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Swollen legs: what helps?
The treatment of swollen legs should always be based on the causal diseases. However, it is often possible to achieve a significant improvement in the short term just by putting your feet up. The causes of the complaints are not resolved in this way. Only the outflow of blood is facilitated, since this no longer has to be pumped towards the heart against gravity. Cold leg castings and foot exercises can also have a positive effect on leg swelling, but they also do not help to remedy their causes in the long term.
Treatment of venous disorders
In the case of venous disorders, lifting up the legs usually promises to reduce the excessive pressure in the vessels, which can significantly reduce the risk of further health problems. With a thrombosis, however, putting the legs up has the opposite effect and the symptoms tend to increase. Exercises and physiotherapy to promote blood circulation and general strengthening of the cardiovascular system can also be considered as supportive measures in the treatment of venous disorders. In addition, the reduction of possibly existing excess weight is mostly part of the therapy. Tinctures, creams and ointments, for example based on horse chestnuts, which are said to have vascular strengthening and anti-inflammatory effects, can also be used for less severe venous diseases. However, further measures are usually essential to long-term remedy of the vein problems as the cause of the swollen legs.
In the treatment of venous diseases, so-called compression stockings are used more often, which build up external pressure, thus promoting blood drainage and preventing leg swelling. In principle, compression stockings are available in different versions for the treatment of varicose veins, calf or leg vein thrombosis, lymphedema and the so-called post-thrombotic syndrome (damage to the deep veins after thrombosis). Diuretics are also part of the therapy, although the patient's fluid balance should be given special consideration. The diuretics should only be used after consulting a doctor.
Treat varicose veins
If varicose veins are the cause of leg swelling, a surgical procedure is carried out relatively frequently, which can be carried out in different forms depending on the form. For example, in the case of superficial varicose veins, obliteration using a laser or other methods is conceivable. In the case of more severe varicose vein disorders, interventions such as the so-called crossectomy are used. The mouthpiece of the largest superficial leg vein is cut out into the main leg vein. This is often followed by so-called vein stripping, in which the sections of the veins affected by varicose veins are cut out and removed. After vein stripping has been completed, those affected usually receive a compression stocking that they should wear for several weeks. In addition, anticoagulants such as those used in the treatment of phlebitis are often prescribed for a few days to minimize the risk of thrombosis.
Venous thrombosis: treatment
Once the diagnosis of venous thrombosis has been established, treatment with the anticoagulant heparin is usually carried out to prevent an enlarged blood clot and to minimize the risk of pulmonary embolism. As soon as no further platelets are deposited on the clot, the body's own breakdown, the so-called fibrinolysis, of the thrombus can begin. The enzyme plasmin takes over the breakdown of the existing blood clot, however, substances are released which increase the blood clotting and thus entail the risk of a new thrombosis. Therefore, even after the venous occlusion has been removed, patients continue to receive anticoagulant drugs (so-called coumarin derivatives), most of them only for a few months, but some of them all their lives. This requires continuous medical checks. Because the blood coagulation of the patient is often reduced in such a way that even minor injuries can result in considerable blood loss. There is also an increased risk of internal bleeding. Compression stockings and bandages are usually used in the course of therapy for leg vein thrombosis. In addition, the thrombus may be surgically removed.
Treatment of lymphatic disorders
If an impaired lymphatic drainage is the cause of the swollen legs, special massages, compressions and movement exercises can help to reduce the swelling. If these physical measures are started early, the lymphatic drainage can be completely stabilized again in the long term. However, if there is already extensive damage to the lymphatic vessels, the treatment can only help to alleviate the symptoms and must be repeated regularly.
So-called lymphatic drainage is a frequently used treatment method to promote the removal of body fluids. With this form of decongestive therapy, the lymphatic drainage is stimulated by gentle massage. Compression stockings and bandages are also well suited for therapy in the case of lymphedema. In addition, physiotherapy can make a contribution to improving lymphatic drainage. If a bacterial infection such as erysipelas is the cause of the lymphatic disorders, high-dose intravenous antibiotics are usually used.
However, the resulting lymphedema cannot usually be treated with medication, but requires the physical therapy measures mentioned above. If inflammation or allergic reactions of the skin occur at the same time, some doctors prescribe accompanying cortisone or antihistamines. Surgery also offers a way to combat lymphedema. However, doctors only resort to surgical measures such as lymphatic vessel transplantation (removal of healthy lymphatic vessels from the patient elsewhere and re-implantation to replace the damaged lymphatic vessels) or the establishment of a vascular connection between lymphatic vessels and venules in the event that the aforementioned therapeutic approaches or tumors fail. As a rule, such serious interventions are not necessary, since usually the lymphatic disorders can be successfully treated on the basis of the physical treatment methods.
Treatment approaches for heart failure
Even with chronic heart failure, the reduction of existing excess weight, healthy nutrition and physical exercise play an important role in counteracting the worsening of the clinical picture. In addition, there are medications that support the functioning of the heart and / or are supposed to regulate blood pressure. Furthermore, depending on the symptoms of chronic heart failure, diuretics are sometimes used to drain the fluid accumulations via the urinary tract.
