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Ask Dr. Swiner: When is swelling abnormal?
Published Tuesday, July 1, 2014
by C. Nicole Swiner, Columnist

One of the most challenging patient issues I have to deal with is swelling, otherwise known as edema. I have a large variety of patients – big and small, young and old – that come in complaining of this. It’s sometimes on one side, both sides, constant or intermittent. It can be due to something simple or open up a gamet of medical possibilities.

Let me first say that we all have swelling from time to time. It is normal. The simplest explanation is that we all swell a bit when it’s warmer outside. Think about it: A hot dog gets fatter when cooked due to the heat and the sodium it contains. Our legs are the same. So a little bit of swelling is normal, especially if it’s both legs, and we’ve been on them for a longer time than usual in the heat.

We also normally have more swelling on the left side of the body than the right due to the way our main blood vessels in the body sit in the chest and abdominal cavity.

Once we rest and elevate and they return to normal size, it’s OK. However, if swelling persists even after elevating, you may need to see your doctor to make sure it’s not due to another cause.

The first that comes to mind is congestive heart failure. There are two types of this condition: systolic (when the heart muscle contracts) and diastolic (when it relaxes).

One can imagine if the heart doesn’t pump blood or receive blood well, how it can lead to a back flow of fluid and cause swelling in the legs. Generally speaking, not only can heart failure cause fluid in the legs, but it can also cause fluid in the lungs, causing shortness of breath, chest discomfort or difficulty breathing when lying flat. So when a patient is concerned about abnormal swelling, I always ask questions about these other symptoms to be reassured.

Kidney issues also can lead to swelling if there is a lack of blood flow or strain on the kidneys. These two organs are most affected by conditions such as dehydration, high blood pressure (hypertension), high blood sugar (diabetes) and drugs and medications. Renal insufficiency or renal failure can cause decreased filtering through the small tubules inside the kidney, leading to increased protein in the blood and water being leaked out, thereby causing swelling.

Other causes include hypothyroidism, iron deficiency anemia, obesity, liver disease or eating too much salt. All in all, if swelling continues to be an issue and doesn’t go away for weeks, go see your doctor before you reach for that over-the-counter water pill.


Dr. C. Nicole Swiner works at Durham Family Medicine, where she treats newborns to elderly patients. She can be found at www.durhamfamilymedicine.net.




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