What is edema
Edema is nothing more than an accumulation of fluid that occurs in the interstitial tissues (the free space between cells outside the vessels) and that typically produces swelling. It can be localized or generalized and, therefore, involve the whole organism.
Although it is generally customary to mistake edema for bruising (bruising), these are two different manifestations, which are often confused. The first, in fact, refers to an accumulation of water and liquids, naturally present in our body, which accumulate in the interstitial spaces between blood vessels. In the case of ecchymosis instead, or hematoma, we speak of an accumulation of blood leaked from the circulatory system, often at the capillary level.
Causes of edema
Most often edema is caused by trauma, such as a “blow”, a sprain or a muscle tear. In this case, almost always, it is associated with the hematoma: as anticipated, a collection of blood under the skin, but outside the blood vessels (called extravasation).
In this case, those who play sports are subject to it. And under accusation are above all disciplines that involve intense physical effort (such as tennis, volleyball) or frequent physical contact and particularly at risk (such as football, basketball or rugby). Athletes may, for example, find themselves with a swollen malleolus due to a sprained ankle.
However, the risks related to accidental trauma or more trivial injuries, perhaps due to small distractions, cannot be excluded. Even a simple fall can in fact give rise to edema.
The resulting muscle trauma can cause the body to release interstitial fluid in that area. Concurrently, there is the appearance of edema, the external manifestation of which is characterized by a swelling: a swelling in the area affected by the trauma.
At the origin of the edema there may not even be a traumatic event, but a defect of venous circulation, especially at the level of the legs.
Varicose veins or a slowing of circulation for other reasons (cardiovascular failure, renal failure, severe liver failure with cirrhosis, obesity) can cause leakage of fluid from the vessels and edema in the absence of trauma.
Varicose veins and venous insufficiency, in fact, are characterized by the loss of elasticity by the walls of the veins, or by the deterioration of the internal valves of the veins of the legs, whose function is precisely to assist the return of blood from the lower limbs to the heart.
This loss of elasticity, making it more difficult to transport blood to the heart, and causes stagnation and, sometimes, its transfer into the surrounding tissues and the consequent localized swelling typical of edema.
If you suffer from widespread problems with the cardiovascular system, and you notice signs of the formation of an edema, it is possible that the cause is to be attributed to the circulation, and not to a physical trauma. Standing for a prolonged period, for example, causes an increase in venous pressure in the lower part of the body (legs and feet), which in turn increases the accumulation of fluids, which causes edema.
Peripheral edema can also be a rather common side effect of some calcium channel blocker drugs, especially if the therapy lasts for a long time (over six months).
Calcium channel blocker therapies are quite common in the treatment of hypertension and other diseases typical of the cardiovascular system.
When edema is generalized and spread to the whole body, in medicine we speak of anasarca. It is a condition that has no inflammatory origins, and can be caused by the presence of severe heart failure, a condition of liver failure or nephrotic syndrome.
Instead, we speak of lymphedema when the phenomenon is due to an anomaly affecting the lymphatic system, usually due to excessive permeability of the lymphatic vessels. Lymphedema can have a congenital origin, or it can occur as a result of trauma or damage to the lymphatic system, which can occur as a result of surgery or radiotherapy.
In fact, the lymphatic circulation and the apparatus responsible for the latter, are the main means by which the body is able to reabsorb interstitial fluids, and thus prevent the formation of edema and swelling. If the lymphatic system does not work efficiently, the risk is to incur recurrent and regular complications.
Leg edema is also a common symptom during pregnancy. To cause it can be hormonal factors (increased production of estrogen, progesterone and other hormones), biochemical (increase in the liquid components of the blood, at the expense of proteins) and vascular (vasodilation and increased vascular permeability).
Edema can also be caused by a malfunction of the kidneys, the organs responsible for filtering and purifying the blood. When these are no longer able to eliminate the right amounts of sodium and other liquids, there is a risk of increasing pressure within the blood vessels.
Edema can also have hepatic origin: liver diseases such as cirrhosis cause an overload of the organ and, as happens for the kidneys, increase blood pressure inside the surrounding vessels, causing ascites, ie an accumulation of fluid in the abdomen.
Other cases of edema, with a rarer onset and linked to specific factors, can be angioedema (inflammatory reaction of the skin similar to urticaria), macular edema (leakage of liquids at eye level, resulting in vision problems) and cerebral edema.
Finally, pulmonary edema is the only one that can have potentially fatal consequences and can be primary (i.e. caused by infections or alterations in the lungs themselves) or secondary (generally due to heart disease).
Common symptoms
For edema due to trauma the first symptom that appears is local pain. Swelling and hematoma (bluish discoloration of the skin) may appear even later.
Usually due to pain and swelling, it is difficult to move the affected part. It is a physiological inflammatory reaction put in place by the body and serves to “protect” the affected part from further trauma.
Although we generally tend to counteract it, the inflammatory process is one of the first mechanisms by which our body is able to counteract the appearance of edema, and to give the affected area time to recover and absorb excess fluids, preventing further dangers.
