Edema: Common risk factors and complications

Edema is a common condition that refers to swelling caused by excess fluid being trapped within tissue.

It can occur in almost any area of the body. Causes of edema range from injury, chronic medical conditions, medications, deep venous thrombosis (DVT), obstructed lymph nodes, pregnancy and even inactivity.

Within the chronic medical conditions, among the most common are kidney disease, congestive heart failure, and cirrhosis. Diabetes is often associated with co-morbidities such as kidney and heart disease, and therefore many diabetics are at increased risk for developing – among other troublesome side effects – edema. Certain diabetic medications may also cause edema, as do NSAIDs, high blood pressure medications, estrogens, and steroids (ironically often used to reduce swelling and inflammation).

Edema can become noticeable suddenly, but it may also occur over time. What may be thought to be weight gain from the accumulation of excess calorie intake may be a sign that excessive fluid is being retained in the body.

A simple method to assess for edema is an inspection of the skin. Pressing the fingers into an area of the body for several seconds where edema is present will result in dimpling or what is referred to as “pitting.”  Pitting is the noticeable impression on the skin where fingertip pressure was applied, and depending on how deep the impression is, can be an indication of the severity of the edema. In addition to the phenomenon of pitting, the skin in an area where edema is present will often become stretched and may display a waxy or shiny appearance.

Shortness of breath, difficulty breathing, and chest pain can also be signs of excessive fluid within the body. These symptoms in particular are indications to seek medical attention. Over time, and if left untreated, a downward spiral will likely ensue.

If edema is persistent and not treated, it may cause excess stress on the heart and further fluid accumulation within the body. If you have congestive heart failure, one or both of your heart’s lower chambers lose their ability to pump blood effectively. As a result, blood can accumulate in your legs, ankles, and feet, causing edema. 

This can also lead to a decrease in energy levels, which results in less physical activity, and subsequently, less fluid being pushed through the body and excreted through kidney function. Bottom line, symptoms will worsen if excess fluid is not reduced (often through medications known as diuretics).

Other complications may occur, and none are pleasant! Pain may come with edema along with difficulty ambulating. Skin may, as previously mentioned, may become stretched and itchy and may result in open sores and non-healing wounds, often accompanied by infection (known as cellulitis). Skin may also become brawny in texture due to scarring that occurs between the layers of soft tissue. Swelling of the legs can also lead to decreased circulation in bringing blood to the feet and returning blood to the lungs to receive oxygen.

Maintaining skin integrity when edema is present is often difficult, especially when chronic swelling has been present for any length of time. Moisturizing, hygiene, compression garments and exercise may all help, but the source of the underlying cause of edema must be identified and treated. Attempting to self-treat edema is potentially dangerous, and should symptoms occur, especially in a high-risk individual, professional medical attention must be expedited.