Did you know that 55 percent to 60 percent of your body weight is water? Water flows throughout your body from one area to another. It is present inside and outside of your cells and it keeps your tissues moist. Your bones, joints, spinal cord and brain need water, too. (1) But sometimes too much water can build up in your tissues, leading to swelling in your arms and legs. This is called peripheral edema. It’s caused by several factors that vary in seriousness. For some people, a peripheral edema is only temporary and will go away on its own. But for others, it’s a serious issue that’s brought on by a severe — sometimes life-threatening — health condition.
It certainly helps to be aware of the symptoms of pitting versus non-pitting edema and how these conditions differ in seriousness. It’s also good to know that there are natural ways to relieve swelling that’s due to water retention. Some herbs work as natural diuretics. Essential oils help to reduce inflammation. Dietary changes can balance the sodium levels in your body, helping you to avoid an electrolyte imbalance.
Edema is an accumulation of fluid in the interstitial space that occurs as the capillary filtration exceeds the limits of lymphatic drainage, producing noticeable clinical signs and symptoms. Causes of peripheral oedema Conditions that are associated with gen-eralised or localised peripheral oedema are summarised in Figure 2. Generalised peripheral oedema Heart failure Heart failure is a common and serious cause of generalised peripheral oedema (Figure 3). Left heart failure – either sys-tolic or diastolic – can cause pulmonary. Peripheral Edema Shaun Cho, MD, J. Edwin Atwood, MD Peripheral edema often poses a dilemma for the clinician be-cause it is a nonspecific finding common to a host of diseases ranging from the benign to the potentially life threatening. A rational and systematic approach to the patient with edema al.
What Is Peripheral Edema?
Peripheral edema means swelling in your arms and legs. This happens when fluid gathers in your tissues and causes a heavy, swollen and even painful area in the body.
Your body works to make sure that you maintain proper water levels in your cells. It naturally balances water intake and water loss. It works to keep the total amount of water and electrolytes in the blood constant. However, a number of health conditions or situations can cause too much fluid to collect in the tissues and cause noticeable swelling. When the capillaries in your blood vessels begin to leak fluids into your tissues, this causes puffiness and skin tightness, usually in your lower limbs because there’s more pressure on these areas.
Peripheral Edema Signs & Symptoms
The symptoms of peripheral edema depend on the cause of the condition. You will generally notice a swollen area that is stretching the skin and can feel warm to the touch. You may notice that the swelling depends on gravity. So it may appear more serious when you are standing than if you have the area elevated.
There’s a difference between pitting and non-pitting edema. If you apply pressure to the swollen area and your finger leaves an indentation, you have pitting edema. Water retention from too much sodium in the body, standing or sitting for too long, or pressure from your body weight usually causes it. Non-pitting edema, on the other hand, does not leave a mark when you press your finger into it. This can be a more serious condition caused by issues with the heart, lungs, liver or kidneys.
Generally, the most common signs and symptoms of peripheral edema include (2):
- a full or heavy feeling in your arm or leg
- swelling and puffiness, leaving a dent with your finger when you press on the area (which is called “pitting”)
- skin that feels tight and warm
- immobility or difficulty moving joints around the affected area
- pain and tension around the affected area
- a feeling of pressure around the affected area, which can be related to pressure on the veins in your legs
- when shoes, clothing or jewelry becomes tight around the swollen area
Peripheral Edema Causes & Risk Factors
A number of health conditions or situations can cause edema. Sometimes the cause is a harmless case of water retention. But it can also result from a chronic, serious condition that needs to be treated immediately. Here’s a breakdown of the possible peripheral edema causes and risk factors:
- Water retention: When the body holds on to or stores water and it builds up in the tissues, this causes temporary swelling in the hands, ankles, feet and face. This can happen when you consume too much sodium. The sodium holds on to water and keeps it in the body. Water retention is also caused by sitting or standing in one position for too long and hormone changes during a women’s monthly period or pregnancy. When a woman is pregnant, her uterus puts pressure on the major blood vessel that’s responsible for returning blood to the heart from the legs. This pressure can allow fluids to get into her tissues, causing swelling in the legs, ankles and feet. (3)
- Inflammation: Inflammation in your tissues may cause swelling in your legs. Inflammation may be a response to allergies, trauma (like a broken bone or sprained ankle), an infection or wound in the leg, arthritis, gout or cellulitis.
