms part of the body's immune system. They are responsible for helping to remove fluids from various parts of the body. Therefore If the lymph nodes in the pelvis are damaged or absent, this can cause fluid to build up in the legs.
A person who has lymphedema may experience a feeling of heaviness or swelling in the legs or other affected body parts.
Treatment
Some treatment options for lymphedema include:
- Performing gentle exercises to encourage drainage
- Massaging the lymph nodes to encourage drainage
- Bandaging the affected leg
- Wearing compression stockings
- Practicing good skincare to reduce the risk of infection and associated lymphedema
- Venous insufficiency
There are special valves within a person's leg veins that prevent blood from flowing backward. Venous insufficiency is a condition in which these valves no longer function properly. As a result, the veins no longer transport adequate amounts of blood from the legs back up to the heart.
When a person has venous insufficiency, their blood flows back down the legs and becomes trapped in the soft tissues of the lower legs and ankles.
A person with venous insufficiency may also experience:
- infections
- skin ulcers
- changes in skin color
Treatment
The treatment for venous insufficiency involves returning blood flow to the legs. This may involve:
- Elevating the legs
- Avoiding crossing the legs when sitting or lying down
- Exercising regularly
- Wearing compression stockings
People may also receive medications to treat venous insufficiency. The type of medication will depend on the severity of their condition and their overall health.
- Blood clot
A blood clot in the legs can cause swelling in a person's ankles and legs. Blood clots in the legs tend to develop on one side of the limb.
There are two main types of blood clot:
- Superficial blood clots, which occur in veins that are close to the surface of the skin
- Deep vein blood clots or “deep vein thrombosis” (DVTs), which occur in veins deep within the body
A person should seek immediate medical attention if they experience any of the following symptoms of a blood clot:
- Low grade fever
- A heavy ache in the affected leg
- A change in the color of the leg
- Swelling and pain in one leg
- An area of warm skin on the affected leg
- An area of red skin behind and below the knee
Sometimes, a piece of the clot breaks loose and travels to the heart, lungs, or brain. This can be life-threatening if left untreated.
Treatment
Typically, people who with blood clots receive anticoagulant medications, which help prevent clots from getting bigger the same medications also help prevent new clots from forming.
- Liver disease
The liver produces albumin, a protein that prevents fluid from leaking out of blood vessels and into surrounding body tissues. A diseased liver does not produce enough albumin. Liver disease can, therefore, cause fluid to pool in the legs, ankles, and feet.
Most people who have liver disease do not experience symptoms until they have developed severe liver damage, or cirrhosis.
Treatment
The only cure for liver cirrhosis is a transplant. Treatment will however aim to manage the disease and prevent further complications. Treatments can also help to alleviate some of the symptoms of cirrhosis.
People who experience swollen legs as a result of cirrhosis may require diuretics. People may also need to reduce their dietary intake of salt, as doing so can alleviate fluid retention.
- Kidney disease
The main role of the kidney is to regulate the amount of water in the body, and balance levels of salt and other minerals in the blood.
Kidneys that are severely damaged by disease are unable to filter the blood effectively and excrete fluid and other waste products through urine. This can lead to a buildup of fluid and other waste products within the body, including in the lower legs and ankles.
Some other early warning signs of kidney disease include:
- blood or protein in the urine
- high blood pressure, or hypertension
- swollen hands or feet, or persistent puffiness around the eyes
- more frequent urination, especially at night
Treatment
The treatment for kidney disease will depend on the underlying cause. According to some studies some causes (e.g. urinary tract infections and kidney stones), respond well to treatment.
Kidney disease may also occur as a result of an underlying medical condition, such as high blood pressure or diabetes. In such cases, a doctor will prescribe medications to manage these conditions and slow the rate of kidney disease.
In some cases of chronic kidney disease the condition may progress to kidney failure. At this stage, a person will require dialysis or a kidney transplant.
- Side effects of medications
In some cases, medications can cause a person's ankles or legs to swell. Medications that may cause swelling as a side effect include:
- antidepressants
- calcium channel blockers
- hormones, such as estrogen
- steroids
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- diabetes medications
If a person experiences side effects from their prescribed medications, they should talk to their doctor. The doctor may reduce the dosage of the medication or switching to a different drug altogether.
Other causes of leg swelling
- Salt Retention - Approximately 1.5 litres of fluid is retained in the body when too much salt is consumed and this continues as long as a higher salt intake is consumed.
- Idiopathic Edema (Swelling of Unknown Cause, Typically in Women) - a common cause of fluid retention and swelling in women. 'Idiopathic' means that the cause of this condition is unknown.
- Trauma Injury (Contusion) - While the term contusion might sound serious, it's just a medical term for the common bruise. A contusion happens when an injured capillary or blood vessel leaks blood into the surrounding area.
- Leg Vein Obstruction - Occurs when thrombus (a blood clot) forms in one or more of the deep veins in the body, usually in the legs.
- Liver Failure - Liver failure happens when large parts of the liver become damaged beyond repair and the liver can't work anymore.
- Medications - A medication is a drug used to diagnose, cure, treat, or prevent disease.
- Nephrotic Syndrome - Nephrotic syndrome is a kidney disorder that causes the body to pass too much protein in the urine.
