Causes, symptoms of leg edema, how to remove?
What is leg edema?
Swelling of the legs is an overflow of fluid in the cells and intercellular space of the muscle tissue of the legs. The distal segments of the lower extremities - the legs and feet - are most often subjected to such pathological changes. This phenomenon is associated with the highest functional load, which is performed by the feet and legs of a person in the process of life, and their lowest position in relation to the central parts of the body when in an upright position.
All fluid in the body is located in the vascular and intercellular spaces. The possibility and degree of edema increase depends on the balance between them.
In this self-adjusting mechanism, the key links belong to:
- Hydrostatic blood pressure on the vascular wall;
- Hydrodynamic characteristics of blood flow;
- Indicators of osmotic and oncotic activity of plasma and intercellular space.
Swelling of the legs can have varying degrees of severity, but they are always evidence of an imbalance between the actual possibilities of physiological mechanisms for regulating fluid exchange and the load on the intercellular space. Swelling of the legs can be both an adaptive normal reaction of the body to environmental conditions, and the first manifestation of serious diseases.
Content:
- What is leg edema?
- Symptoms of severe leg edema
- Causes of leg swelling
- How to remove swelling from the legs?
- Diuretics for leg swelling
Symptoms of severe leg edema
You can understand and suspect the presence of leg swelling based on certain symptoms. They can have varying degrees of severity, and at the same time are able to remain stable or progress. In the first case, they talk about the physiological mechanisms of the appearance of edema syndrome. In the second, it is definitely about pathology. Therefore, considering such issues, one cannot ignore any manifestations of edema, which may indicate a dangerous disease.
Alarming symptoms include:
- Pasty. It is a diffuse light impregnation of the skin and subcutaneous tissue of the legs in the lower third and the area of the ankle joint along the entire circumference on both limbs. Its presence is evidenced by light traces remaining after strong pressure on the skin of the anterior surface of the lower leg in the projection of the tibia. The same diagnostic value belongs to the sock marks;
- Local swelling. As a rule, it is located on one or two limbs in the area of the ankles or around the circumference of the ankle joint;
- Severe edema of one or both legs or feet. However, it spreads to the level of the knee joint or even higher. After pressing on the skin, a large depression remains, which does not expand for a long time;
- Trophic skin disorders due to edema. They occur exclusively with severe edema, causing hyperextension of the skin. Against this background, an increased outflow of fluid from the skin surface develops and cracks appear, which transform into erosion, wounds, trophic ulcers and dermatitis.
Causes of leg swelling
Swelling of the legs is not a separate disease, but a symptom that must be correctly interpreted in relation to determining the possible cause of its occurrence. There are several groups of diseases manifested by leg edema. All these diseases and the main differential diagnostic criteria are shown in the table:
| What does edema look like? | |
| Swelling of the legs in healthy people, caused by overloading of the lower extremities and hydrostatic effect on the vessels of the microvasculature against the background of a long stay in an upright position. | Both legs and feet swell to the same extent. Edema is represented by pasty in the lower third of the entire circumference of the legs. Appears in the evening after standing or physically demanding work. After rest, such edema disappears. |
| Swelling of the legs, as a sign of heart failure | With heart disease, accompanied by circulatory failure, there is a constant congestion in the veins. This is manifested by edema of varying density and prevalence: from mild and insignificant in the initial stages, to dense and widespread up to the knee joint during decompensation. Both limbs swell. In the morning, the swelling may decrease slightly. |
| Swelling of the legs with renal pathologies | The shins and feet are most swollen with nephritic syndrome and severe renal failure. The same severity on both limbs is required. Unlike cardiac edema, this edema is more pronounced in the morning, and decreases in the evening. Puffiness of the face is more typical than the lower extremities. |
| Swelling of the legs in diseases of the venous system of the extremities (varicose veins, thrombophlebitis, post-thrombophlebitic syndrome) | Edema is necessarily unilateral, and if bilateral, then with a predominant lesion of one of the legs. Such edema is very persistent and dense. Sharply worse after being in an upright position, especially motionless. The swelling of the peri-malleolar region is most pronounced. After being in a horizontal position, the swelling decreases. |
|
Swelling of the legs in diseases of the lymphatic system of the extremities (erysipelas and its consequences, lymphovenous insufficiency, lymphedema) |
Like venous edema, edema is located mainly on one side. They are distinguished by their particularly high density and durability. Rarely diminish from any manipulation and action. A characteristic manifestation of lymphatic edema is localization on the dorsum of the foot in the form of a pillow. |
| Swelling of the legs with pathology of the osteoarticular system | Almost always, one-sided, limited, localized in the area of the affected joint or bone, accompanied by pain and impaired support and walking functions. |
| Swelling of the legs with inflammatory and purulent-infiltrative diseases of the skin and soft tissues, with injuries of the extremities |
The edema is limited. The severity can be different. With bites and injuries, edema spreads around the lesion. With deep abscesses, the entire affected segment increases in volume. For fractures, local edema at the site of the fracture is more characteristic, for ruptures of ligaments and sprains - widespread edema of the type of hematoma. |
|
Other causes of leg swelling:
|
The edema is soft, uniform, located on both limbs. The exception is cases of diseases of the nervous system, accompanied by unilateral paralysis. In such a situation, the edema is localized on the affected limb. These edema is relatively stable throughout the day, but may worsen in the evening. They do not reach great severity, with the exception of cases of decompensation of diseases and an aggravation of the general condition, due to the addition of other causes of increased puffiness. |
When determining the possible causes of the appearance of leg edema, the general condition and accompanying symptoms must be taken into account. If there are any, this is definitely pathological edema that requires medical intervention!
