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home : columns : ask the doctors June 3, 2020

2/28/2020 7:54:00 AM
Edema cannot be cured, but it can be managed

Dear Doctor: I am a 76-year-old man who has dealt with edema in various intensities for several years. Now I have been diagnosed with early-stage congestive heart failure. I know I'm not the only senior affected by edema, and I hope you might consider devoting a column it.

Dear Reader: You're correct that many older adults experience edema, which is the medical term for swelling. It occurs when fluid becomes trapped in the affected tissues.

Edema can occur in any part of the body, and it shows up most commonly in the ankles, feet, legs and hands. This is known as peripheral edema. Symptoms include visible swelling or puffiness and skin that looks tight and shiny. Severe edema causes a condition known as pitting, which is when pressure applied to the swollen area causes an indentation that is slow to fade. Edema can also cause abdominal swelling, shortness of breath, elevated heart rate and chest pain.

A common cause of edema in older adults is venous insufficiency. This is when age, illness, injury or the side effects of medications cause the veins and the valves within them to be less efficient at returning blood to the heart. It's an uphill journey from the extremities to the heart, and venous insufficiency allows the blood to pool.

Edema is also a symptom of congestive heart failure, a progressive condition in which the heart becomes unable to pump enough blood to meet the body's needs. The backup of blood from these conditions causes pressure, which forces fluid from tiny capillaries in the area and into the surrounding tissues.

These types of edema cannot be cured, so the goal is management. Exercise, particularly involving the affected limbs, can help veins return blood to the heart. So does spending time with the affected limbs elevated above the heart. Once swelling has lessened, compression garments, such as sleeves and stockings, can help prevent new fluid accumulation. Limiting dietary salt is important because excess sodium causes fluid retention.

Medications known as diuretics, or water pills, help the body release water and sodium via the urine. They're helpful in managing congestive heart failure. Diuretics work by changing how the kidneys handle sodium, which increases the amount of water and sodium released in the urine. Studies show that this may also result in a drop in venous pressure, which can help capillaries to reabsorb some of the water they released. Water loss from diuretics can affect the electrolyte balance in the body, particularly potassium, which is crucial to heart function. Supplemental potassium is often prescribed. People who take a potassium-sparing diuretic must be monitored for excess amounts of the mineral.

It's important to protect areas of edema from pressure and injury, as healing takes longer and infection is a risk. Moreover, if you experience redness, heat or pain; develop an open sore; develop shortness of breath; or start swelling on just one side of the body, seek immediate medical care.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.





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