Fluid Retention

Overview

Fluid retention, also called oedema (say "eh-DEE-muh"), happens when extra fluid builds up in the tissues of your body instead of being carried away as normal. Gravity usually pulls this fluid downwards, so it most often shows up as swelling in your feet, ankles and lower legs. It can also affect your hands, face, belly, or — less often — your lungs. The swelling is not a disease on its own. It is a sign that something else is going on, such as a heart, kidney or liver problem, a side effect of a medicine, or simply standing for a long time. Finding the cause is the most important step.

Yes, fluid retention is very common. Many people get mild ankle swelling after standing for a long time or in hot weather, and it usually settles with rest. More persistent or one-sided swelling is worth getting checked.

Anyone can get fluid retention, but it is more common in older adults, people who are pregnant, people with heart, kidney or liver conditions, people who are less mobile or sit for long periods, and people taking certain prescription medicines. Swelling in children is less common and should always be checked by a doctor.

Symptoms

Common symptoms

• Swelling in the feet, ankles, legs, hands or fingers
• Clothes, shoes or rings feeling tight, especially by the end of the day
• Skin that looks shiny or feels tight and puffy
• A small dent left in the skin after you press it with a finger
• Swelling that is worse in the evening or after long sitting or standing
• Unexplained weight gain over a few days
• Feeling that your belly is bloated or full

Symptoms in children

• Puffiness around the eyes, which may be most noticeable in the morning
• Swelling in the feet or legs, or nappies and shoes fitting differently
• Weight gain that is not explained by normal growth
• Less urine than usual, or urine that looks frothy
• Swelling in children is not common, so it should always be checked by a doctor

Symptoms in older adults

• Swelling that comes on more easily because of less movement and weaker leg veins
• Swelling linked to several medicines taken together
• Thin, fragile skin that can break down or become sore over swollen areas
• Breathlessness or needing extra pillows to sleep comfortably
• Swelling that makes walking, shoes and balance more difficult

Causes

Main causes

• Standing or sitting still for long periods, especially in warm weather
• Heart problems that make it harder for blood to circulate
• Kidney problems that affect how well your body removes fluid and salt
• Liver problems, which can change the balance of fluids and proteins in the body
• Side effects of some medicines — ask your pharmacist whether any of yours could be involved
• Problems with the leg veins or lymph channels (the body's drainage system)
• Being pregnant, when extra fluid and pressure on leg veins are normal
• A blood clot in a leg vein — this needs urgent medical attention
• Low levels of protein in the blood, for example from poor nutrition or bowel problems
• An underactive thyroid gland, which can cause puffiness

Risk factors

• Being older, as veins become less efficient and long-term conditions are more common
• Being less mobile, or sitting or standing for many hours
• Being overweight
• Having a long-term condition affecting the heart, kidneys or liver
• Taking several medicines, some of which can cause fluid to build up
• Pregnancy
• A high-salt diet
• A previous injury, surgery or clot affecting the leg veins or lymph channels

When to see a doctor

See a doctor urgently if:

• Swelling in only one leg, or one leg much more swollen than the other
• Swelling that appears suddenly or is quickly getting worse
• Swelling with breathlessness, chest pain, or difficulty lying flat
• Swelling with very little urine being passed
• Swelling with fever, redness, warmth or pain in the skin
• Swelling of the face, lips or throat

Book a routine appointment if:

• Swelling that lasts more than a few days or keeps coming back
• Swelling that does not improve after resting with your legs raised
• Swelling with tiredness, breathlessness on exertion, or unexplained weight gain
• Swelling that is affecting your shoes, clothes, walking or daily life
• You are taking a medicine and think it may be causing swelling
• You are pregnant and notice new or worsening swelling

Diagnosis

Your doctor will start by talking with you about when the swelling began, where it is, what makes it better or worse, your other health conditions, and every medicine you take, including anything bought over the counter. They will examine you, look at both legs, feel the swelling, and often press gently on the skin to see if it leaves a dent. They may also listen to your heart and lungs, check your blood pressure, and weigh you. From there, they can decide which tests, if any, are needed.

Tests that may be done

• Blood tests to check how your kidneys, liver, thyroid and heart are working
• A urine test to look for protein or other signs of kidney strain
• Blood pressure and weight measurements, sometimes over several days
• An electrocardiogram (ECG), a quick tracing of your heart's electrical activity
• A heart ultrasound scan if a heart problem is suspected
• A chest X-ray if there is breathlessness
• An ultrasound scan of the leg veins if a blood clot is a possibility

What to expect at your appointment

Most people need only a conversation, an examination and some simple blood and urine tests. Results usually come back within days to a couple of weeks. If tests are normal and the swelling is mild, your doctor may simply suggest watching it and making some lifestyle changes. If something is found, you will be told what it means and what happens next, and you can ask questions at any point.

