Edema

Signs and Symptoms

These will vary and may include the following:

• Swollen limbs (possibly accompanied by pain, redness, heat)
• Facial puffiness
• Abdominal bloating
• Shortness of breath, extreme difficulty breathing, coughing up blood
• Sudden change in mental state or coma
• Muscle aches and pains

What Causes It?

Some of the following factors may cause edema:

• Sitting or standing for long periods
• Certain medications
• Hormonal changes during menstruation and pregnancy
• Infection or injury to a blood vessel, blood clots, or varicose veins
• Blocked lymph channels (lymphedema)
• Allergies to food or insect bites
• Kidney, heart, liver, or thyroid disease
• High or low blood pressure
• Eating salty foods
• Brain tumor or head injury
• Exposure to high altitudes or heat, especially when combined with heavy physical exertion

What to Expect at Your Doctor's Office

Your health care provider will look for varicose veins, blood clots, wounds, or infections. An x-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI), urine test, or blood test may be necessary. Pulmonary edema, which occurs when fluid builds up in the lungs, can be caused by other diseases, such as cardiovascular disease or by climbing at high altitudes. It can be life threatening and may require hospitalization.

Treatment Options

Treatment may involve using compression bandages and pressure sleeves tightened over swollen limbs to help force the body to reabsorb the fluid. Other options include a salt reduction diet, daily exercise, resting with legs elevated above the heart level, wearing support hose, taking a diuretic, and massage.

Drug Therapies

• Medication for your underlying disorder. Talk to your health care provider.
• Diuretics. For example, loop diuretics or potassium-sparing diuretics. These medicines reduce body fluid levels, but they also deplete important vitamins and minerals, which can result in loss of bone mass. Diuretics may have several other possibly serious side effects.

Surgical Procedures

Surgery may be needed to remove fat and fluid deposits associated with a type of edema called lipedema, or to repair damaged veins or lymphatic glands to reestablish lymph and blood flow.

Complementary and Alternative Therapies

The following nutritional and herbal support guidelines may help relieve edema, but the underlying cause must be addressed. Tell your health care provider about any complementary or alternative therapies (CAM) you are considering. If you are pregnant, or thinking about becoming pregnant, do not use any CAM therapies unless directed to do so by your physician.

Following these nutritional tips may help reduce symptoms:

• Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your provider may want to test you for food allergies.
• Reduce salt intake. If you are taking diuretics, your doctor should give you specific instructions about salt intake.
• Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables. If you are taking certain diuretics, your provider may give you specific instructions about getting different nutrients into your diet, such as potassium and/or potassium potassium restrictions. Potassium is in many vegetables. Follow your provider's instructions strictly.
• Eat natural diuretic vegetables, including asparagus, parsley, beets, grapes, green beans, leafy greens, pineapple, pumpkin, onion, leeks, and garlic. Some of these foods may interact with diuretic medications.
• Eat antioxidant foods, such as blueberries, cherries, tomatoes, squash, and bell peppers.
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy cooking oils, such as olive oil.
• Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid alcohol, and tobacco.
• Exercise lightly 5 days a week if your health care provider says you can.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium. Many multivitamins contain calcium and potassium, two minerals your doctor may want you to avoid in large quantities if you are taking certain types of medications. Talk to your provider.
• Vitamin C, as an antioxidant.
• If you use diuretics, your doctor may have you take potassium aspartate (20 mg per day), since diuretics flush out potassium from the body and cause a deficiency. DO NOT take extra potassium without informing your doctor. Some diuretics do the opposite and cause potassium to accumulate in the body.

Herbs are generally a safe way to strengthen and tone the body's systems although they can interact with many medications and have certain side effects. As with any therapy, you should work with your doctor to determine the best and safest herbal therapies for your case before starting treatment, and always tell your provider about any herbs you may be taking. If you are pregnant or nursing, do not use herbs except under the supervision of a provider knowledgeable in herbal therapies. Your doctor may need to strictly monitor your potassium levels if you take certain types of diuretics, and some herbs may be naturally high in potassium. You should not use herbal remedies without first consulting your physician. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

• Bilberry (Vaccinium myrtillus) standardized extract, for antioxidant support. DO NOT use bilberry if you are on blood-thinning medications.
• Dandelion (Taraxacum officinale). Dandelion leaf is itself a diuretic, so it should not be used while taking diuretic medications. Speak with your doctor. DO NOT use dandelion if you have gall bladder disease, take blood-thinning medications, or have allergies to many plants. Dandelion can interact with many medications, including antibiotics and lithium. Talk to your provider.
• Grape seed extract (Vitis vinifera), standardized extract, for antioxidant support. Evidence suggests that using grape seed extract may improve chronic venous insufficiency, which causes swelling when blood pools in the legs. Grape seed can interact with some medicines, including blood-thinning medications such as warfarin (Coumadin).

• Dry skin brushing. Before bathing, briskly brush the surface of the skin with a rough washcloth, loofa, or soft brush. Begin at your feet and work up. Always stroke in the direction of your heart.
• Cold made with yarrow tea.
• Contrast hydrotherapy involves alternating hot and cold applications. Alternate 3 minutes hot with 1 minute cold. Repeat 3 times to complete one set. Do 2 to 3 sets per day for a short term only. Check with your provider to make sure your heart is strong enough for this therapy.
• Put a pillow under your legs when you're lying down.
• Wear support stockings, which you can buy at most drugstores.

Acupuncture may improve fluid balance.

Therapeutic massage can help lymph nodes drain.

Special Considerations

Excessive fluid retention during pregnancy (toxemia) is potentially dangerous to both you and your baby.

Supporting Research

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Haritoglou C, Gerss J, Hammes HP, et al. Alpha-lipoic acid for the prevention of diabetic macular edema. Ophthalmologica. 2011;226(3):127-37.

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