In depth into symptoms and conditions: edema (part 2)

Causes of swelling in the legs

Venous Insufficiency

Venous insufficiency is a condition where the veins in the legs start to fail to efficiently return blood to the heart. This pooling causes pressure to push fluid out of the circulatory system into the lower legs. Similar to the river that overflows its banks and floods a neighborhood. This often results in a heavy feeling in the legs that can be relieved with elevation. In extreme cases red blood cells squeeze out of the veins causing red staining of the shins, and when the fluid pressure becomes so great the fluid actually begins to push out through the skin.

What are the risks of untreated Venous Insufficiency

Left untreated there is increased risk of infections (cellulitis), surface wounds (stasis dermatitis), and permanent damage to the tissues from the excessive stretch and pressure. It is important that patients with venous insufficiency work with their health care providers to develop long term management strategies to avoid chronic infections and permanent tissue changes. Unfortunately, many of the patients that I have met over the years have been given the misguided impression that they need to “just live with it”. Nothing could be further from the truth, and I will be discussing management strategies in Part II of this article.

Swelling in Congestive Heart Failure (CHF)

Swelling can also be a symptom of a serious health condition, congestive heart failure. With congestive heart failure, the fluid builds up in the extremities due to the inefficiency of the pump (heart) to move fluid through the circulatory system causing it to pool and leak out into the interstitial space (typically in the lower legs). Swelling that is the result of congestive heart failure is serious and requires careful monitoring and management by your healthcare team. Management strategies are often employed by therapists in conjunction with good medical management to improve function and quality of life.

Persistent swelling in breast cancer

The most common form of cancer associated with persistent swelling is breast cancer. Although the vast majority of cases of persistent swelling involve the lower extremities, the after effects of breast cancer treatment involve swelling of the upper extremity. Unfortunately, breast cancer often infiltrates the nearby lymphatic system, and the surgical interventions and radiation treatments can all result in damage to the lymphatic system. As a result, fluid movement in the affected upper extremity becomes compromised resulting in persistent swelling. Advances in surgical intervention techniques and targeted radiation have thankfully reduced the incidence of persistent swelling (lymphedema). In addition, Oncologists have worked with lymphedema therapists to ensure effective management strategies for breast cancer patients.

Primary Lymphedema

The last cause of swelling we will discuss as part of this article is Primary Lymphedema. This is when people experience swelling due to a genetic predisposition. Just like some of us are tall or short, the efficiency of our lymphatic system has a genetic component. This inefficient lymphatic system although rare may be present and observable from birth, or first noticed during a period of increased demand such as pregnancy or injury.

As you can see there are many causes of swelling but regardless of the cause, it is important to recognize that swelling is an abnormal condition and the longer it persists the greater the risk for permanent tissue damage and secondary complications such as wounds or infection. If you have persistent swelling it is important that you discuss management options with your medical provider knowing that you don’t have to “just live with it”. In the Part II of this article we will discuss treatment options and management techniques employed to address swelling issues.

Steve Johnson DPT is a Physical Therapist from the La Crosse area with over twenty years of clinical practice experience and has been Lymphedema Certified Therapist since 2004.