Formula Medical Group
Apple Valley, CA

James Krider, MD

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Swelling - edema

Edema is the abnormal swelling or bloating of some part of the body due to a buildup of fluid in body tissues. It most often occurs in the lower legs or ankles, but also may appear as generalized body puffiness or unusual weight gain. Sometimes the swelling is a temporary response to hormonal changes, such as menstruation. In other instances, the swelling may be a symptom of a serious medical problem, such as kidney disease.

Causes of swelling

Anaphylactic shock
This is a medical emergency brought on by a severe allergic reaction to an insect sting, certain foods, or other substances to which a person may be hypersensitive. Drugs (most commonly penicillin) may produce an anaphylactic reaction. One of the symptoms is swelling all over the body — an indication to seek immediate medical help.

Birth control pills
Swelling can be a problem for many women who take birth control pills. The higher the estrogen content of the pill, the more likely the woman is to develop edema.

Some types of cancer cause swelling. For example, one of the first symptoms of ovarian cancer is often extreme abdominal swelling caused by fluid accumulation. Kidney cancer can cause generalized swelling and facial puffiness, and liver cancers may cause abdominal swelling.

Circulation problems
When the veins in the lower limbs fail to keep pace with the arteries, the outward flow of blood lags behind the inward flow, leading to swelling of the lower legs and ankles.

Congestive heart failure
This condition, in which the heart fails to pump effectively, is a frequent cause of edema. When inadequate amounts of blood are circulating, salt and water are retained in the legs and sometimes the abdomen. The result can be a weight gain of 10 pounds or more. Excessive fluid also may accumulate in the lungs, especially when lying down.

Puffy, swollen ankles are a common sign of fluid retention associated with pregnancy and premenstrual syndrome.

Puffy, swollen ankles are a common sign of fluid retention associated with pregnancy and premenstrual syndrome.

Kidney disorders
If the kidneys are unable to excrete excess salt from the body, a buildup of body fluids may occur. Swelling associated with kidney disease is often first noticed as a puffiness in the face.

Liver disease
Liver disorders, particularly cirrhosis, may also lead to a buildup of excess body fluids. The swelling is usually abdominal.

Some drugs may cause salt retention and swelling unless they are taken with a diuretic (water pill). Diuretics prevent the reabsorption of salt and water by the kidneys, decreasing edema. Other drugs, especially corticosteroids, can cause fluid retention and swelling.

All pregnant women normally have some edema, most often in the feet and legs. This is due to sluggish circulation in the lower limbs caused by a combination of the force of gravity, the weight of the uterus, and hormonal changes. A more serious generalized swelling during pregnancy may be due to Pre-eclampsia, or toxemia of pregnancy.

Premenstrual syndrome
Swelling is a common symptom of this condition, which affects some women just before the menstrual period begins and disappears with its onset. Swelling is most noticeable in the breasts, legs, and abdomen.


Swelling (especially of the feet) accompanied by other symptoms such as shortness of breath or waking at night with a feeling of breathlessness is a possible symptom of congestive heart failure. See your doctor as soon as possible if you have these symptoms.

Excessive salt consumption can be responsible for edema in both healthy people and those with certain medical problems.

Sickle-cell anemia
This hereditary blood disease attacks black people almost exclusively. In infants, the first sign may be swollen hands and feet.

Advice about swelling

  • Swollen ankles and feet are common in people who must stand up a lot, such as dentists, bank tellers, and hairdressers. If your job requires standing for long periods, take hourly breaks to sit down and raise your feet.
  • Avoid tight garments around the upper legs.
  • Elastic support stockings ease discomfort and promote circulation in your legs, especially if you have varicose veins.
  • Exercises that strengthen the leg muscles, especially those around the calf, can help prevent swelling. This is particularly important for older women whose leg muscles may deteriorate with normal aging.
  • Restrict salt intake, since salt is a major contributor to edema.
This article was last reviewed November 14, 2005 by Dr. James Krider.
Reproduced in part with permission of Home Health Handbook.

Anaphylactic shock
Anemia, sickle-cell
Contraception, women
Cancer, kidney
Cancer, liver
Cancer, ovarian
Congestive heart failure
Decreased leg circulation
Fatty leg syndrome
Kidney disease
Kidney failure
Kidney, polycystic
Liver fibrosis
Med's, diuretics
Med's, steroid
Pregnancy and diet

Varicose veins

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