Water retention

The causes of water retention or oedema can be Heart failure, Liver Cirrhosis, Kidney Nephrotic syndrome and other forms of renal disease, Drug Induced, and or premenstrual edema and pregnancy

1.    Chronic venous disease — A common cause of leg edema is chronic venous disease, a condition in which the veins in the legs cannot pump enough blood back up to the heart because the valves in the veins are damaged. This can lead to fluid collecting in the lower legs, thinning of the skin, and in some cases, development of skin ulcers.

2.    DVT:  Edema can also develop as a result of a blood clot in the deep veins of the lower leg (called deep vein thrombosis). The edema is usually limited to the feet or ankles and may affect only one side (the left or right). 

3.     Pregnancy — Pregnant women retain extra fluid. Swelling commonly develops in the hands, feet, and face, especially near the end of pregnancy. It is not necessarily a sign of toxemia.

4.    Monthly menstrual periods — Edema in women that occurs during mensesd can be due to hormonal changes related to the menstrual cycle. This is is common, but does not require treatment because it resolves on its own.

5.     Drugs — Edema can be a side effect of drugs including some oral diabetes medications, high blood pressure medications, non-prescription pain relievers (pain killers), and estrogens.

6.     Kidney disease — The edema of kidney disease can cause swelling in the lower legs and around the eyes.

7.     Heart failure: here the heart is weakened and its pumping action is impaired. It can cause swelling to develop in the legs and abdomen, as well as other symptoms. Heart failure can also cause fluid to accumulate in the lungs causing shortness of breath.

8.     Liver Cirrhosis — People with cirrhosis can develop pronounced swelling in the abdomen or in the lower legs.

9.    Travel — Sitting for prolonged periods, such as during air travel, can cause swelling in the lower legs. If the leg(s) remain swollen or one develops pain hours or days after the flight one shoud consult the doctor. 

Drugs

1.    Certain drugs can induce edema by enhancing renal sodium reabsorption. Examples are pain killers, minoxidil and diazoxide. The mechanism by which these agents stimulate sodium retention is uncertain.

2.     Peripheral edema occurs in 4 to 6 percent of diabetic patients treated with a thiazolidinedione such as pio or rosiglitazone (compared to 1 to 2 percent with placebo) and in a higher percentage of patients with a history of heart failure or those also treated with insulin. The mechanism is stimulation of sodium reabsorption by the sodium channels in the luminal membrane of collecting tubule cells, which is the same site stimulated by aldosterone.

3. Calcium channel blockers, particularly the dihydropyridines in which leakage out of the capillary due to dilatation of the precapillary sphincter appears to be of primary importance.
4. Nonsteroidal antiinflammatory drugs inhibit renal prostaglandin synthesis and can exacerbate edema in patients with underlying heart failure or cirrhosis.
5. Fludrocortisone is a synthetic mineralocorticoid used in the treatment of hypoaldosteronism and orthostatic hypotension. Although this drug initially causes fluid retention, edema is unusual because of the phenomenon of mineralocorticoid escape.
6. Estrogens (alone or in oral contraceptives) may promote sodium retention, primarily in patients with impaired estrogen metabolism due to hepatic disease.
7. Pramipexole , a dopamine-agonist utilized in patients with Parkinson disease and restless legs syndrome, causes peripheral edema in approximately 5 percent of patients; this effect appears to be dose-related but the mechanism is uncertain.
8. Docetaxel, used in the treatment of metastatic breast cancer, produces fluid retention that is cumulative and often dose-limiting

Treatment includes several components: treatment of the underlying cause (if possible), reducing the amount of salt (sodium) in the diet, and in many cases, use of a medication, called a diuretic, to eliminate excess fluid. Compression stocking and elevating the legs may also be recommended.

Not all types of edema require treatment. Edema related to pregnancy or menstrual cycles is not usually treated. Peripheral edema and ascites are usually treated slowly to minimize the side effects of rapid fluid loss (such as low blood pressure).

Sodium, which is found in table salt, can worsen edema. Reducing the amount of salt you consume can help to reduce edema, especially if you also take a diuretic.

Diuretics are a type of medication that causes the kidneys to excrete more water and sodium, which can reduce edema. Diuretics must be used with care because removing to much fluid too quickly can lower the blood pressure and impair kidney function.

You may have to empty your bladder more frequently for several hours after taking a loop diuretic. However, other side effects are uncommon when diuretics are taken at the recommended dose.

Leg edema can be prevented and treated with the use of compression stockings. Stockings are available in several heights, including knee-high, thigh-high, and pantyhose. Knee-high stockings are sufficient for most patients. Some stockings can cause skin irritation or pain, although proper measurement and fitting of the stockings can reduce the risk of discomfort.

Effective compression stockings apply the greatest amount of pressure at the ankle and gradually decrease the pressure up the leg.

Leg, ankle, and foot edema can be improved by elevating the legs above heart level for 30 minutes three or four times per day. Elevating the legs may be sufficient to reduce or eliminate edema for people with mild venous disease, but does not usually help in more severe cases. In addition, it may not be practical for those who work to elevate their legs several times per day.

 Do not indulge in non supervised early morning water therapy. If your kidney functions are compromised it can be risky and lead to water retention. Ask your doctor to evaluate your kidney functions which can be measured by a simple formula 140- age x weight in kg divided by 72 x serum Creatinine. This value is to be multiplied by 0.85 in women. The function should be more than 90%.