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Edema

Also listed as: Water retention

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Special Considerations
• Supporting Research

Edema (also known as dropsy or fluid retention) is swelling caused by the accumulation of abnormally large amounts of fluid in the spaces between the body's cells or in the circulatory system. It is most common in feet, ankles, and legs. Edema is a symptom, not a disease or disorder. Widespread, long-term edema can indicate a serious underlying health problem.

Signs and Symptoms

These will vary and may include the following.

• Swollen limbs (possibly accompanied by pain, redness, heat)
• Facial puffiness
• Abdominal bloating
• Shortness of breath, extreme difficulty breathing, coughing up blood
• Sudden change in mental state or coma
• Muscle aches and pains

What Causes It?

Some of the many factors that cause edema are as follows:

• Sitting or standing for long periods
• Certain medications
• Hormonal changes during menstruation and pregnancy
• Infection or injury to a blood vessel, blood clots, or varicose veins
• Blocked lymph channels (lymphedema)
• Allergies to food or insect bites
• Kidney, heart, liver, or thyroid disease
• High or low blood pressure
• Eating salty foods
• Brain tumor or head injury
• Exposure to high altitudes or heat, especially when combined with heavy physical exertion

What to Expect at Your Provider's Office

Your health care provider will look for varicose veins, blood clots, wounds, or infections. An x-ray, CT scan, MRI, urine test, or blood test may be necessary. Pulmonary edema, which occurs when fluid builds up in the lungs, can be caused by other diseases such cardiovascular disease or by climbing at high altitudes. It can be life-threatening and may require hospitalization.

Treatment Options

Treatment may involve using compression bandages and pressure "sleeves" tightened over swollen limbs to help force the body to re-absorb the fluid. Other options include a salt-reduction diet, daily exercise, resting with legs elevated above the heart level, wearing support hose, taking a diuretic, and massage.

Drug Therapies

• Medication for your underlying disorder -- talk to your health care provider.
• Diuretics -- for example, loop diuretics or potassium-sparing diuretics. These medicines reduce body fluid levels, but they also deplete important vitamins and minerals, which can result in loss of bone mass. Diuretics may have several other possibly serious side effects.

Surgical Procedures

Surgery may be required to remove fat and fluid deposits associated with a type of edema called lipedema, or to repair damaged veins or lymphatic glands to reestablish lymph and blood flow.

Complementary and Alternative Therapies

The following nutritional and herbal support guidelines may help relieve edema, but the underlying cause must be addressed.

Nutrition and Supplements

• Reduce salt intake. A low-salt, high-protein diet may help edema. (However, you should not eat a high-protein diet if you have kidney disease.) You should also reduce how much sugar and refined carbohydrates you eat.
• Eliminating food allergens from your diet decreases inflammation.
• Natural diuretics: asparagus, parsley, beets, grapes, green beans, leafy greens, pineapple, pumpkin, onion, leeks, and garlic.
• Vitamin B6 (50 - 100 mg per day) and B1, or thiamine (200 mg per day), are mild diuretics.
• Vitamins C (250 - 500 mg two times per day), E (400 - 800 IU per day), and coenzyme Q10 (50 - 100 mg two times per day).
• If you use diuretics, your doctor may have you supplement with potassium aspartate (20 mg per day), since diuretics flush out potassium from the body and cause a deficiency. Do not take extra potassium without informing your doctor.
• Magnesium (200 mg two to three times per day) and calcium (1,000 mg per day) help maintain fluid exchange in the body.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Do not take these herbs if you are already taking a prescription diuretic. Herbs with diuretic properties include

• Bilberry (Vaccinium myrtillus), 80 - 100 mg three times per day.
• Dandelion ( Taraxacum officinale ), 4 - 10 g of dried leaf steeped in one cup hot water. Strain and cool. Dandelion also is a good source of potassium, which is often reduced by diuretics.
• Horse chestnut (Aesculus hippocastanum), 250 mg two times per day, standardized for aescin content. Use only reputable brands that have been professionally formulated. Crude preparations can contain a toxic compound. Do not use if you have liver or kidney disease or take blood-thinning medication, and do not exceed recommended dosage.
• Cleavers ( Galium aparine ), 2 - 4 g steeped in one cup hot water. Strain and cool. Drink three times per day.
• Juniper ( Juniperus communis ), 1 - 2 g of juniper berry three times per day. Or steep 1 tsp. crushed juniper berry in one cup hot water. Strain and cool. Drink three times per day. Do not use for more than 4 weeks. Do not take juniper if you are pregnant, have kidney disease, are diabetic, or take blood pressure medication.

Grape seed extract ( Vitis vinifera ) is a powerful antioxidant that also shows evidence of improving chronic venous insufficiency, which causes swelling when blood pools in the legs. Studies have used a dose of 360 mg two times a day or 720 mg once a day. Taking grape seed extract along with a vitamin C supplement may raise blood pressure, so check with your doctor.

Homeopathy

Homeopathy may be useful as a supportive therapy.

Physical Medicine

• Dry skin brushing. Before bathing, briskly brush the entire skin surface with a rough washcloth, loofa, or soft brush. Begin at your feet and work up. Always stroke in the direction of your heart.
• Cold compresses made with yarrow tea.
• Contrast hydrotherapy involves alternating hot and cold applications. Alternate 3 minutes hot with 1 minute cold. Repeat three times to complete one set. Do two to three sets per day.

Acupuncture

Acupuncture may improve fluid balance.

Massage

Therapeutic massage can help lymph nodes drain.

Special Considerations

Excessive fluid retention during pregnancy (toxemia) is potentially dangerous to both you and your baby.

Supporting Research

Anon. Final report on the safety assessment of Juniperus communis Extract, Juniperus oxycedrus Extract, Juniperus oxycedrus Tar, Juniperus phoenicea extract, and Juniperus virginiana Extract. Int J Toxicol 2001;20:41-56.

Balch JF, Balch PA. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing Group; 1997.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:73, 155, 156, 188.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:424, 425, 429.

Clement DL. Management of venous edema: insights from an international task force. Angiology. 2000; 51:13-17.

Kiesewetter H, Koscielny J, Kalus U, et al. Efficacy of orally administered extract of red vine leaf AS 195 (folia vitis viniferae) in chronic venous insufficiency (stages I-II). A randomized, double-blind, placebo-controlled trial. Arzneimittelforschung 2000;50:109-17.

Mindell E, Hopkins V. Prescription Alternatives. New Canaan, Conn: Keats Publishing Inc; 1998.

Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals . London, UK: The Pharmaceutical Press, 1996.

Weiss RF. Herbal Medicines. Beaconsfield, England: Beaconsfield Publishers, Ltd; 1988:188-191, 241.

• Review Date: 6/27/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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