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Oedema or Å“dema (British English), Edema (American English), formerly known as dropsy or hydropsy, is the increase of interstitial fluid in any organ. Generally, the amount of interstitial fluid is in the balance of homeostasis. Increased secretion of fluid into the interstitium or impaired removal of this fluid may cause edema.
Generation of interstitial fluid is regulated by the Starling equation of tissue fluid which states that it depends on the balance of osmotic pressure and of hydrostatic pressure which act in opposite directions across the semipermeable capillary walls. Consequently, anything that increases oncotic pressure outside blood vessels (for example inflammation), or reduces oncotic pressure in the blood (states of low plasma osmolality, for example cirrhosis) will cause edema. Increased hydrostatic pressure inside the blood vessel (for example in heart failure) will have the same effect. If the permeability of the capillary walls increases, more fluid will tend to escape out of the capillary, as can happen when there is inflammation.
Abnormal removal of interstitial fluid is caused by obstruction of the lymphatic system, for example due to pressure from a cancer or enlarged lymph nodes, destruction of lymph vessels by radiotherapy, or infiltration of the lymphatics by infection such as elephantiasis.
Oedema (oidema, swelling) is the abnormal accumulation of excess fluid in the interstitial spaces (Mosby, 1997). Oedema may have a multitude of causes, and it is important for the clinician to determine this cause. The simplest way to do this is ask yourself “is the oedema bilateral?†and “on palpation, is it soft (pitted) or indurated (non-pitted)?†(Nelson, 1992).
If the condition is bilateral, then it is most likely of a systemic origin, which is causing venous hypertension. The most common cause of this is congestive heart failure, usually simply due to ageing. Other systemic causes include renal and thyroid conditions. Bilateral oedema is usually pitted and involves the entire lower leg and foot to the level of the digits.
If the condition is unilateral, oedema is most likely due a localised abnormality. The most common cause is DVT, but may include lymphangiactasis, lymphatic obstruction, varicose vein, previous trauma with venous obstruction, or failure of the muscle pump due to AFO’s or neuromuscular conditions that cause apropulsive gait (Nelson, 1992).
Most unilateral oedema is also pitted, however lymphatic-originated oedema will be seen as indurated.
Oedema basically prevents “ideal†tissue perfusion. Depending on the cause, in the early stages this may have no impact on the patient’s life, as there is adequate perfusion for tissue sustainance. However, long-term oedema can manifest into a number of conditions, due to the pressure being directly exerted onto blood vessels and surrounding tissues. These include: haemosiderin, telangiactasia, cellulitis, varicosities, and venous ulceration (LTU PM331 manual).
As mentioned above, the calf “muscle-pump†that is activated during normal gait helps greatly assists in return blood to the heart against gravity, so it is worth being aware that patient’s with an apropulsive gait or wheel chair bound patients may develop oedema and require calf exercises.
So the podiatrist must be aware of oedema as it can be a good indicator of venous insufficiency and lymphatic problems; and may also elicit other manifestations.
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Peripheral edema
Edema without a modifier usually refers to peripheral or dependent edema, the accumulation of fluid in the parts of the body that are most affected by gravity. In ambulatory people these are the legs, although in those who are bedbound the first manifestation may be sacral edema. If severe enough, peripheral edema may progress to involve the abdominal or even thoracic wall (this may be referred to as generalized edema or anasarca). In particular edema states (e.g. nephrotic syndrome, see below), periorbital edema (around the eyes) may be present.
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Some phenomena may distinguish different causes of peripheral edema. Most peripheral edema is pitting edema – pressing down will lead to a shift in the interstitial fluid and the formation of a small pit that resolves over seconds. Non-pitting edema may reflect lymphedema, a form of edema that develops when the lymph vessels are obstructed, or myxedema, which occurs in Grave’s disease.
Causes of peripheral edema are:
high hydrostatic pressure of the veins, leading to poor reabsorption of fluid
venous obstruction, e.g. deep vein thrombosis (typically one-sided)
congestive heart failure
varicose veins
asymmetric compression of thigh and leg (e.g., knee pads, tight jeans)
low oncotic pressure
cirrhosis
malnutrition
nephrotic syndrome (renal protein loss)
epidemic dropsy
obstruction of lymph drainage
infection
cancer
fibrosis after surgery
filariasis
inflammation (active secretion of fluid into the interstitial space due to increased membrane permeability by inflammatory mediators):
allergic conditions (e.g. angioedema)
any other form of inflammation (tumor – or swelling – is one of the main characteristics of inflammation)
Organ-specific Oedema
Edema of specific organs (cerebral edema, pulmonary edema, macular edema) may also occur, each with different specific causes to peripheral edema, but all based on the same principles. Ascites is effectively edema within the peritoneal cavity, as pleural effusions are effectively edema in the pleural cavity. Causes of edema which are generalized to the whole body can cause edema in multiple organs and peripherally. For example, severe heart failure can cause peripheral edema, pulmonary edema, pleural effusions and ascites.
Common and usually harmless appearances of cutaneous edema are observed with mosquito bites and skin contact with certain plants (urticaria).
Edema may be found in the eyes after corrective surgery.
Symptoms:
People with oedema may notice that a ring on their finger feels tighter than in the past, or they might have difficulty in putting on shoes, especially toward the end of the day. They may also notice a puffiness of the face around the eyes, or in the feet, ankles, and legs. When oedema is present, pressure on the skin, such as from the elastic band on socks, may leave an indentation that is slow to disappear. Oedema of the abdomen, called ascites, may be a sign of serious underlying disease and must be immediately evaluated by a doctor.
Modern Medical treatments:
Over the counter diuretics containing ammonia chloride and caffeine (Aqua-Ban) may be used to relieve symptoms related to oedema or water retention when taken five to six days before menses. More severe edematous conditions require medical attention.