SYMPTOMS
Leg swelling generally occurs because of abnormal accumulation of fluid in the tissues of the lower parts of the body. The medical term for leg swelling from excessive fluid in the tissues is peripheral edema. The indentation of a swollen leg after pressure from a finger is known as pitting edema. Common causes of leg swelling include salt retention, cellulitis, congestive heart failure, venous insufficiency, pregnancy, and side effects of medication. Less common causes of leg swelling include deep vein thrombosis (blood clots in the leg), parasite infection, lymphedema, liver disease and cirrhosis, kidney disease and Nephrotic syndrome, broken ankle, broken leg etc. When leg swelling occurs for unknown reasons, it is referred to as idiopathic edema.
Symptoms associated with leg swelling include
- leg pain,
- itching,
- numbness,
- redness,
- rash,
- short breath, and
- Ulceration of the skin.
Related Symptoms & Signs
- Joint Pain
- Leg Sore
- Leg Pain
WHEN TO SEE A DOCTOR
Even as swelling in the lower extremities usually is not cause for concern, it could in some cases be sign of something more serious. The under listed are some guidelines that can help identify when swelling warrants a visit to the doctor.
Please schedule an appointment with a doctor if one has:
- Swelling that gets worse over time
- Sudden or severe swelling while pregnant
- Heart or kidney disease and are experiencing swelling
- Liver disease and are experiencing leg swelling
- Swollen areas that are red and feel warm to touch
- Body temperature that is higher than normal
- Not been successful with home remedies
People should see their doctors immediately if they experience any of the following symptoms along with foot, leg, and ankle swelling:
- Feeling lightheaded or faint
- Pain, pressure, or tightness in the chest area
- Dizziness
- Confusion
- Difficulty with breathing or shortness of breath
RISK FACTORS
If a woman is pregnant, her body retains more sodium and water than usual due to the fluid needed by the fetus and placenta. This increases the risk of developing edema.
The risk of edema is increased if a person is on certain medications, including:
- Estrogens
- Certain diabetes medications called thiazolidinedione
- High blood pressure medications
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Steroids
A chronic illness (e.g. Congestive heart failure or liver or kidney disease), can increase the risk of edema.
COMPLICATIONS
If left untreated, edema can cause:
- Decreased elasticity of arteries, veins, joints and muscles
- Blood circulation difficulties
- Increasingly painful swelling
- Difficulty in walking
- Stiffness
- Stretched skin, which can become itchy and uncomfortable
- Increased risk of infection in the swollen area
- Scarring between layers of tissue
- Increased risk of skin ulcers
DIAGNOSIS
Some doctors use a scale to determine the severity of pitting edema. These scales are based on either how deep the pitting is, or how long the pitting persists.
In non-pitting edema, which usually affects the legs or arms, pressure applied to the skin does not result in a persistent indentation. Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema (a disturbance of the lymphatic circulation) that may occur after a mastectomy, lymph node surgery, radiation therapy, morbid obesity, venous insufficiency, or be present from birth (congenital).
Another cause of non-pitting edema is called pretibial myxedema (a swelling over the shin that occurs in some people with hypothyroidism). Non-pitting leg edema is difficult to treat especially as diuretic medications are generally not effective. Elevation of the legs periodically during the day and compressive devices may reduce the swelling.
TREATMENT
Mild edema usually goes away on its own, particularly if the affected limb is elevated higher than the heart.
More-severe edema may be treated with diuretics (drugs that helps the body expel excess fluid in the form of urine). However, the doctor will determine whether these types of medications are a good option based on personal medical history.
Long-term management typically focuses on treating the underlying cause of the swelling. If edema occurs as a result of the use of a medication, the doctor may adjust the prescription or check for an alternative medication that would not cause edema.
LIFESTYLE AND HOME REMEDIES
The following may help decrease edema and/or keep it from recurring. However try to talk to the doctor before trying these self-care techniques, about which ones are best for you.
Movement – Move as much as possible and use the muscles in the part of the body that is affected by edema, especially the legs. This may help pump the excess fluid back toward the heart.
Elevation - Hold the swollen part of the body above the level of the heart several times a day. In some cases, raising the affected body part while you sleep may be helpful.
Massage - Stroke the affected area toward the heart using firm, but not painful, pressure. This may also help move the excess fluid out of that area.
Compression - The doctor may recommend the wearing of compression stockings, sleeves or gloves, usually worn after the swelling has gone down, to prevent further swelling from occurring. These garments keep pressure on the limbs to prevent fluid from collecting in the tissue.
Protection - The affected area must be kept clean, moisturized and free from injury. Dry, cracked skin is more prone to scrapes, cuts and infection. Always wear protection on your feet especially if that is where the swelling typically occurs.
Reduce salt intake - Salt can increase fluid retention and worsen edema follow the doctor's suggestions about limiting salt consumption.
PREVENTION
In some cases, making certain lifestyle changes may help prevent or alleviate swollen legs and ankles. These lifestyle changes include:
- Checking the feet for bruises, cuts, and scrapes frequently, especially if one is diabetic
- Performing regular exercises
- Eating a diet that promotes heart, kidney, and liver health
- Avoiding contact sports that can cause injury to the legs and ankles