Synonyms in a broader sense
- Edemas
- Dropsy
- Water retention in the legs
- Water accumulation in the legs
An accumulation of water in the legs is called edema. The water retention is often caused by a transfer of fluid from the vascular system to the surrounding tissue. This is the case when the proportion of proteins (albumin) in the blood decreases or when the kidneys can no longer excrete enough water and electrolytes (mainly sodium) and thus there is more and more water in the body.
Furthermore, water retention can also occur due to insufficient reabsorption by the lymphatic system (lymphedema). Water retention can vary in its extent depending on the time of day or the female cycle or it can only occur in certain situations. They are not always signs of a disease, but should be clarified in any case, as they often indicate a disease, a drug side effect or an allergy.
Causes
The accumulation of water in the legs can have many different causes. These include heart diseases such as cardiac insufficiency, and kidney diseases such as the so-called nephrotic syndrome or kidney inflammation. Furthermore, venous occlusion (thrombosis) can cause water retention and swelling of a leg.
In addition, water retention after injuries in the area of the leg/foot, as well as through infections/inflammations or through allergies is quite possible. Furthermore, edema can occur as side effects of medication (painkillers, cortisone, ASA, estrogens, antidepressants) throughout the body, including in the legs. Naturally (phyiologically) occurring water retention can often be observed in the week before menstrual bleeding (premenstrual syndrome) or during pregnancy and is due to hormonal changes. Water retention can also be caused by diseases of the lymph vessel system or pulmonary hypertension.
Cause heart
Heart weakness or also heart muscle weakness (cardiac insufficiency) is a particular risk factor for the development of water retention (edema) in the legs. If the heart is weakened, it can no longer generate the force required to eject the blood. Consequently, if the right heart is weak, the blood accumulates in the large bloodstream (i.e. back into the body); if the left heart is weak, the blood accumulates in the lungs.
Due to the above-average pressure in the dammed up vessels (veins that transport the blood back to the heart), fluid is now pressed into the surrounding tissue and water retention occurs. In the case of right heart weakness (right heart failure), which can occur, for example, due to heart valve defects (pulmonary stenosis), lung diseases with increased pulmonary blood pressure (cor pulmonale) or as a result of left heart failure (left heart failure), these water accumulations can be found mainly on the front of the lower legs (pretibial), on the feet and in the ankle area. During pregnancy, the increased production of the female sex hormone estrogen can lead to water retention (edema) in the tissue.
These are usually natural and not signs of disease. Water retention often occurs towards the end of pregnancy and after long periods of standing or sitting. These water retentions do not need to be treated and usually disappear again after birth.
However, it is also possible that the edema can be reduced or become less frequent during pregnancy by appropriate physical activity, by putting up the legs, wearing support stockings or by avoiding very salty food. Especially the feet of pregnant women are often swollen. However, so-called pregnancy edema can also be a sign of illness.
For example, so-called preclampsia, in which the affected persons suffer from high blood pressure (hypertension) and protein loss via the kidneys (proteinuria), can lead to water retention in the legs. Since this pregnancy disease requires urgent treatment, a doctor should always be consulted in the event of additional occurrence of high blood pressure, headaches, flickering eyes, dizziness, ringing in the ears or even sudden pain in the upper abdomen.In the last few weeks before birth, the pressure exerted by the growing uterus on the pelvic vein can cause the blood to flow back into the leg veins, resulting in water retention (edema). After birth, the water retention usually disappears quite quickly, but there is no generally accepted time by which the edema has disappeared.
How long the water retention in the legs continues after the birth varies from woman to woman. In some cancers, but also in the treatment of cancer, water retention in the legs (edema) can occur. These water accumulations can usually be explained by a congested lymphatic drainage pathway from the legs.
On the one hand, such a lymph congestion can be caused by the cancer itself or by its metastases (lymph node metastases), on the other hand, cancer therapies such as radiation or the removal of lymph nodes can disturb the lymph drainage and thus cause water retention in the legs. Manual lymph drainage and compression therapies can stimulate the lymph vessels, promote lymph drainage and prevent hardening of the tissue. First of all, the detailed questioning (anamnesis) of the patient by the physician is an important first step in identifying water retention (edema) in the legs and its causes.
In particular heart, kidney or cancer diseases as well as existing pregnancies and the intake of certain medications should be questioned. Changes depending on the time of day and female cycle as well as recent weight gains can also be of great interest. Afterwards the patient should be physically examined by the doctor.
The legs are first inspected in detail for changes in color and shape as well as for swelling. Afterwards it is checked whether the water retention can be pressed in and whether it remains as a visible dent. If it is a so-called venous stasis oedema, e.g. due to heart failure, a dent is usually left after the swollen area has been pressed in.
The situation is different in the case of so-called lymphedema, in which it is not possible to push the swollen area away due to the high protein content of the edema fluid. In addition, the lungs and heart should be examined in a medical clinical examination. As a further diagnostic measure, blood tests can be considered. These should include kidney parameters (e.g. creatinine), proteins, electrolytes, BNP (brain natriuretic peptides) if heart failure is suspected and D-dimers to rule out venous vessel occlusion (thrombosis). In addition, imaging procedures such as X-rays or ultrasound (sonography) can reveal possible additional water accumulation in the lungs or abdomen.