When edema is generalized, the first sign is weight gain due to the high amount of fluid that accumulates in the subcutaneous layer.
In edema due to defects in venous circulation, the most frequent form of which affects the lower limbs, the first symptom is heavy legs, especially in the evening, and swelling of the ankles.
Complications
The healing of an edema is relatively simple and uncomplicated if of traumatic origin, although in trauma edema, if it is severe, the swelling and hematoma are more evident, and can hide a fractured joint bone.
If, on the other hand, it is edema in the legs, generalized or in any case of other origin that is not traumatic, if not treated promptly or when prevention is not sufficient, it can have serious consequences.
Extravasation can cause inflammation in the affected area and phlebitis (inflammation of the veins).
In generalized edema, complications are mainly related to the pathology that caused it, a pathology that must be framed through appropriate medical examinations.
In leg edema, if the cause is not treated, it can lead to the rupture of a varicose vein, the onset of phlebitis or thrombosis.
Even in the case of pulmonary edema, and especially acute pulmonary edema, the diagnostic process and treatment must be immediate. Neglecting symptoms, which may include dyspnea, breathlessness and difficulty breathing, could lead to very serious complications, including heart failure with a fatal outcome for the patient.
Treatment
In case of trauma edema, treatment is aimed at resolving the injury. If the trauma is not very serious and is treated immediately in the correct way, the edema can also be prevented, or otherwise minimized, and recovery is usually quite fast.
The most widely used approach to treating injury trauma is the so-called RICE protocol. It is an acronym coined by the English language, which highlights the four behaviors to be taken to stem the traumatic symptoms:
Rest | Rest: so as not to further stress the part affected by the injury |
Ice | Ice: to cool the affected part |
Compression | Compression: to reduce swelling and limit edema |
Elevation | Elevation: to facilitate the return of venous blood to the heart and limit stagnation and decanting |
An elastic bandage, when possible, can help reduce edema. It is also useful the local application of anti-inflammatories and anti-edemas, which assist the reabsorption of liquids.
In all cases of generalized edema, therapies consist of treating the pathology that caused it. These specific treatments are often associated with a low-salt diet and therapy with diuretic drugs, to promote the elimination and drainage of excess fluids.
Obviously, special therapies must be carefully evaluated, taking into account the clinical picture of the patient. For example, the presence of cardiomyopathies, cardiovascular diseases, a lack of blood pressure and history of embolism and deep vein thrombosis, must be absolutely taken into account if there is no possibility of immediately attributing the origin of the edema to a specific trauma.
In case of leg edema, venous pathology (varicose veins or venous insufficiency) must first be treated. The resorption of edema can be facilitated by the use of appropriate compression stockings. The latter are especially useful for some specific categories of patients such as pregnant women or those who, for various reasons, cannot undergo surgery or specific pharmaceutical therapies.
It is a good idea, in any case, to avoid all conditions that favor the stagnation of the circle at the ends; Especially if you lead a sedentary lifestyle, it is recommended to try to keep moving, for example by getting up from the desk at least once an hour of work and periodically doing stretching exercises.
During the night, it is advisable to keep the legs slightly elevated with respect to the body, preferring the supine position to the prone one, and perhaps keeping a pillow under the feet, to facilitate circulation.
Also useful are some vaso-protective preparations. They are purchased at pharmacies and are available in the form of tablets or ointments. These drugs work by increasing the resistance of blood vessels and reducing the permeability of their walls.
In addition to blood vessels, they also act on the lymphatic system, improving the functioning of capillaries. It should be remembered, however, that the effectiveness of these remedies is limited, which is why the national health system does not cover the purchase, and is almost always associated with other forms of therapeutic intervention.
To counteract edema of traumatic origin, some natural remedies are also available that perform an anti-inflammatory and pain-relieving action: ointments based on aloe vera or arnica, but also extracts such as bromelain (derived from pineapple) or escin (extracted from horse chestnut seeds).
Bromelain has specific anti-edema properties and can be easily taken orally, twice a day, and helps reduce swelling.
As far as escin is concerned, it has a protective action especially on muscle fibers, increasing the protection of the capillaries and favoring the absorption of liquids that give rise to edema. Escin can also be taken orally or administered topically.
When to consult your doctor
Apart from cases where edema is clearly due to minor trauma, which can be treated with self-medication, the appearance of edema should always be reported to the doctor, who will be able to make a diagnosis, correctly identify the cause, and set up appropriate treatment.
In addition to visual examination of the affected part (in most cases the legs), the doctor can exclude the possible involvement of other organs through blood and urine tests, useful to highlight dysfunctions affecting the kidneys or liver. Above all, in the event that the area affected by a relevant trauma tends to remain swollen for an excessive period of time, with an apparently chronic edema, only the specialist will be able to prescribe specific examinations.
In the case of pulmonary edema, your doctor can easily detect fluid by auscultating the lungs or by taking a chest X-ray. Once the presence of the pathology has been verified, it will be possible to undertake a specific therapy, and in cases of acute form evaluate the use of surgery.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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