Edema (Angiodema, Lymphedema)

An abnormal accumulation of fluid in body tissues causes a type of swelling called edema. This swelling may be localized, as with ascites (the distended abdomen that develops in cases of liver disease and some types of cancer), or generalized, occurring throughout the body, as with progressive kidney failure. In the early stages of generalized edema, the swelling may not be obvious, but a rapid, seemingly mysterious weight gain may take place.

Hormonal factors can produce edema. Two examples are the swelling that occurs during pregnancy and the premenstrual phase of a woman's monthly cycle. Heart failure, advanced kidney disease, malnutrition, and thyroid disorders are among the other causes.

Diagnostic Studies and Procedures

Since edema is a symptom of a wide range of disorders, the diagnostic goal is to find the underlying cause. In addition to taking a medical history and conducting a physical examination, a doctor will pay special attention to the location and nature of the swelling. For example, facial puffiness and generalized swelling point to possible kidney failure. Swelling of the lower legs, accompanied by difficult breathing, indicates congestive heart failure. Marked swelling of one leg or arm suggests blockage of that limb's lymph channels. After observing such signs, a doctor will order tests, which may include X-rays and scans, to verify or rule out probable causes.

Medical Treatments

The medical approach varies according to the underlying cause, but the use of diuretics, commonly referred to as water pills, are a mainstay in the treatment of many forms of edema. For example, diuretics combined with digitalis, a medication that slows and strengthens the heartbeat, may help edema caused by heart failure; however, the digitalis dose must be carefully adjusted to make sure that it is large enough to be effective but not so large as to cause toxicity. Diuretics alone are usually sufficient during the early stages of edema from kidney failure, but this condition may require dialysis eventually. A kidney transplant may also be considered in severe cases.

An antihistamine such as diphenhydramine may counter edema when it is part of an allergic response. Anaphylactic shock -- which includes marked, generalized swelling that threatens to block the airway -- may necessitate an injection of adrenaline (epinephrine), in addition to antihistamine.

Sometimes excess fluid, as from abdominal swelling related to liver disease or ovarian cancer, can be drained away with a hollow needle.

Alternative Therapies

Edema often has a serious underlying cause that requires conventional medical treatment. Alternative therapies should be considered only after checking with your doctor.

Herbal Medicine. Dr. William Withering, an 18th-century English physician, observed that the leaves of the foxglove, or digitalis, plant reduced edema. Thus, digitalis became the first effective heart medication, and a synthesized form of the herb remains one of the most effective treatments for heart failure. You should never attempt to prepare your own drug, however, because digitalis made from foxglove can be lethal if too much is consumed. Herbalists recommend uva-ursi as a much safer diuretic. The usual dosage is one to three capsules a day or a tea made from one tablespoon of the dried herb in a cup of water.

Nutrition Therapy. Salt restriction is an important aspect of reducing edema. Other dietary limitations may also apply, depending upon the cause of the edema. For example, edema related to kidney disease may require a low-fat, low-protein diet. In such cases, a qualified nutritionist should be consulted in structuring a balanced diet.

T'ai Chi and Yoga. The gentle exercises of these movement therapies can help minimize arm and leg swelling from obstructed lymph vessels.

Self-Treatments

In addition to restricting your intake of salt, you can do the following:

• Strive to maintain weight that is ideal for your age and height.
• For leg swelling, rest several times a day with your legs elevated. Also, try wearing elastic or surgical stockings.
• To alleviate nighttime pulmonary edema, sleep in a semi-sitting position; use extra pillows or elevate the head of your bed a few inches.
• Abstain from alcohol, or use it in moderation, especially if the edema is related to liver disease.
• If your eyelids swell, you may be allergic to your makeup. Try a hypoallergenic brand. Treat lid puffiness with cold compresses or with compresses made from used lea bags.

Other Causes of Fluid Buildup

In addition to the diseases already mentioned, alcoholism, the use of oral contraceptives and other hormonal preparations, injuries, and certain infections may result in edema.