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"Oidema" means swelling in ancient Greek. An older term for edema in the body is dropsy. The most important facts about water retention in brief:
- Edema has different causes and occurs in different parts of the body.
- We see edema in the tissue near the epidermis as external swelling. We often only recognize internal edema from physical complaints.
- Edema is usually caused by an underlying disease such as heart failure, circulatory problems, cirrhosis of the liver or inflammation of the kidneys.
- Edema does not have to be pathological. Most of the water accumulation in the body occurs in healthy people and regresses on its own.
Edema occurs on different parts of the body and each has certain characteristics there.
Edema on the feet
Here the feet swell. Often, those affected no longer fit their shoes or the elastic bands of stockings cut into the skin.
Swelling of the hands
If you have swollen hands, your fingers are often too thick to put a ring over it that fits beforehand, or your skin tenses and hurts when you clench your fist.
Edema on the face
The victims look as if they have had a fight: the eyelids swell. Some also look like they have gained weight without it. Your cheeks are round. The face often looks bloated as if they have an alcohol problem. Such swelling of the face can develop within minutes. Those affected look as if a wasp had stung their lips.
Here the body reacts to a stimulus, be it medication, food or an infection. Physical exertion, extreme cold or tremors can also trigger angioedema.
Thick lip? Immediately to the doctor!
You should definitely go to the doctor because the edema can be life-threatening if it extends to the tongue, throat, or larynx. Then shortness of breath threatens and this can lead to suffocation. Patients who have ever had this type of edema on their face therefore receive an emergency kit that they should always carry with them.
Edema in the abdomen
If edema develops in the abdominal cavity, the affected person looks as if they have a "beer belly". The waist circumference swells. Problematic for the diagnosis: Due to the accumulation of fluid, people also gain weight, and can erroneously conclude that they have become "fatter". But the big belly does not come from fat, but from liquid.
Edema inside the body
Edema on internal organs such as the lungs, brain or throat is less obvious. Here, those affected do not see the swelling themselves, but only notice the physical consequences. These are also not very specific.
Edema in the lungs is sometimes the result of untreated heart failure. Here the excess liquid gradually penetrates into the alveoli. Breathing is difficult and sounds bubbling, but there can also be a rattle. Caution: progressive pulmonary edema can lead to respiratory arrest and thus be fatal. Pulmonary edema must be corrected as soon as possible.
Excessive fluid accumulates in the brain, especially in the following situations: after a stroke, brain inflammation, brain injury and altitude sickness.
Brain edema is manifested by headache, nausea and vomiting. Irritation follows, i.e. a disturbance of consciousness. Immediate treatment is necessary: if the brain edema progresses, a coma can result and even death or life-long disabilities such as paralysis, blindness or extreme psychological impairments - depending on which area of the brain is affected.
Edema on the epiglottis
This edema is as rare as it is dangerous. Allergies or infections can cause glottic edema. It manifests itself by breathing difficulties, whistling in the throat, difficulty swallowing, a deep or hoarse voice. The symptoms get worse the more the epiglottis swells. If breathing is no longer possible, the lack of oxygen leads to unconsciousness. The circulation breaks down and in the end the patient dies.
Causes of edema
Water retention in the body is not a disease in itself, but a consequence of illnesses. In pulmonary edema, the origin is usually a weak heart. Other causes include allergies, disorders of lymphatic drainage, lack of protein, problems with blood transport in the veins or weak kidneys. Some of these diseases are promoted by alcoholism, excessive obesity as well as malnutrition, nicotine, tar and other substances contained in tobacco smoke.
Edema on the ankle does not only arise from sprains, but also after standing or sitting for a long time, or also from heat. This is not a cause for concern. Such swellings go away on their own.
Edema is much more serious as a result of liver diseases such as cirrhosis of the liver, inflammation of the kidneys or heart valve defects. Varicose veins or blood clots in the veins can also cause edema. In addition, edema is rarely caused by tumors.