How to remove swelling from the legs?
Treatment of leg edema is not always the right and rewarding business. After all, eliminating a symptom cannot relieve a person of the disease. Therefore, it is more correct to treat not edema, but the disease that led to their appearance. The exception is cases of hydrostatic edema in healthy people against the background of overstrain of the legs.
Differentiated treatment tactics for leg edema can be as follows:
-
Hydrostatic edema in persons without pathology:
- Limiting physical activity on the legs;
- Periodic unloading for the calf muscles in the form of their elevated position, gymnastics and massage;
- The use of compression hosiery (stockings, knee-highs, tights), which help to retain fluid in the vascular space by compressing soft tissues;
- Specialized measures are not required due to the physiological origin of edema. It is permissible to use ointments and gels described in the section "Treatment of edema of venous origin".
-
Cardiac and renal edema:
- Diuretics. Various loop (furosemide, lasix, trifas), thiazide (indapamide, hypothiazide) and potassium-sparing (veroshpiron, spironolactone) diuretics are used. The frequency of administration, dosage form and duration of treatment depend on the degree of heart failure. Severe edema is treated with injectable loop diuretics with a gradual transition to tablet administration of identical drugs or drugs from another group. For long-term decongestant therapy, thiazide diuretics are best suited in combination with verospiron;
- Potassium preparations (Panangin, Asparkam). Necessarily included in the drug therapy with loop diuretics. This is necessary in order to compensate for the loss of potassium ions, which are excreted in the urine during stimulation of diuresis. But such drugs are contraindicated in renal failure.
- Cardioprotective agents. They do not have a direct anti-edema effect, but they strengthen the heart muscle, the weakness of which causes heart failure and swelling of the legs.
-
Venous edema:
- Compression of the legs and feet with elastic bandages or special knitwear. This event should be the first in the complex treatment of edema syndrome, since it not only helps in the fight against edema of the legs, but is a really good method for preventing the progression of venous insufficiency. The main thing is to follow all the rules of elastic bandaging;
- Phlebotonics (Escuzan, Troxevasin, Detralex, Normoven). The mechanism of the anti-edematous action of the drugs of this group is to strengthen the walls of the veins and vessels of the microvasculature. Phlebotonics of plant origin (escuzan) can be prescribed in the absence of obvious signs of varicose veins, if at the same time there is a pronounced pastiness that goes beyond the usual hydrostatic edema;
- Blood-thinning agents (Ascard, Cardiomagnil, Lospirin, Clopidogrel). The mechanism for reducing leg swelling is associated with a decrease in blood viscosity. If it becomes more liquid, then its outflow improves, and this prevents stagnation and sweating in the tissue in the form of edema;
- Local preparations in the form of ointment and gel (lioton gel, heparin ointment, troxevasin, hepatrombin, venohepanol, aescin, venitan). Their local application is quite effective, both for venous pathology and for edema against the background of the usual fatigue of the legs as a result of overstrain.
On the subject: How to remove swelling from the legs at home?
Diuretics for leg swelling
Diuretics for leg edema have a common name - diuretics.
They, in turn, are subdivided into several classes:
- Saluretics, which can be represented by: loop drugs (Bumetanide, Torasemide, Ethacrynic acid, Lasix, Furosemide), thiazide agents (Cyclomethiazide, Hypothiazide), carbonic anhydrase inhibitors (Diacarb, Acetazolamide) and sulfonamides Chorthaliumidone,
- Potassium-sparing diuretics, including: Spironolactone, Amiloride, Veroshpiron, Triamteren, Eplerenone.
- Osmotic are Mannitol and Urea.
All these drugs differ in their effectiveness, duration of action and the speed of onset of the therapeutic effect. They have indications and contraindications and are prescribed exclusively by a doctor in accordance with the patient's illness.
Author of the article: Lebedev Andrey Sergeevich | Urologist
Education: Diploma in the specialty "Andrology" received after completing residency at the Department of Endoscopic Urology of the Russian Medical Academy of Postgraduate Education in the urological center of the Central Clinical Hospital No. 1 of JSC Russian Railways (2007). Postgraduate studies were completed here by 2010.
