Swelling

Alternative names
Edema; Anasarca

Definition

Swelling involves the enlargement of organs, skin, or other body structures. It is caused by excessive buildup of fluid in the tissues. This buildup can lead to a rapid increase in weight over a short period of time (days to weeks).

Swelling can occur throughout the body (generalized) or it may be limited to a specific part of the body (localized).

Considerations

Slight edema of the lower legs commonly occurs in warm summer months, especially if a person has been standing or walking a lot.

Generalized swelling, or massive edema (also called anasarca), is a common sign in severely ill people. Although slight edema may be difficult to detect, especially in an overweight person, massive edema is very obvious. Edema can indicate a chronic and progressive medical illness.

Edema may be generally described in one of two ways:

     
  • Pitting edema - When you press a finger against a swollen area for 5 seconds and then quickly remove it, an indentation is left that fills slowly.  
  • Nonpitting edema - When you press a finger against a swollen area for 5 seconds and then quickly remove it, no indentation is left in the skin.

Common Causes

     
  • Too much salt or sodium intake  
  • Burns  
  • Sunburn  
  • Too little albumin in the blood (hypoalbuminemia)  
  • Malnutrition  
  • Pregnancy  
  • Drugs       o Androgenic and anabolic steroids       o Antihypertensives       o Corticosteroids such as prednisone (causes sodium retention)       o Estrogens       o Nonsteroidal anti-inflammatory drugs (see NSAIDs)       o Calcium channel blockers  
  • Nephrotic syndrome  
  • Acute glomerulonephritis  
  • Chronic kidney disease  
  • Heart failure  
  • Liver failure from cirrhosis  
  • Thyroid disease

Home Care

Follow prescribed therapy to treat the underlying cause of the swelling. Discuss with your health care provider the options to prevent skin breakdown (for chronic edema) such as a pressure-reducing mattress, a lamb’s wool pad, or a flotation ring.

Maintain everyday activities. When lying down, keep limbs above the heart level, if possible, to facilitate drainage. Do not do this if shortness of breath results - see your doctor instead.

Reduced sodium (salt) in the diet may be recommended.

Call your health care provider if

If you notice any unexplained swelling, contact your health care provider.

What to expect at your health care provider’s office

Except in emergency situations (such as cardiac failure or pulmonary congestion), your health care provider will obtain your medical history and will perform a physical examination.

Medical history questions documenting swelling in detail may include the following:

     
  • Time pattern       o When did you first notice this?       o Is it present all the time?       o Does it come and go?  
  • Quality       o How much swelling is there?       o When you poke the area with a finger, does the dent remain?  
  • Location       o Is it overall or in a specific area (localized)?       o If swelling is in a specific area, what is that area?  
  • Other       o What seems to make the swelling better?       o What seems to make the swelling worse?       o What other symptoms are also present?

Diagnostic tests that may be performed include the following:

     
  • Albumin levels  
  • ECG  
  • Echocardiography  
  • Serum electrolyte tests  
  • Urinalysis  
  • X-rays  
  • Liver function tests  
  • Kidney function tests

Treatment may include fluid and sodium restriction, diuretics, or water pills. Your fluid intake and output should be monitored, and you should be weighed daily.

Avoid alcohol if liver disease (such as cirrhosis or hepatitis) is causing the problem. Vascular support hose may be advised.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.