Many medications cause water to accumulate in the body. These include products for high blood pressure such as diuretics and calcium channel blockers, non-steroidal anti-inflammatory drugs and anti-depressants. Probably the best known is the "swelling" of patients who take cortisone.
Are Edema Dangerous?
Most edema occurs in healthy people and is harmless. Many women accumulate fluid shortly before the period, especially on the face, hands and body tissues. We then speak of premenstrual edema.
When we stand for a long time, fluid collects in the shins. This is not due to an illness, but to gravity. If we lie at night, they recede.
Angioedema - edema in the tissue
If the skin swells during edema, the water usually collects in deeper tissue. The blood vessels of the subcutaneous tissue become perforated and let water in from the nearby veins. Even if we can see the swelling on the outside, it is deeper. It is most evident in the mucous membranes, eyes or lips.
Histamine-mediated angioedema is both allergic and drug-induced. Then there is angioedema due to a C1 inhibitor deficiency. They are inherited. DC1 inhibitor is a protein that is used in the blood for immune defense. Either the patient does not form this inhibitor in sufficient quantity or with defects. There is also rarely angioedema due to acquired C1 inhibitor deficiency.
Angioedema very often arises as a symptom of hives, also known as urticaria, which affects 20 to 25 percent of all people at least once in their life. However, only one in 100,000 people suffer from genetic angioedema.
Angioedema in ACE inhibitors
Such edema often forms when treated with ACE inhibitors, medications for high blood pressure or heart failure. Up to 2.2 percent of all those treated with it develop angioedema, intensified in the first three weeks of use, but sometimes much later. The cause of such edema, which only occurs months or years after treatment, is often not recognized. While ACE inhibitors are known to cause edema, we don't know exactly why.
Very important: If an ACE inhibitor triggers edema, you must no longer use it.
Edema can have a number of causes. First of all, the doctor must roughly limit which ones it could be. If an intolerance to a certain substance in food is suspected, the patient is advised to avoid it and to see whether the edema resolves as a result.
In addition, those affected are asked in detail about which medications they are taking. If there are ACE inhibitors, antidepressants or cortisone, there is a high probability that this is the cause. In addition, allergy tests are often carried out to show whether the edema is an allergic reaction. A detailed survey on the medical history can provide further information. X-rays, ultrasound, blood and urine samples show the exact cause.
Smaller edema on the feet and hands usually go away on their own. With histamine-related angioedema, doctors can inject antihistamines. They will also do this in the case of suspected harmless accumulations, if the eyes and lips are swollen, so that those affected do not have to walk around disfigured. Swellings on the larynx require immediate adrenaline spray and an oxygen mask against shortness of breath - in extreme cases artificial ventilation. The doctor will then administer antihistamines by infusion.
Antihistamines do not help with hereditary angioedema and doctors can only treat the symptoms here. Acute seizures can be treated with a C1 inhibitor concentrate that compensates for the deficiency. Those affected will always suffer from angioedema, as there is nothing to be done about the inheritance disorder. The treating doctors can prevent this in the long term, for example with male hormones such as danazol, stanozol and oxandrolone. In women, however, strong hair growth can result up to the "lady beard", in men there is a risk of overweight and liver damage. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Steven K. Herrine: Systemic changes in liver diseases, MSD Manual, (accessed August 15, 2019), MSD
- Torsten Zuberbier et al .: S3 guideline urticaria, German Society for Allergology and Clinical Immunology (DGAKI), German Dermatological Society (DDG), (accessed August 15, 2019), AWMF
- Lyall A. J. Higginson: Edema, MSD Manual, (accessed August 15, 2019), MSD
- Edouard Battegay: Differential diagnosis of internal diseases, Thieme Verlag, 21st edition, 2017
- Jonathan A. Bernstein, Joseph Moellman: Emerging concepts in the diagnosis and treatment of patients with undifferentiated angioedema, International Journal of Emergency Medicine, (accessed August 15, 2019), PubMed
ICD codes for this disease: R60ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.