There is also the option of using medicines such as statins to lower cholesterol levels in the blood in order to avoid further impairments of the cardiac function. If the blood flow is slowed down to such an extent that there is a risk of thrombosis, anticoagulant medication may also be used for chronic heart failure. There are a number of medications available for the treatment of chronic heart failure, but these should be used with caution, not least because of the impending side effects.
In the case of particularly severe forms of cardiac insufficiency, a surgical intervention may be necessary in which the narrowed coronary arteries are dilated by a so-called balloon catheter. The implantation of a stent (vascular support) can then prevent the vessels from closing again. Bypass surgery may also be considered for chronic heart failure. The damaged coronary arteries are bypassed by an inserted vein or artery or appropriate vascular prostheses to ensure the blood supply to the heart muscle.
Other surgical interventions that are considered for chronic heart failure include surgery to correct heart valve defects (mostly minimally invasive heart valve surgery), pacemaker implants and the use of defibrillators. If the heart is severely damaged, a heart transplant may remain the last option. Since the heart weakness usually develops over years and often a worsening of the condition can be avoided with relatively simple countermeasures (healthy eating, exercise, abstaining from alcohol and tobacco), early diagnosis is particularly important here.
Therapy for kidney diseases
The first goal in kidney disease is to avoid further damage to the organ. For this purpose, a lowering of the blood pressure, a correct setting of the blood sugar and the basic renunciation of substances that damage the kidneys (for example medication) are provided. Those affected should also take care to drink enough fluids and possibly reduce their protein intake when eating. Otherwise, the therapeutic measures should be based on the causes of the kidney problems. For example, appropriate antibiotics are used for acute bacterial inflammation. If, on the other hand, an autoimmune disease is the cause of kidney failure, drugs are used to suppress the immune response. If relief cannot be achieved with the help of the medication, those affected often only have dialysis (blood purification). If the kidneys are permanently damaged, patients are dependent on dialysis for the rest of their lives or a kidney transplant is carried out using a healthy donor organ.
Treatment of liver disease
In the case of liver diseases, it is imperative that all cell-damaging substances - especially alcohol - be avoided. A possibly existing vitamin deficiency should also be compensated for by taking appropriate preparations and, under certain circumstances, the protein intake should be limited. In principle, the necessary medical measures must be based on the causes of the liver disease. With alcohol addiction, withdrawal therapy is recommended, with hepatitis, however, a medication against the viruses. However, if the function of the organ cannot be restored, the only remaining remedy here is the transplant. Separate treatment methods are provided for the side effects of liver diseases, such as the so-called ascites.
Thyroid disorders: treatment
If the thick legs are caused by a thyroid disorder, medical treatment of the symptoms is usually indicated. In the case of hypothyroidism, the missing thyroid hormones are replaced by medications such as levothyroxine in order to avoid further health problems. If the thyroid gland is permanently damaged and enough hormones cannot be made available in the long term, patients will have to rely on the appropriate medicines for the rest of their lives. If there is a suspicion that acute inflammation of the organ is the cause of the underfunction, this is also treated with medication. The dosage in which the thyroid hormones are to be taken differs depending on the clinical picture and should therefore be determined by the doctor individually for each patient. Medical care is urgently required, since an underactive thyroid gland threatens long-term significant further, in the worst case fatal health effects.
In the case of hyperthyroidism, medical care primarily provides for the use of so-called thyrostatics, with the help of which the hyperfunction should be eliminated. The drugs are often sufficient to defeat the disease in the long term, but life-long medication may also be required here. Under certain circumstances, those affected may face an operation to remove a so-called goiter (including goiter, visible enlargement of the thyroid gland) or to remove lumps in the tissue. Radioiodine therapy can also be used for hyperthyroidism, whereby this method takes advantage of the fact that iodine - including radioiodine - is only stored by the thyroid gland. A very high radiation dose can be achieved in the thyroid tissue without disproportionately stressing the rest of the organism. The programmed cell death is triggered by the radiation exposure and the function of the thyroid gland ideally returns to a normal level. However, the treatment does not always show the desired success.
Swollen legs: naturopathy
In naturopathic therapy for leg swelling, measures are primarily used to stimulate the outflow of body fluids from the legs and to remove drainage inhibitors. However, if the swollen legs are based on a structural disease, this treatment method can hardly improve. Elevating the legs, Kneipp cures with cold leg castings, gymnastic exercises to strengthen the muscle pump (support of the blood circulation through the movements of the muscles), special breathing techniques and mechanical treatment methods such as osteopathy or Rolfing are often part of a naturopathic treatment of the thick legs . Active ingredients from the field of herbal medicine, such as the ingredients of horse chestnut or stone clover, can also be used to strengthen the vessels and support lymphatic drainage. Massages to promote blood circulation and lymphatic drainage are also often part of naturopathic treatment.
Complementary procedures are also occasionally used in naturopathy to treat swollen legs. The choice of homeopathic remedies for treating thick legs is rather small, but there are also opportunities here. For example, the homeopathic active ingredient of the stone flower (Flor de piedra) is said to have a positive effect on venous congestion. Well-tried home remedies for water in the legs have also proven to be effective. Experienced therapists have a total of numerous naturopathic treatment methods available, which can be used to combat leg swelling. In an emergency, however, further medical measures are essential to avoid life-threatening impairments of the patients. (fp)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters
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- Gerd Herold: Internal Medicine 2019, self-published, 2018
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