Swollen legs can be a sign of this common condition

Swelling in the legs, also known as edema, can be a nuisance and often painful and even dangerous. By understanding what the condition is and how it works, you can take steps to relieve it.

Edema is a common ailment, more so in women, especially as we get older. It occurs when a person’s legs swell, due to an effusion of fluid into the tissue. Part of the reason it occurs is because of our anatomy, explained Vascular Surgeon James Knox, MD, of the Vascular and Vein Center of Cape Cod – Falmouth. The heart pumps blood through the arteries down to our feet, but we don’t have a pump in our feet to return the blood to the heart.

Instead, we have veins and lymphatics in our legs that rely on a series of one-way valves to direct blood and fluid back to the heart. The problem is those valves are fragile and prone to failure.

“Since we spend most of the day standing or sitting with our feet below the level of the heart, with gravity fluid accumulates in our lower legs,” he said. “So, that’s kind of a physiologic disadvantage and it’s really amazing that more of us don’t have edema.”

Some of the most common causes of edema in our legs, according to Dr. Knox are:

• Chronic venous insufficiency which is when the valves stop working in our veins and the blood pools in the legs. Patients with chronic venous insufficiency may have more varicose veins, more swelling, more discoloration, and leg ulcers.
• Lymphedema is when we have an inadequate number of lymphatics to drain the protein-rich fluid and waste products from our legs. Lymphatics can also be damaged by surgery or radiation treatments. Lymphedema causes the skin to be more prone to cellulitis and infection because the lymphatics help clear out infections. Unfortunately, cellulitis can make lymphedema worse, which then makes the cellulitis worse.
• Lipedema is when we develop hypertrophy of fatty tissue in the legs, making them large and uncomfortable.
• Pelvic venous disorders such as May-Thurner Syndrome may occur when the iliac veins in the pelvis get compressed or narrowed, which can result in swelling in the legs. If it is severe, a stent can be placed to relieve the obstruction.

“For most people, it’s a combination of lymphatics and veins that aren’t emptying well and consequently we get swelling,” Dr. Knox said. “It’s more common in women.”

Doctors suspect that hormones contribute to the reason women are more prone to edema, he said. Estrogen may increase sodium retention and relax the smooth muscle cells in the vessels, so the vessels dilate. Then more fluid builds up, which creates more pressure. That makes the valves more incompetent, which makes it more difficult to get the fluid out of the legs.

Other Culprits

Other causes of edema include side effects from medications, like NSAIDs, and calcium channel blockers, like Amlodipine, which is used to control hypertension. Those medications dilate the blood vessels and cause fluid accumulation.

It’s important to rule out other things that can cause swollen legs, according to Dr. Knox. If one leg swells up, especially after a plane trip or during or shortly after pregnancy, it could be a blood clot. A family history of blood clots also increases your risk. An ultrasound is used to detect any blood clots and, if you have one, your doctor will prescribe a blood thinner.

If a patient has edema accompanied by shortness of breath, doctors make sure it’s not heart failure or liver, kidney, or thyroid problems, he said.

Mitigation Options

Unfortunately, there is no quick cure for edema. If the edema is caused by venous insufficiency, there is no magic medicine, cream, vitamin, or diet that makes it go away. Dr. Knox recommends that patients buy a wedge-shaped pillow to prop up the legs.

“We generally tell patients to elevate the legs above the level of your heart for about 15 minutes at a time five times a day,” he said. “And then, at night, a wedge pillow can help, or you can raise the foot of your bed. Elevating well above the level of your heart at night in bed is an eight-hour therapy session for your legs. It’s free of charge and it doesn’t take up any extra time out of your day. That can really be much more helpful than people realize.”

Some patients who are able to lie on the floor put their legs against the wall for their 15-minute elevation sessions. Others put their legs over the back of the couch.

Dr. Knox also recommends prescription support stockings during the day. The prescription ones are fitted specifically for your legs. Many of the over-the-counter stockings are designed so they don’t fall down, which can make the band at the top too tight. It can create a tourniquet effect that makes the swelling worse because it blocks the outflow of fluid.

“If people can’t get stockings on, there are also fitted Velcro wraps that they measure you for,” he said. “You strap the Velcro a little bit tighter down at the ankle and it has a mark for how tight to wrap the Velcro. It’s less tight as you are moving up the leg so you’re not having a tourniquet up high, but it’s tighter near the ankle.”

Other suggestions to help decrease edema are eating a low-sodium diet of under 2,300 milligrams of sodium a day, daily exercise, and weight loss.

“Exercise is so important because, as our calf muscles work, that helps propel the venous blood and fluid out of our legs,” he said. “If we are more sedentary, that doesn’t happen. Walking can make a big difference.”

Manual lymphatic massage or compression with pneumatic pumps can also help. For the pump, you put a big boot on that goes up to your thigh, zip it up, plug it in and it will sequentially inflate to help remove the fluid from your legs. People do that for about an hour twice a day, Dr. Knox said.

Another form of therapy that Dr. Knox recommends is swimming or exercising in a pool. The pressure and weight of the water acts like a compression stocking. The pressure is greater at your feet with less pressure up closer to your thigh, so it helps squeeze the fluid out of your leg.

“If you’re swimming, you’re horizontal so that’s good, but even if you are walking in the water, the weight of the water is acting like a stocking on your leg,” he said.