Swelling in one leg (peripheral edema) usually suggests a problem with the venous or lymphatic system. Your health care provider can tell if you have this condition by pressing on the swollen area of your skin for 15 seconds and looking for a dimple (pit).
The swelling could be caused by a blood clot deep in your vein or a tumor blocking fluid flow. It can also be due to an infection or inflammation.
Causes
Fluid retention causes the skin to look puffy, shiny or stretched. This condition affects any part of the body but is most common in the legs, ankles and feet. Swelling may cause pain or a feeling of fullness or tightness. It can be caused by many things, including:
The most common cause of leg edema is venous insufficiency. This is when the veins in the legs weaken and don’t properly pump blood up toward your heart. This causes the blood to pool in your lower legs, causing swollen feet and legs. Venous insufficiency is more common as you get older, and it can be hereditary. It’s also more likely to affect women than men.
Another common cause of edema is a blood clot in the leg veins. This is called deep vein thrombosis, or DVT. It happens when a clot forms in one of the blood vessels in your legs, usually in the calf. This is a serious medical problem that needs to be treated right away.
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Other causes of edema include poor circulation, infections or injuries. It can also be a side effect of some drugs, such as diuretics (water pills). These medicines help flush salt and extra fluid out of the body through your urine.
Swelling can also be a sign of an underlying health problem, such as heart failure, liver disease or kidney problems. It’s also common during pregnancy or before and after a baby is born.
Other conditions can cause swollen legs and feet, including varicose veins, which are weakened veins. It can also be a sign of low protein in the blood, which is called hypoalbuminemia. This happens when the body doesn’t have enough of a protein called albumin, which helps keep fluid in blood vessels. In some cases, a doctor may order a blood test to check your protein level. If it’s low, he or she might recommend a special diet to improve your protein intake. In other cases, a doctor might prescribe a medicine to treat the underlying health condition. This could include a blood thinner, such as warfarin (Coumadin). It might also include other medicines to control your symptoms or reduce fluid buildup.
Symptoms
The fluid that accumulates in the legs is called edema. It may indicate a serious health problem or it may be temporary, depending on the cause. It is important to recognize the symptoms of leg edema so that you can get prompt medical attention.
The severity of a swollen leg can be assessed by how deep or “pitted” the skin becomes when pressure is applied. Your doctor will gently press on the swollen area of your leg and record the depth of the depression and how long it takes for the pressed area to return to its normal appearance, then rate the edema on a scale of 1 to 4, with 4 being the most severe. Pitting is usually a sign of peripheral edema but lymphoedema (blockage in the lymphatic system) doesn’t tend to pit so easily.
If the swelling is painful, warm to the touch, has a reddish tinge, or appears infected with blisters and ulcers, it could be a sign of a DVT or a more serious infection. If the swollen leg suddenly gets worse, if you are having chest pain or trouble breathing, or if the swollen leg has a black or purple coloration, seek emergency medical attention because these can be signs of pulmonary edema, a life-threatening condition in which fluid leaks into the lungs.
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Symptoms of the more serious conditions that can cause leg edema include shortness of breath, feeling tired all the time, and having blood in your urine. You may also have a fever, feel bloated or have abdominal pain.
Treatment for leg edema depends on the underlying cause. A low-salt diet, elevating your legs when sitting, and wearing compression stockings are the first treatments that you should try. A prescription diuretic—a water pill—can help reduce fluid retention in some people, especially when combined with other treatment options. Exercise can also be helpful, because it works the calf muscles to push the fluid toward your heart. Surgery is sometimes needed to improve the flow of blood through leg veins. You can also try taking a supplement of horse chestnut seed extract, which is thought to help with circulation.
Diagnosis
A vascular specialist can evaluate your symptoms and determine the cause of the swelling. A full history and physical exam is essential. This includes questions about any recent trauma or surgery, whether the limb is one or both, medication you take including calcium channel blockers and heart medications (especially if taken for more than a few weeks) and your family history of vascular disease and other serious illnesses.
Your vascular specialist may do blood tests, a chest x-ray and an electrocardiogram (EKG) to see how well your heart is working. They might also order ultrasound tests of your arteries and veins. These can show whether your arteries are narrowing or whether you have a blood clot in a vein. They can also determine if you have an infection, a ruptured cyst at a joint or cellulitis (infection of the skin and fatty tissue).
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If you are not at risk for DVT and your edema is mild, it might go away on its own if you lie down or change positions often. Elevating your legs (raising them above your heart) several times a day might help, too. Wearing compression stockings might also reduce edema in some people. You can buy these in pharmacies and online.
A doctor might give you a medicine called a diuretic (water pill). These work by making your body get rid of more fluid through urine. You might be advised to eat a low salt diet and to drink less water. Your doctor might recommend exercise and a leg raise while sleeping to improve the flow of blood and reduce swelling.
You might need a procedure, such as an ultrasound guided compression therapy or surgery to treat the underlying problem causing your edema. For example, if you have DVT, your doctor might use a treatment called a vena caval filter to prevent a clot from forming in a deep vein in your leg. This is more common in the calf, but it can be done in other areas of your leg as well. This is a safe, effective treatment and it can be performed in an outpatient setting.
Treatment
For most people, treating edema is a matter of changing habits and taking medicines. Swelling from a minor injury may resolve on its own, but more severe or persistent swelling requires medical care. It’s important to identify the cause of the edema so that the right treatments can be used.
A doctor can usually tell whether the edema is due to something simple, such as pregnancy, or to more serious conditions, such as heart disease or liver problems (cirrhosis). Treatment will depend on the underlying cause.
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If the edema is caused by fluid retention, the doctor will likely recommend that you reduce your salt intake. The doctor may also recommend that you elevate the affected area several times a day to encourage fluid drainage. This can be difficult, especially for people who sit for long periods of time at work or on a long car ride or flight.
Other treatment options for edema include medicines, such as diuretics to help your body get rid of excess fluid, or compression stockings or sleeves. These can be worn on the legs, arms, or chest.
If you have a condition that causes you to retain water or salt, such as congestive heart failure, kidney disease, liver disease (cirrhosis), or thyroid problems, your doctor will prescribe a medicine to treat the underlying problem.
If you have a sudden or severe swelling in your ankles, feet, hands, or arms, call your doctor immediately. The swelling could be a sign of a serious condition, such as a blood clot in your leg (deep vein thrombosis or DVT). If this clot breaks off and travels to your lung, you might have pulmonary edema, which can be life-threatening. Other signs of pulmonary edema include chest pain and difficulty breathing. If you have these symptoms, seek emergency care.