- Certain medications: Certain drugs can cause edema because they cause the body’s sodium and water levels to become unbalanced, or they contribute to renal dysfunction. Medications that may cause this issue include NSAIDs (such as ibuprofen or naproxen), insulin, steroid therapy and drugs for high blood pressure. (4)
- Low protein levels in the blood: Fluid leaks out of your blood vessels more easily when there isn’t enough of the protein called albumin (protein that is made by the liver) in your blood. Malnutrition or health conditions that affect how much protein the body produces, like liver and kidney diseases can cause low protein levels in your blood. (5)
- Problems with your veins: When your veins aren’t able to transport enough blood to the feet and then back to the heart — which is called venous insufficiency — your ankles and feet become swollen. Blood gathers in your legs, forcing fluid out of your blood vessels and into the surrounding tissue. This is the most common cause of leg swelling among people over 50 years old, especially in women. (6) Edema can be a sign of thrombosis. This develops as a result of slow-flowing blood and causes a blood clot. Peripheral edema can also be caused by varicose veins. These occur when blood pools in the legs or when blood flow slows down. (7)
- Kidney diseases: When the kidneys aren’t able to remove enough sodium and water from the body, this creates pressure on your blood vessels and can lead to peripheral edema. (8)
- Congestive heart failure: If the heart becomes too weak to pump blood around the body, it will gather in front of the heart and put pressure on your veins. This can cause fluid to seep out into the surrounding tissue. This leaking fluid leads to swelling in the legs or in the abdomen.
- Lung conditions: If pressure in the lungs and heart gets very high, which can happen when your body is reacting to certain medical conditions, this can cause the legs and feet to swell. This can happen as a result of serious lung conditions like emphysema or pulmonary fibrosis. Or it can occur if you have congestive heart failure and your heart isn’t strong enough to pump the blood that’s returning from your lungs. Since the heart, lung, kidneys and brain all work together to regulate fluid levels in the body, when one organ is forced to work harder as a result of a medical condition, hormones are often released to either retain or provide more fluids. Fluid buildup in the lungs is called pulmonary edema. This means water collects in the air sacs of the lungs. Pulmonary edema can make it very difficult to breathe. (9)
Aside from peripheral edema that develops in your arms and legs, edema in the lungs and abdomen is also possible. This is known as “non-pitting” edema because if you pressed on the swollen area with your finger, it wouldn’t leave a pit, or indentation. Some causes of edema that develop in places other than the arms and legs include:
- Lymphedema: Lymphedema means there is damage to the lymphatic system and the body can’t drain fluids properly. This may cause a non-pitting edema in the arms or legs. A disturbance to the lymphatic system may occur after procedures like lymph node surgery, a mastectomy and radiation therapy. Obesity or venous insufficiency may also cause it. (10)
- Liver diseases: Liver disease can cause ascites. This means edema in the abdomen. Ascites happens because conditions of the liver, like cirrhosis, cause protein levels to become too low and create congestion in the liver. This causes pressure in the blood vessels and allows fluids to seep out into the abdomen.
Conventional Treatment
Treatment for peripheral edema depends on the cause of the condition. Doctors will attempt to pinpoint the cause of the swelling by completing a thorough history and examination. He or she will also test your urine in order to make a diagnosis. The treatment plan will depend on the underlying disorder or issue that’s causing fluid retention. Usually a doctor will recommend restricting sodium intake in order to minimize fluid retention and he will prescribe diuretic therapy. (11)
Diuretics (like Lasix) are commonly prescribed to patients with heart failure in order to treat peripheral edema. Although emergency diuretics are sometimes necessary, patients who use diuretics for a long period of time sometimes become dependent on them and experience withdrawal symptoms when they stop taking these medications. Research shows that chronic diuretic use can lead to potassium deficiency and the depletion of blood volume in your blood vessels. (12)
For patients with non-pitting edema, diuretics are usually not effective. Because non-pitting edema is difficult to treat, doctors will commonly suggest elevating the legs periodically and wearing compressive stockings or devices to reduce swelling.
