Swelling happens when fluid collects in small spaces around tissues and organs inside the body. Another word for swelling is "edema.” Some common parts of the body where people can have swelling are the lower legs or hands, belly, face and inside the chest (swelling can occur in the lungs or in the space around the lungs).

Swelling in the legs, hands, and belly can be uncomfortable and can be a symptom of a more serious condition. Swelling in the lungs can be life-threatening, because it is usually a symptom of a serious heart problem.

Symptoms of edema depend on the cause and they may include; swelling or puffiness of the skin, causing it to appear stretched and shiny. This is typically more noticed in the areas of the body that are closest to the ground (because of gravity). Therefore, edema is generally more seen in the lower legs (called peripheral edema) after walking about, standing, sitting in a chair for a period of time, or at the end of the day. It accumulates in the lower back (called sacral edema) after being in bed for a long period. Pushing on the swollen area for a few seconds will leave a dimple in the skin. Increased size of the abdomen may be experienced if the edema involves the abdomen (called ascites) and shortness of breath, and difficulty in breathing especially on lying flat in bed can be experienced with fluid accumulation in the lungs (with edema in the chest).

A common cause of edema in the lower legs is chronic venous disease, a condition in which the veins in the legs cannot push 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 sores (ulcers).

Pregnancy is usually associated retaining of a lot of body fluids, hence swelling commonly develops in the hands, feet, and face, especially near the end of a normal pregnancy. Swelling without other symptoms and findings is usually normal and not a sign of any complication of pregnancy.

Edema in women that occurs in a cyclic pattern (usually once per month) can be the result of hormonal changes related to the menstrual cycle. This type of edema is common but does not require treatment because it resolves on its own.

Edema can be a side effect of a variety of medications, including some oral diabetes medications, high blood pressure medications, non-prescription pain relievers (such as ibuprofen), and estrogens.

Heart failure, also called congestive heart failure, is due to a weakened heart, which impairs its pumping action. Heart failure can cause swelling in the legs and abdomen, as well as other symptoms. Heart failure can also cause fluid to accumulate in the lungs (pulmonary edema), causing shortness of breath. This can be a very dangerous condition requiring emergency treatment.

Liver cirrhosis, a liver condition in which the liver has been damaged and formed scars from various causes such as long standing alcohol use, hepatitis, can cause pronounced swelling in the abdomen (called ascites) or in the lower legs (peripheral edema).

Kidney diseases such as kidney failure can be associated with morning puffiness of the face and swelling of the legs, and the puffiness in the face usually goes away as the day goes by.

Sitting for prolonged periods, such as during air travel, can cause swelling in the lower legs. This is common and is not usually a sign of a problem, although if one’s leg(s) remain swollen or develops leg pain hours or days after the flight, medical attention needs to be sought as continued swelling and pain of the leg can be a sign of a blood clot (DVT).

Treatment for the medical condition that is causing the swelling will lead to regression of the edema and the associated symptoms. Other modifications such as; diet changes to reduce the amount of salt in the food that you eat, medicines to help your body get rid of extra fluid, special socks called compression stockings, these fit tightly over the ankle and leg, and can reduce leg swelling. If your doctor or nurse recommends that you wear them, he or she will tell you which type to wear and how to put them on, raising the legs up can help reduce swelling of the legs and some people can reduce swelling in the legs, ankles, and feet by raising their legs up three or four times a day for 30 minutes each time. The legs need to be raised above the level of the heart, for example, by placing your legs and feet over pillows while lying down.

It is important to know that not all types of swelling need medical treatment. For example, swelling that occurs during pregnancy or before monthly periods usually does not need treatment.

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospitaliangashugi@gmail.com