Edema Is a common problem often ignored

BY W. GIFFORD- JONES MD & DIANA GIFFORD-JONES

What is one of the most common health problems that develop in people as they age, and also one of the least discussed? The answer is chronic swelling of the legs. At best, it’s a natural consequence of aging, but also known as peripheral edema, there can be: medical, nutritional, or lifestyle causes and serious health consequences.

Edema is a general term meaning swelling. Peripheral edema occurs in the: legs, ankles, feet, as well as arms and hands. Swelling in other parts of the body include: pulmonary edema (in the lungs), cerebral edema (in the brain), and macular edema (in the eye). It’s a medical emergency when the lungs or brain are affected, and a life-altering condition when vision is impacted.

In the legs, while victims must deal with pain, weakness, and limitations on mobility, for many, there is a sense of stigma, when once shapely or muscular legs have become less sightly. That’s at least one reason why there’s not a lot of information about how many people are suffering from the condition. In the minds of sufferers, it doesn’t warrant a visit to the doctor, and clothes can help conceal the issue, if not make it go away.

One research team at the University of Rochester used data from the American Health and Retirement Study, a nationally representative longitudinal survey of about 20,000 U.S. adults over the age of 51, to estimate prevalence of the condition, which they found to be 19-20% of survey respondents.

They also found social disparities among those reporting lower limb edema. Blacks/African Americans and other racial minorities, women, and less wealthy individuals were more affected. As is the case with many other health conditions, the researchers reported, “Minority racial status and lower wealth could be associated with peripheral edema for multiple reasons, including higher rates of other chronic health conditions as well as lower access to healthy foods and preventive care services.”

What is causing edema is not always easy to determine. For the individuals involved, it can be hard to know if the swelling is the result of fluid gathering in the tissue. Or is it from the build-up of fat? Known as Lipedema, it is fat, not fluid, that occurs in the limbs, and in the early stage, people do not typically have: diabetes, high cholesterol, or high blood pressure, but peripheral edema is an accumulation of fluid.

Causes of fluid build-up can be long periods of sitting or standing. Pregnant women can develop the condition, as can people with low levels of protein in the diet.

More sinister causes are also common, including chronic lung diseases or congestive heart failure, when the heart muscle doesn’t pump well. Chronic venous insufficiency occurs when leg veins fail to carry blood back up to the heart. When valves that normally ensure blood flows toward the heart don’t work well, gravity takes over, causing blood to pool in the legs.

Depending on the cause, the treatment should be tailored. This is not the time for armchair medicine. An accurate diagnosis depends on a full medical history and potentially a battery of tests to pinpoint the issue.

Keep in mind; it’s better to treat the underlying cause than the symptom. Raising the affected limbs will help. Diuretics can also help but need to be used with care as removing too much fluid too quickly can, among other things, impair kidney function.

Attention to diet, consistent moderate exercise, and maintenance of a healthy weight should be the goal – early in life, and all lifelong.