7 Natural Treatments for Peripheral Edema
1. Reduce SodiumConsumption
Your kidneys work to control the amount of salt that stays in your body by excreting salt through urine. This is also regulated by certain hormones and physical factors. But when the kidneys aren’t working properly, which can be the result of kidney disease or decreased blood flow due to heart problems, the body retains salt. Retaining salt leads to water retention and swelling because water follows sodium in the body. (13)
People who are prone to peripheral edemas should reduce their consumption of sodium foods, like table salt, soy sauce, olives, ham, salami and bacon. Many processed and packaged foods are also high in sodium. Stick to eating fresh produce, lean protein and healthy fats instead. It also helps to cook more foods at home so you can control the amount salt you use in your meals.
2. Move Around
To keep your bodily fluids pumping back to your heart, you need to stay active and move around throughout the day. If you work at a desk for several hours a day or you’re on a long flight, take frequent breaks. Stand up and walk around a bit. You want to keep the blood flowing in your legs so that fluid won’t pool and cause swelling. Aim to get up and move around 5–8 times per day, even if it’s just for 10 minutes.
The human body is designed to move. With so many of us spending up to 70 percent of our days sitting down, we can run into some serious health issues. A sedentary lifestyle can lead to reduced blood circulation. This causes swollen legs, ankles and feet, blood clots and pain. Not sure how to stay active during the day? Try having a walking meeting at work instead of sitting in a conference room. Or choose to pick up your lunch during the day instead of opting for delivery. Standing workstations are also gaining popularity and they can certainly help to reduce lower extremity edema. You can also set an evening routine that involves a short walk after dinner and then some stretching before bed. It really doesn’t matter how you move your body. Just avoid too much sitting so that your blood can continue to flow properly.
3. Eat (or Drink) Parsley
Parsley can be used as a natural diuretic that helps to relieve water retention and bloating. It does this by stimulating the production of urine by the kidneys and it draws out excess water that can cause peripheral edema. (14)
One of the best ways to use parsley as a natural and safe diuretic is to make parsley tea. You can do this by adding a quarter cup of chopped parsley to one cup of boiling water. Let the tea steep for about 5 minutes. Strain the parsley leaves and add a teaspoon of honey. You can drink parsley tea twice a day or when you notice symptoms of water retention. Keep in mind that women who are pregnant should not consume parsley tea because it’s a very powerful herb that may cause complications. To treat mild edema, add parsley to soups, salads or even juices.
4. Drink Dandelion Tea
Dandelion root serves as a natural diuretic. It allows your liver to eliminate toxins that can be causing inflammation. A 2009 study published in the Journal of Alternative and Complementary Medicine found that when fresh leaf dandelion extract was ingested by volunteers, it caused a significant increase in the frequency of urination in the five-hour period after the first and second dose. Researchers concluded that dandelion shows promise as an effective and natural diuretic for humans. (15)
To use dandelion as a diuretic to treat less severe cases of peripheral edema, you can buy dandelion tea at your local health food store. Or you can make your own. To make dandelion tea, simply steep the root or flowers for 30 minutes in boiling water. Then strain the dandelion and it’s ready to drink. Start by drinking a small amount to make sure that you don’t experience any adverse reactions.
5. Use Essential Oils
Grapefruit and fennel essential oils help to reduce water retention because they work as natural diuretics and they reduce inflammation. You can use both oils to stimulate blood circulation and relieve swelling associated with peripheral edema.
