Edema

Person with edema in one legPerson with edema in one leg

Edema is described as swelling in due to a build up of fluids in your body’s tissue.  Swelling may simply be the result of sitting or standing too long or it may involve a serious underlying disease.  Edema occurs when there is a disruption in the normal balance of fluids in cells and results in fluid buildup in one or more extremity.

Edema is often associated with physical conditions such as being overweight or inactive, but it can also be related to medical conditions that involve heart or circulation problems. Fluid build-up from medical conditions resulting in edema include venous hypertension, venous insufficiency, blood clots occurring in the leg, lymphedema and heart or kidney failure.

Edema often occurs with aging and is initially most prominently seen in the ankle/lower leg area as ankle swelling and/or varicose veins.

Chronic Edema

Chronic lower leg edema is a persistent, abnormal swelling of the leg that is present for at least 3 months.   Blood carrying oxygen, proteins, and nutrients to the lower extremities is released into the interstitial space surrounding capillaries. Fluid is then reabsorbed into either the venous (bloodstream) or the lymphatic system and returned to the upper body to carry cell waste for disposal.  Fluid balance is maintained by this circulation. When an imbalance occurs as a result of venous disease, lymphatic disease, or obesity, the drainage of fluid is impaired, resulting in swelling or edema.

There can be many causes of chronic edema but more often involve venous disease and cardiac failure including hypertension, chronic venous insufficiency, severe varicose veins, history of deep vein thrombosis, phlebitis, leg trauma, obesity, immobility, cancer, post-thrombotic syndrome, cardiac disease, renal disease, and medications.

Chronic edema effects the viability and structure of the skin.  Early skin changes involve skin pitting, seen as indentions in the skin that often go unrecognized.  Symptoms can also include spider veins in the ankle area, varicose veins and dermatitis.

As the disease progresses without treatment, more apparent and severe skin changes take place, including hemosiderin staining due to venous insufficiency.  This can result in ulcerations, including venous stasis ulcers with fluid leakage and infection.

Over time, gradual hardening of lymphatic system tissues can take place as waste products accumulate due to the lymphatic system failing to drain the excess fluid.  If left untreated, chronic edema of the leg can result in cellulitis, a common bacterial infection of the skin and subcutaneous tissue that is often difficult to treat.  Reoccurrence of cellulitis is common and can lead to more severe complications, including death.

Management of Edema and Chronic Edema includes:

  • Treatment of the underlying medical conditions
  • Use of compression for swelling reduction and maintenance
  • Movement and exercise to improve venous and/or lymphatic flow
  • Wound care to heal ulcerations
  • Skin care to improve the condition of affected skin

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