Swelling of the Legs

Swelling of the legs is a common symptom that most of the patients complain about. Sometimes, the swelling starts with its appearance after prolonged travel that often gets dismissed. When the swelling becomes a bit more, then it gets attention.

Body Fluid Distribution:

Swelling of the Legs

It is interesting to note that 60% of the body weight in men and 50% of the body weight in women is due to water. This water is distributed into two different compartments – intra-cellular i.e., inside the cells (2/3rds of the fluid) and extra-cellular (1/3rd) compartments.

The extra cellular fluid again can be inside the blood vessels (intra-vascular) and interstitial compartments. The movement of fluid from inside the blood vessels to outside causes edema formation.

What Keeps the Fluid in Its Normal Locations?

The proteins in the blood exert pressure and keep the fluid within it. Whenever the protein content in the blood goes down, the fluid comes out of the blood vessels and edema appears. Kidney diseases cause urinary protein loss and decrease blood protein content. Similarly, liver diseases cause decreased protein production, loss of protein in chronic diarrhea and decreased protein intake – all cause edema formation.

Swelling of the Legs

Increased fluid content inside the blood vessels pushes the fluid outside the blood tubes. Kidney diseases, where there is a decreased ability to make urine, and heart failure cause edema formation.

What Are the Common Locations of Fluid Accumulation?

Generally, fluid accumulates in the legs. When the individual lies down, then it redistributes itself to the back. That’s why, when the patient lifts the legs by keeping pillows under the legs, it appears that the swelling becomes less and it gives a false sense of reassurance to the patient.

Liver diseases generally cause abdominal fluid accumulation. Heart failure usually causes fluid to accumulate in the lungs and the patient feels breathless, especially when he sleeps at night

Are There Any Other Reasons for Swelling?

One-sided leg swelling is always due to local factors – varicose veins, lymphatic blocks, local infections, etc.

Few commonly used drugs for blood pressure reduction (amlodipine, nifedipine) and blood sugar control (pioglitazones) cause swelling.

Dos and Don’ts:

  • Never ignore when you get swelling of feet.
  • Keeping a pillow while sleeping only redistributes the swelling.
  • Get a regular health check-up to identify the reason for the swelling and get it treated in its initial stages itself.
  • Avoid taking medications for swelling without identifying the reason for it.
Dr R Balasubramaniyam

Dr R Balasubramaniyam
Chief of Nephrology
Kauvery Hospital Chennai


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