Grapefruit essential oil works by activating the lymphatic system and helping to control fluid retention. It promotes the detoxification of toxins and waste that can lead to inflammation and bloating. It also increases blood flow, thereby reducing fluid retention in the legs and relieving joint pain and aches that develop when you’ve been standing or sitting in the same position for too long. To use grapefruit oil to relieve the symptoms of peripheral edema, simply combine 3–4 drops of grapefruit with 1 teaspoon of coconut oil. Massage the mixture into the affected area. You can do this 2–3 times daily until the swelling has gone down. (16)
Fennel oil also helps to relieve inflammation and remove wastes that can cause swelling. It also has diuretic properties and can be used internally or topically to relieve peripheral edema symptoms. Just add 1–2 drops of fennel essential oil to warm water or a cup of herbal tea (like chamomile). Or combine 3–4 drops of fennel with 1 teaspoon of any carrier oil and massage the mixture into the affected area. (17)
6. Get a Massage
A gentle massage that promotes the flow of blood to your heart can help to remove pressure on your blood vessels that may be causing swelling. Massage therapy is recommended for less severe edema caused by water retention. A study published in the International Journal of Nursing Practice evaluated the effect of foot massages for decreasing lower leg edema in late pregnancy. Eighty pregnant women participated in the study. Half of them received a 20 minutes foot massage every day for five days. Compared to the control group, who received no massage, the experimental group had a significantly smaller leg circumference after the five days of massage. (18)
7. Elevate the Affected Area
To reduce water retention in your legs, try to elevate the affected area a few times a day in order to relieve pressure. This can be helpful after a day of work, when you’ve been sitting or standing in the same position for an extended period of time. This can also be extremely helpful for pregnant women who are experiencing swollen legs, ankles and feet. Simply prop one or two pillows under your feet for 15–30 minutes at a time. (19)
Precautions
Sometimes, lower extremity edema can be a sign of a blood clot in your lungs or a serious heart condition. If you experience peripheral edema along with symptoms like chest pain, shortness of breath or dizziness, seek medical care immediately. If your peripheral edema occurs suddenly, seemingly out of nowhere, or it’s a result of trauma to your arm or leg, you should also see your health care provider for treatment.
Speak to your health care provider before using any herbal remedies if you are pregnant and want to relieve a peripheral edema naturally. And only receive a massage from a licensed prenatal massage therapist.
Final Thoughts on Peripheral Edema
- Peripheral edema means swelling in your arms and legs. This happens when fluid gathers in your tissues and causes a heavy, swollen and even painful area in the body.
- The symptoms of peripheral edema depend on the cause of the condition. You will generally notice a swollen area that stretches the skin and can feel warm to the touch.
- A number of health conditions or situations can cause edema. Sometimes the cause is a harmless case of water retention. But it can also be the result of a chronic, serious condition that needs to be treated immediately. More frequently, peripheral edema is caused by water retention due to consuming too much sodium, being inactive for long periods of time, hormonal changes due to PMS or pregnancy. Being overweight or taking certain medications can also put you at risk of developing edemas more often.
- Natural diuretics like parsley and dandelion can help to reduce water retention. Limiting sodium consumption, staying active, getting a massage and elevating the area of concern can also be extremely helpful.
- Grapefruit and fennel essential oils serve as natural diuretics that help to reduce inflammation, promote circulation and help to treat water retention.
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Peripheral edema is swelling of your lower legs or hands. The cause may be simple, such as sitting for too long on a plane or standing for too long. Or it may involve a more serious underlying disease.
Edema occurs when something disrupts the usual balance of fluids in your cells. As a result, an abnormal amount of fluid accumulates in your tissues (interstitial space). Gravity pulls the fluid down into your legs and feet.
Peripheral edema is common in older adults and pregnant women, but it can occur at any age. It may affect one or both legs. If its onset is sudden and painful, you should see a doctor as soon as possible.
Symptoms of peripheral edema vary according to the underlying cause. In general, your legs or other affected area may:
- look swollen and puffy
- feel heavy, achy, or stiff
- be bruised or discolored from an injury
Other symptoms may include:
- skin in the swollen area that feels tight or warm
- pitting (when you press on your skin for about five seconds, your finger leaves a dent in the skin)
- swollen legs or feet that make it hard for you to walk
- difficulty putting on stockings or shoes
- weight that goes up from the fluid increase
Peripheral edema has a wide variety of causes. In general, if your edema subsides overnight, it indicates a milder cause. Constant peripheral edema, day and night, suggests a more difficult underlying cause.
