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What causes water retention in the legs and what can I do to minimize it?
May 21, 2001 -- I've seen many a patient with swelling of the legs, ankles, or feet. This condition, common in people who stand for long periods of time, has a number of possible causes and is often quite correctable.
Let's start with the basics. Every cell in your body is bathed in watery liquid -- fluid that constantly cycles back and forth between your bloodstream and the gaps between your tissue cells called the interstitial space. Any disruption in the flow of fluid between this space and your blood can cause water retention, which can result in swollen ankles and legs.
In varicose veins, for instance, broken-down veins no longer do the job of keeping the blood moving back to your heart. Blood backs up in your legs, where it causes excess interstitial fluid that may result in swelling.
A number of other conditions may contribute to leg swelling, also called edema. In idiopathic edema, leg swelling occurs for unknown reasons after standing for several hours, especially in hot weather. People with congestive heart failure often have trouble with swollen legs as the heart pump fails and blood stagnates in the veins. Those afflicted with malnutrition; disorders of the liver, kidney, or intestines; or conditions like allergies, burns, blood clots, insect bites, or bacterial infections may suffer from swollen extremities for a variety of reasons. Blockage of the lymphatic system -- such as from cancer or lymph gland inflammation -- as well as pregnancy can also cause leg edema.
Whatever the cause, there are several simple and effective ways to relieve swollen legs:
Elevate your legs. Swelling goes down faster when your feet are 6 to 12 inches higher than your heart. Do this at night and at least several times a day by putting pillows under the foot of a mattress. If that's not possible, sit down and prop up your feet on a footstool or sofa.
Wear support hose. Put them on before you get out of bed in the morning -- before your ankles have a chance to swell.
Exercise. Inactivity makes your circulation sluggish. But as soon as you start walking, muscle contractions help push your blood through veins back to your heart.
Halt the salt. Since too much sodium increases swelling, stay away from salt-cured foods and don't add extra salt when you cook.
Watch your weight. Weight loss can reduce the pressure on the veins in your legs and abdomen.
Consider diuretics. If the above measures don't work, your healthcare provider may prescribe a "water pill" to get rid of excess salt and water through your kidneys. The most common kinds include thiazides (hydrochlorothiazide), loop diuretics (furosemide, bumetanide), and potassium-sparing diuretics (spironolactone, triamterene).
I advise you to contact your provider promptly if you notice any warning signs that may signal a more serious condition. These include pain, redness, or heat in your legs, an open sore, shortness of breath, or edema of only one limb. In addition, consult your provider about any swelling that persists more than a few days despite treatment.
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