Treatment

Treatment for fluid retention has two parts: dealing with the swelling itself so you feel more comfortable, and finding and treating the reason behind it. Because the causes vary so much, the plan is tailored to you. Many people improve a great deal once the underlying cause is managed.

Self-care at home

• Raise your legs when resting — for example, put your feet on a stool or cushions so they are above the level of your heart
• Keep moving: walk regularly and wiggle your ankles and feet when sitting for long periods
• Avoid standing still for long stretches; take breaks and sit down when you can
• Cut back on salt, as salty food makes your body hold on to more fluid
• Check your feet and legs daily for redness, cracks, blisters or sore patches
• Keep the skin moisturised and avoid very hot baths, which can make swelling worse
• Wear loose, comfortable shoes and avoid tight socks or bands around your legs
• Weigh yourself at the same time of day, a few times a week, and note any sudden changes
• Ask your pharmacist to review your medicines if you suspect one may be contributing

Medical treatments

Your doctor will first treat the underlying cause — for example, by improving control of a heart, kidney or liver condition, or by changing a medicine that is contributing. If the swelling itself needs treatment, they may prescribe a medicine that helps your kidneys pass more urine, often called a "water tablet". These are usually started at a low dose and adjusted with check-ups and blood tests. Compression stockings, fitted by a healthcare professional, can also help leg swelling. Never start, stop or change any medicine on your own — always talk to your doctor or pharmacist first.

When is surgery considered?

Surgery is rarely needed for fluid retention. It may sometimes be considered for long-standing swelling caused by damaged lymph channels, or as part of treating the underlying condition. Your specialist team would discuss this with you if it applied to your situation.

Living with this condition

Most people can manage fluid retention well with a few daily habits. Plan short walks into your day, put your feet up during breaks, and check your legs and feet each evening. Keep an eye on how your shoes and rings fit, and on your weight, as these are simple ways to notice changes early. If swelling makes everyday tasks harder, talk to your doctor — there is often more that can be done.

Lifestyle tips

• Stay active within what feels comfortable for you
• Reduce salty foods such as ready meals, crisps, processed meats and salty sauces
• Avoid long periods of sitting or standing still
• Raise your legs for short periods several times a day
• Keep to a healthy weight if you can
• Limit alcohol and avoid smoking, as both put extra strain on your heart and circulation
• Follow your doctor's advice on managing any long-term condition you have

Diet and exercise

A balanced diet with less salt and plenty of vegetables and fruit helps your body balance fluids. Home-cooked meals let you control how much salt goes in. Gentle, regular movement — walking, swimming, or simple ankle and leg exercises while seated — helps your muscles push fluid back towards your heart. Build up gradually and stop if you feel breathless or unwell. If you have a heart or kidney condition, ask your doctor or a dietitian about the right amount of salt and fluid for you.

Mental health and emotional wellbeing

Ongoing swelling can be tiring and worrying, especially if it affects your clothes, mobility or confidence. It is understandable to feel frustrated or anxious about it. Talking to your doctor about your concerns, and to family, friends or a counsellor if low mood is building, can make a real difference. You do not have to cope alone.

Prevention

Some types of fluid retention can be prevented or reduced, while others cannot. You can lower your chances of everyday swelling by staying active, avoiding long periods of standing still, cutting back on salt, keeping to a healthy weight, and having your medicines reviewed regularly. If you have a heart, kidney or liver condition, following your treatment plan closely is the best way to prevent fluid building up.

Screening programmes

There is no general screening programme for fluid retention. Instead, if you have a condition that can cause it, your doctor will check your weight, blood pressure, blood tests and symptoms at routine appointments. Attending those check-ups is the most useful form of monitoring.

Complications

If left untreated

• Skin that becomes stretched, dry and fragile, and breaks down more easily
• Skin infections, such as cellulitis, which cause redness, warmth and pain
• Leg ulcers that are slow to heal
• Stiffness and reduced movement in the affected leg or ankle
• Breathing problems if fluid builds up in or around the lungs
• Worsening of the underlying condition causing the swelling

Long-term outlook

The outlook is usually good. Mild swelling often settles with simple changes, and when there is an underlying cause, treating it generally improves the swelling a great deal. Many people live comfortably with fluid retention by keeping active, watching salt, raising their legs and attending their check-ups. If something does change or get worse, your doctor can adjust your care.

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