Here are some common causes of peripheral edema, both temporary and systemic.
Temporary conditions associated with edema
Injury
A fracture, sprain, strain, or bad bruise in your leg, ankle, foot, or hand can result in swelling and pain. Inflammation in your lower leg may also be caused by an infection, a torn tendon or ligament, or a strained muscle.
Sitting or standing too long
Long plane flights or car rides may cause your legs and ankles to swell. This is common and not usually serious.
Sitting or standing for long periods as part of your work can also lead to peripheral edema.
Pregnancy
Eighty percent of pregnant women develop edema, usually in the hands, feet, and face. Pregnant women retain extra fluid that is needed by the fetus. In 50 percent of cases, the swelling occurs in the lower legs.
This peripheral edema is temporary and goes away after birth.
Hormonal changes
Fluid retention when you have your menstrual period is normal and may cause your legs and feet to swell. It occurs because of monthly hormonal changes.
Excessive salt intake
Eating too much salty food can cause your body to retain fluids, leading to edema.
Drug reactions
Peripheral edema can be a side effect of many drugs, usually because they involve increased water retention. The dosage and length of time you take these drugs affect the edema.
Drugs that may cause peripheral edema include:
- corticosteroids
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- hormones, like estrogen and testosterone
- calcium channel blockers
- diabetes drugs
- anticonvulsants
- proton pump inhibitors
- voriconazole (Vfend), an antifungal
Allergic reaction
Allergies may cause swelling in your arms and legs, although it more often affects other parts of your body. This type of swelling is called angioedema. It can be itchy if it involves hives. Triggers may be drugs, insect bites, or certain foods. Angioedema also may be hereditary.
Angioedema can be acute (sudden), requiring emergency treatment.
Idiopathic edema
“Idiopathic” means that the cause isn’t known. Idiopathic edema is most common in young women in their 20s and 30s. It involves weight gain and swelling of the face, trunk, and limbs.
It’s also associated with diabetes, obesity, and emotional problems.
Obesity
Excess weight causing pressure on veins can result in peripheral edema. Obesity may also lead to other causes of edema, such as obstructive sleep apnea or venous insufficiency.
Wearing tight clothing
Tight pants, panty hose, or leggings may promote edema in your legs.
Low altitude
If you move to a low altitude from a higher elevation, it can cause peripheral edema after about two weeks. The swelling decreases in time.
Diseases associated with edema
Venous insufficiency
Venous insufficiency means that the veins in your legs are damaged or weak, and don’t adequately pump blood up toward the heart. The blood then pools in your lower legs. You may have it in one or both legs.
Venous insufficiency is the most common cause of peripheral edema. It affects up to 30 percent of the population. When people over 50 have peripheral edema and systemic disease is ruled out, the cause is usually venous insufficiency. More women than men tend to have venous insufficiency. It can be an inherited condition.
Varicose veins are often present, but venous insufficiency can occur without them.
Initially, the edema will be soft and touching your leg briefly will leave a dent. In later stages, you may see changes in the pigmentation and elasticity of the skin. Your skin may become thicker and more fibrous.
The edema may get worse if you sit or stand for long periods, or if the weather is hot.
Blood clot
If edema occurs suddenly in one leg and your leg becomes painful, it could be caused by a blood clot in that leg. This is called deep vein thrombosis. It’s a serious condition and requires emergency medical help.
Heart failure
When the right side of your heart isn’t pumping effectively, blood can pool in your lower legs, causing edema. If the left side of your heart isn’t pumping effectively, fluid will accumulate in your lungs. Your breathing may be difficult, and you may also be fatigued.
Pericarditis
Pericarditis is the inflammation of the thin outer membrane surrounding your heart. It’s usually caused by a virus. But it can also result from autoimmune and other diseases.
The symptoms include peripheral edema and chest pain. Pericarditis usually resolves on its own.
