Idiopathic edema


Idiopathic edema is a pitting edema of unknown cause that occurs primarily in pre-menopausal women who do not have evidence of heart, liver, or kidney disease. In this condition, the fluid retention at first may be seen primarily pre-menstrually (just prior to menstruation), which is why it sometimes is called "cyclical" edema. However, it can become a more constant and severe problem. Patients with idiopathic edema often take diuretics to decrease the edema in order to lessen the discomfort of bloating and swelling. Paradoxically, however, the edema in this condition can become more of a problem after the use of diuretics. The patients can develop fluid retention as a rebound phenomenon each time they discontinue diuretics. It is important to talk to your doctor before using any diuretics.


Idiopathic Edema can result in moderate discomfort in any area of excess fluid accumulation. Carpal tunnel syndrome, diffuse aching, morning stiffness and muscle/bone pains as well as headaches often accompany the swelling. It can also masquerade as premenstrual syndrome or make existing premenstrual syndrome worse. It exacerbates the swelling, abdominal bloating and general physical discomfort but it does not usually cause irritability or depressive symptoms as does classic PMS


Prolonged standing or sitting, especially in hot weather, may cause excess fluid accumulation in the feet, ankles and lower legs. Venous insufficiency is a common problem of the weakened valves in the veins of the legs. This leads to varicose veins and build up of fluid. Severe chronic lung disease such as emphysema or chronic bronchitis increase the pressure in the blood vessels to the lungs. This pressure backs up in the right side of the heart and the higher pressure causes swelling in the legs and feet. Congestive heart failure due to decreased pumping action of the heart muscle causes fluid buildup in the lungs and other parts of the body. The swelling is often most visible in the feet and ankles. Pregnancy with leg edema occurs because the pregnant uterus puts pressure on the vena cava, a major blood vessel that returns blood to the heart from the legs. Fluid retention of pregancy also might be caused by a more serious condition called preeclampsia.


To check for edema that is not obvious, you can gently press your thumb over the foot, ankle or leg with slow, steady pressure. If edema is present, an indentation will show on the skin. A professional evaluation to determine the cause of leg swelling is needed. If both legs are swollen, your doctor will inquire about other symptoms and perform a physical examination. A urine test will show whether you are losing protein from the kidneys. Blood tests, a chest X-ray and an electrocardiogram (ECG) may be ordered.


Treatment focuses on correcting the underlying cause of the fluid accumulation. In addition, a low-salt diet and avoiding excess fluid intake usually helps. If you are not short of breath, elevation of the legs above the level of your heart will also keep swelling down. A low dose of a diuretic (water pill) used sparingly might be added in some cases. For swollen ankles and feet caused by pregnancy from the enlarged uterus pushing on the vena cava, elevation of the legs and not lying on your back (either side) helps blood flow and decreases swelling. Most patients with mild leg edema due to varicose veins can be treated with periodic leg elevation and support (compression) stockings. Sometimes surgery is needed to improve the flow of blood through the leg veins. Also, no matter what the underlying cause of edema, any swollen area of the body should be protected from pressure, injury and extreme temperatures. The skin over swollen legs becomes more fragile over time. Cuts, scrapes and burns take much longer to heal and are more prone to infection when skin has edema underneath. Prevention of edema means preventing the cause. Smoking is the No. 1 cause of chronic lung disease. Congestive heart failure most often is due to coronary artery disease and high blood pressure. To avoid leg swelling on long trips or due to long hours at a desk job, stand up and walk around often; ideally you should get up once per hour. If not possible, then exercise your feet and lower legs while sitting. This will help the veins move blood back toward the heart.