Edema Diagnosis and Treatments

Edema is a sign of an underlying problem, rather than a disease unto itself. A diagnostic explanation should be sought. Patient history and presenting symptoms, along with laboratory blood studies, if indicated, assist the health professional in determining the cause of the edema.

Treatment of edema is based on the cause. Simple steps to lessen fluid build-up may include:

• Reducing sodium intake. A high sodium level causes or aggravates fluid retention.

• Maintaining proper weight. Being overweight slows body fluid circulation and puts extra pressure on the veins.

• Exercise. Regular exercise stimulates circulation.

• Elevation of the legs. Placing the legs at least 12 in (30.5 cm) above the level of the heart for 10-15 minutes, three to four times a day, stimulates excess fluid re-entry into the circulatory system.

• Use of support stocking. Elastic stockings, available at most medical supply or drug stores, will compress the leg vessels, promoting circulation and decreasing pooling of fluid due to gravity.

• Massage. Massaging the body part can help to stimulate the release of excess fluids, but should be avoided if the patient has blood clots in the veins.

• Travel breaks. Sitting for long periods will increase swelling in the feet and ankles. Standing and/or walking at least every hour or two will help stimulate blood flow.

The three “Ds”—diuretics, digitalis, and diet-are frequently prescribed for medical conditions that result in excess fluid volume. Diuretics are medications that promote urination of sodium and water. Digoxin is a digitalis preparation that is sometimes needed to decrease heart rate and increase the strength of the heart’s contractions. Dietary recommendations include less sodium in order to decrease fluid retention. Consideration of adequate protein intake is also made.

For patients with lymphedema, a combination of therapies may prove effective. Combined decongestive therapy includes the use of manual lymph drainage (MLD), compression bandaging, garments and pumps, and physical therapy. MLD involves the use of light massage of the subcutaneous tissue where the lymph vessels predominate. Massage begins in an area of the body trunk where there is normal lymph function and proceeds to areas of lymphatic insufficiency, in an effort to stimulate new drainage tract development. (MLD should not be used for patients with active cancer, deep vein clots, congestive heart failure, or cellulitis.) MLD sessions are followed by application of compression garments or pumps. Physical therapy is aimed at strengthening the affected limb and increasing joint mobility.

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