Preeclampsia
Peripheral edema in your hands and feet is a symptom of preeclampsia, a serious complication of pregnancy. Preeclampsia can develop slowly or suddenly. A rise in blood pressure is a main symptom.
Edema isn’t considered a reliable indication of preeclampsia, because normal pregnancies also have peripheral edema.
Cirrhosis
When your liver is damaged by scarring, it can cause peripheral edema by putting pressure on the veins in your legs. The late stage of liver scarring is called cirrhosis.
Over time, hepatitis, alcohol misuse, and many other causes can damage the liver. The scars come from the liver’s attempts to heal itself. The scar buildup disrupts normal blood flow through the liver and its protein quality.
Pulmonary hypertension
Pulmonary hypertension is an often unrecognized cause of peripheral edema.
Pulmonary blood pressure is the pressure your heart needs to pump blood from the heart through the lungs. The pressure gets higher when the arteries in your lungs narrow as a result of lung disease, left heart failure, or sleep apnea.
Renal failure
Renal failure is also called chronic kidney disease or kidney failure. Peripheral edema is one of the symptoms.
When your kidneys are damaged, they don’t properly remove waste products and fluids from your blood. The buildup of excess fluids can lead to edema.
A 2016 study of 12,778 people admitted to a hospital with serious illnesses found that those with peripheral edema had a 30 percent higher risk for acute kidney injury.
Lymphedema
When your lymph system is damaged, fluid builds up in your tissues, causing peripheral edema. In the United States and other industrial countries, lymphedema can result from surgery to remove cancerous lymph nodes. This is called secondary lymphedema.
Primary lymphedema is less common and may be inherited. It can affect arms or legs.
Thirty percent of lymphedema cases are in both legs or both arms. Lymphedema also affects the feet and toes.
Lymphedema is usually painless and not tender. In its later stages, the skin looks darkened, thickened, and warty.
In developing countries, the most common cause of lymphedema is filariasis. This is a parasitic infection caused by the roundworm. It affects more than 90 million people.
Lipedema
Lipedema is an abnormal enlargement of both legs resulting from a misdistribution of fat under the skin. It affects up to 11 percent of women. It’s not always categorized as a true edema.
Inflammation
Arthritis, bursitis, gout, or Baker’s cyst may cause leg swelling.
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Cellulitis
Cellulitis is a bacterial infection of skin tissue that causes red, painful sores and swelling. While it usually occurs on the legs, it can affect any area of skin on your body.
Malnutrition
A diet lacking in protein over a long period can result in fluid accumulation and peripheral edema in both legs.
Cancer and cancer treatments
Pelvic and other cancerous tumors may increase pressure on veins, leading to edema. Peripheral edema may also result from chemotherapy, radiation therapy, and other cancer treatments.
Sleep apnea
Obstructive sleep apnea may cause peripheral edema, even without the presence of pulmonary hypertension. One study of people with edema found that one-third of those who had apnea didn’t have pulmonary hypertension.
Peripheral Edema And Heart Failure
Other diseases
Several other diseases are associated with peripheral edema, including:
Treatment for peripheral edema depends on what’s causing the swelling. If an underlying disease is present, your treatment will be for that disease. In most cases, this will help the swelling.
For edema caused by lifestyle or temporary conditions, there are several remedies to provide relief:
- Elevate your legs (or arms) above the level of your heart a few times a day. Sleep with a pillow under your legs at night.
- Exercise. Your doctor or a physical therapist can suggest specific exercises to keep the muscles involved moving.
- If you have to sit or stand a lot, take breaks to move around.
- Wear compression stockings on the affected legs if your doctor recommends this.
- Reduce your intake of salt.
- Massage the affected area to gently push fluid in the direction of your heart.
- Take horse chestnut. A supplement of horse chestnut seed extract taken twice a day may help leg circulation.
- Lose weight if you’re overweight.
- Take a diuretic (water pill) if your doctor prescribes it.
Peripheral edema can be caused by a serious disease or something more simple. In both cases, treatments are available to relieve the swelling and prevent further complications.
It’s best to see a doctor if there’s no apparent cause for the edema or you have other symptoms.