Retention of fluid is called as Oedema. It can be most easilybe seen round the ankles after you've been standing (peripheral oedema). After lying down for a while, your eyes may look puffy and swollen. In severe cases, oedema can also collect in your lungs and make you short of breath.

What do you understand by oedema?

It is a collection of fluid in the spaces between cells of the body. Fluid leaks out of damaged cells. The fluid cannot be simply drained with a needle and may not improve if you take 'water pills' (diuretics).

Types of oedema include:

  • Idiopathic - no known cause.
  • Localised - fluid retention in a particular part of the body. It is usually due to injury or an allergic reaction.
  • Generalised - affects the whole body. It usually causes puffy ankles after standing and puffy eyes after lying down for a while. This may be due to an underlying heart condition.
  • Cerebral oedema - fluid on the brain, usually due to infection (meningitis) or serious brain disease (stroke or brain tumour).
  • Pulmonary oedema - fluid on the lungs, usually due to heart disease.
  • Lymphoedema - a build-up of lymph fluid when lymph channels are damaged - eg, after breast cancer surgery.
Who are prone to have oedema?

Women are more prone to have oedema as the female hormones (progesterone) tend to cause fluid retention before a period. Itoccur for the first time at any age due to an allergic reaction or become anaemic. Older people can develop oedema, as they sit for long periods of time and also they are more likely to have underlying heart or kidney conditions that may cause oedema.

What are the reasons for oedema formation?

Some of the more common causes include:

  • No known cause (idiopathic)
  • Idiopathic oedema is the term for fluid retention which it not caused by a known medical condition. A gradual weight loss (rather than fasting and bingeing) is recommended. Support stockings and regular exercise are also beneficial. Avoiding long periods of standing can also help.

  • Heart failure can cause pulmonary oedema. Pulmonary oedema means an excess collection of watery fluid in the lungs. The fluid collects in the many air sacs of the lung, making it difficult to breathe. When the heart is not able to pump blood to the body efficiently, the amount of blood staying in the veins that take blood through the lungs to the left side of the heart increases. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs. This fluid reduces normal oxygen movement through the lungs, which can lead to shortness of breath.
  • Angio-oedema is a condition that can cause swelling of the deeper layers of the skin. These include the dermis and subcutaneous tissues. It also affects the tissues just under the lining of the airways, mouth and gut - that is, the submucosal tissues.In most cases there is no known cause and it is not clear why it occurs. Although the cause is not clear, in up to half of cases there is a link to an autoimmune disorder. These include chronic urticaria, systemic lupus erythematosus (SLE), or thyroiditis (hypothyroidism). In some cases there are known triggers that can cause the release of histamine, which leads to tissue swelling of angio-oedema.
  • Other possible causes of oedema include anaemia, pregnancy and some kidney diseases. A blood clot in a leg (deep vein thrombosis) can make the leg (with the blood clot) swell.
How do you treat oedema?

Treatment will depend on the likely cause of your oedema. Most cases will be managed by your GP but you may be referred for further investigation and treatment at a hospital. Treatments include:

  • Regular exercise such as walking or swimming.
  • Losing weight if you are overweight.
  • Raising your legs on a footstool when possible.
  • 'Water pills' (diuretics) - only if prescribed.
  • Treating the underlying condition - eg, heart failure.
  • What are other things that can be done?

    You should call an ambulance if you experience severe shortness of breath or chest pain. Mild puffiness of your ankles that gets better when you lie down for a few hours may not need any treatment. In all cases, you should see your GP to find out if there is an underlying cause.

    How do you prevent oedema?

    You will need to find the underlying cause and try to address it if possible. Idiopathic oedema has no specific cause and is very common. The best approach is to walk regularly, avoid becoming overweight and put feet up on a footstool when resting.

    What is the outlook (prognosis)?

    This depends on the underlying cause but is generally very good. Most oedema is due to standing too long on a hot day, especially if you are overweight. Any increased risk depends on the underlying cause

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