Oedema is the medical term used for swelling caused by collection of fluid in the body. It can occur nearly anywhere in the body.

Some of the most common sites are:

• the legs or hands (also called peripheral oedema)

• the abdomen (called ascites)

• the chest (called pulmonary oedema if inside the lungs, and pleural effusion if in the outer space surrounding the lungs)

What are the symptoms of oedema?

Symptoms depend upon its cause and location, and may include:

• swelling of the skin, causing it to appear stretched and shiny. This is typically worse in the areas of the body that are closest to the ground. Therefore, oedema is generally worse in the legs after walking, standing, sitting for a long period of time, or at the end of the day. On the other hand, it accumulates in the lower back (called sacral oedema) after being in bed for a long period.

• With ascites there is increased size of the abdomen, leading to a fullness and/or a pain sensation.

• With oedema in the chest, there is difficulty breathing that starts with effort, then becomes present at rest and/or during the night, causing one to wake up short of air or to use multiple pills to sleep.

What can cause oedema?

1. Chronic venous disease. A condition in which the veins in the legs cannot pump enough blood back up to the heart because the very small valves in the veins are damaged.

This can lead to fluid collecting in the legs, thinning of the skin and, in some cases, development of skin sores (ulcers). A significant cause for leg venous disease is blood clots or deep vein thrombosis.

In this case, the oedema is mostly limited to the feet or ankles and usually affects only one side.

2. Heart failure. This is due to a weakened heart, which impairs its pumping action. Heart failure can cause swelling in the legs and abdomen, as well as other symptoms.

Heart failure can also cause fluid to accumulate in the lungs (pulmonary oedema), leading to shortness of breath. This can be a dangerous condition requiring emergency treatment.

3. Cirrhosis. This is scarring of the liver from various causes, which can obstruct blood flow through the liver. People with cirrhosis can develop pronounced swelling in the abdomen (ascites) or in the lower legs (peripheral oedema), but usually not above the diaphragm [ie not in the chest cavity].

4. Kidney disease. The oedema of kidney disease can cause swelling in the lower legs and around the eyes.

5. Drugs. Oedema can be a side effect of a variety of medications, including some oral diabetes medications, high blood pressure pills, non-prescription pain relievers (such as ibuprofen), and oestrogen.

6. Angioedema. This is a special, but rather uncommon form of oedema. It is a reaction to some medications or some inherited disorders that can cause fluid to leak out of the blood vessels into surrounding tissues, resulting in a rapid swelling in the face, lips, tongue, throat, and limbs. Swelling of the throat can interfere with breathing and may be life-threatening.

Sometimes, this type of swelling occurs in the bowels (the intestinal wall) and can result in abdominal pain.

7. Lymphoedema. Surgical removal of lymph nodes for the treatment of cancer (most commonly breast cancer) can cause swelling of a limb or limbs, with thickening of the skin on the side of the surgery.

8. Pregnancy. Pregnant women retain extra fluid. Swelling commonly develops in the hands, feet, and face, especially near the end of a normal pregnancy. Swelling without other symptoms and findings is common, and is not usually a sign that a complication, such as pre-eclampsia (sometimes called toxaemia), has developed.

9. Monthly menstrual periods. Oedema in women that occurs in a cyclic pattern (usually once per month) can be the result of hormonal changes related to the menstrual cycle. This type of oedema is common but does not require treatment, because it resolves on its own.

How is oedema treated?

Treatment includes three major components: treatment of the underlying cause, reducing the amount of salt (sodium) in the diet and, in many cases, use of a diuretic to eliminate excess fluid. Using compression stockings and elevating the legs may also be recommended.

• Joe Yammine is a cardiologist at Bermuda Hospitals Board. He trained at the State University of New York, Brown University and Brigham and Women’s Hospital. He holds five American Board certifications. He was in academic practice between 2007 and 2014, when he joined BHB. During his career in the US, he was awarded multiple teaching and patients’ care recognition awards. The information herein is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician. You should never delay seeking medical advice, disregard medical advice or discontinue treatment because of any information in this article