Treatment of oedema with prescription medications is limited to the use of diuretics, commonly referred to as “water pills.†Agents often used include the thiazide diuretics, such as hydrochlorothiazide (HydroDIURIL), indapamide (Lozol), and metolazone (Zaroxolyn®); loop diuretics including furosemide (Lasix, bumetanide (Bumex), and torsemide (Demadex); and potassium-sparing diuretics, such as spironolactone (Aldactone), triamterene (Dyazide, Maxzide), and amiloride (Midamor).
Commonly, treatment consists of managing the underlying condition, which may include inadequate nutrition; liver, heart, and kidney disease; or obstruction of blood or lymph flow. In some cases, a salt-restricted diet may be recommended.
Dietary changes that may be helpful:
High salt intake should be avoided, as it tends to lead to water retention and may worsen oedema in some people. A controlled trial found that a low-salt diet (less than 2,100 mg sodium per day) resulted in reduced water retention after two months in a group of women with unexplained oedema.Strictly avoid fried & fatty food, salt and curd.Go for vegetables like drumstick, green banana,gourd, patola, bitter gourd, ripe papaya.
Lifestyle changes that may be helpful:
If the oedema is affecting one limb, the limb should be kept elevated whenever possible. This allows fluid to drain more effectively from the congested area. To decrease fluid build-up in the legs, people should avoid sitting or standing for long periods of time without moving.Do not indulge in daytime nap ,Move about and avoid sedentary habits .
Nutritional supplements that may be helpful:
Several double-blind trials2 have found that 400 mg per day of coumarin, a flavonoid found in a variety of herbs, can improve many types of oedema, including lymphedema after surgery. However, a large double-blind trial detected no benefit using 200 mg coumarin twice daily for six months in women who had arm oedema after mastectomy (surgical breast removal).6 (Coumarin should not be confused with the anticlotting drug Coumadin,)
A group of semi-synthetic flavonoids, known as hydroxyethylrutosides are also beneficial for some types of oedema. One double-blind trial found that 2 grams per day of hydroxyethylrutosides reduced ankle and foot oedema in people with venous disorders after four weeks.
Another double-blind trial found that 3 grams per day of hydroxyethylrutosides significantly reduced lymphedema of the arm or leg and lessened the associated uncomfortable symptoms.
A combination of the flavonoids diosmin (900 mg per day) and hesperidin (100 mg per day) has been investigated for the treatment of a variety of venous circulation disorders.
However, in a double-blind trial, this combination was not effective for lymphedema caused by breast cancer treatments.
In a preliminary study, individuals with lymphedema of the arm or head-and-neck region were treated with approximately 230 mcg of selenium per day, in the form of sodium selenite, for four to six weeks. A quality-of-life assessment showed an improvement of 59%, and the circumference of the edematous arm was reduced in 10 of 12 cases.
Because coumarin, hydroxyethylrutosides, and diosmin are not widely available in the United States, other flavonoids, such as quercetin, rutin, or anthocyanosides (from bilberry), have been substituted by doctors in an attempt to obtain similar benefits. The effect of these other flavonoids against oedema has not been well studied. Also, optimal amounts are not known. However, in one study, quercetin in amounts of 30–50 mg per day corrected abnormal capillary permeability (leakiness),13 an effect that might improve oedema. A similar effect has been reported with rutin at 20 mg three times per day.14 Doctors often recommend 80–160 mg of a standardized extract of bilberry, three times per day.
Whereas vitamin B6 is sometimes recommended for reducing oedema, no research has investigated its effectiveness.
Herbs that may be helpful
A double-blind trial found that a formula containing butcher’s broom extract, the flavonoid hesperidin, and vitamin C, which is used in Europe to treat venous and lymphatic system disorders, was superior to placebo for reducing lymphedema. The amount of butcher’s broom extract typically used is 150 mg two or three times per day.
Herbs that stimulate the kidneys were traditionally used to reduce oedema. Herbal diuretics do not work the same way that drugs do, thus it is unclear whether such herbs would be effective for this purpose. Goldenrod (Solidago cnadensis) is considered one of the strongest herbal diuretics.16 Animal studies show, at very high amounts (2 grams per 2.2 pounds of body weight), that dandelion leaves possess diuretic effects that may be comparable to the prescription diuretic furosemide (Lasix. Human clinical trials have not been completed to confirm these results. Corn silk (Zea mays) has also long been used as a diuretic, though a human study did not find that it increased urine output. Thus, diuretic herbs are not yet well supported for use in reducing oedema.
Aescin, isolated from horse chestnut seed, has been shown to effectively reduce post-surgical oedema in preliminary trials. A form of aescin that is injected into the bloodstream is often used but only under the supervision of a qualified healthcare professional.
Horsetail has a diuretic (urine flow increasing) action that accounts for its traditional use in reducing mild oedema. Although there is no clinical research that yet supports its use for people with oedema, the German government has approved horsetail for this use. The volatile oils in juniper cause an increase in urine volume and in this way can theoretically lessen oedema; however, there is no clinical research that yet supports its use for people with oedema.
Cleavers is one of numerous plants considered in ancient times to act as a diuretic. It was therefore used to relieve oedema and to promote urine formation during bladder infections.
Herbs :Punarnava (Borhaavia diffusa) and Hasti sundi
Ayurvedic Supplement: 1.Sothari Madhur, 2.Sothari Lauh. 3. Punarnavaristha (BUY)
Yoga Option:Pranayam and Meditation
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.
Resources:
http://www.allayurveda.com/ail_oedema.htm
http://www.latrobe.edu.au/podiatry/vascular/oedema.html
en.wikipedia.org
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