Edema

Edema, characterized by the accumulation of excess fluid in the body’s tissues, is a common clinical finding that can complicate wound healing and patient management. Understanding its risk factors, symptoms, etiology, treatment, and prevention is crucial for clinicians in the field of wound care.

Etiology

The pathogenesis of edema involves multiple mechanisms:^1,2

• Damage to the endothelial glycocalyx layer increases vascular permeability (Starling principal)
• Increased capillary hydrostatic pressure 
• Regional venous hypertension (including dDeep vein thrombosis, compartment syndrome, and chronic venous insufficiency)
• Systemic venous hypertension (including heart failure, pericarditis, pulmonary hypertension, and liver failure/cirrhosis)
• Increased plasma volume (including pregnancy, premenstrual edema, renal failure, heart failure, and drugs)
• Decreased plasma oncotic pressure 
• Protein loss (including nephrotic syndrome and preeclampsia/eclampsia)
• Reduced protein synthesis (including malnutrition/malabsorption, liver failure/cirrhosis, and vitamin deficiencies)
• Increased capillary permeability (including burns, insect bites, cellulitis, and allergic reactions)
• Lymphatic obstruction 

Risk Factors

Several factors predispose individuals to the development of edema. 

Certain medications—most commonly those treating endocrine conditions or calcium channel blockers and other vasodilators—can cause fluid retention.¹ Less common medication causes include antidepressants, nondihydropridine calcium channel blockers, and anti-Parkinsons drugs.

Other factors for edema development include age and gender, a sedentary lifestyle, and dietary factors.^1,3,4 

Symptoms

Edema presents with various clinical manifestations:

Swelling. Noticeable puffiness, especially in the limbs, which may be more pronounced after prolonged periods of immobility.⁵ 

Skin changes. The affected area may appear stretched, shiny, or discolored.⁵ 

Pitting. Applying pressure to the swollen area may leave an indentation, indicating pitting edema.⁵ 

Stiffness. Joint stiffness can occur due to increased fluid accumulation.⁵ 

Weight gain. Rapid weight gain over a short period may occur due to fluid accumulation.⁵ 

Treatment

Management of edema focuses on addressing the underlying cause and alleviating symptoms:

Lifestyle modifications. These can include dietary changes in the form of reducing sodium intake to decrease fluid retention, and physical activity, as regular movement and exercise can improve venous return.¹

Pharmacologic interventions. Diuretics such as furosemide, when indicated, promote fluid excretion.¹ 

Compression therapy. Use of compression stockings, wraps, or devices can reduce peripheral edema by enhancing venous and lymphatic return.¹ 

Elevation. Elevating the affected limbs above heart level can facilitate fluid drainage.¹ 

Prevention 

Preventive strategies are vital in reducing the incidence and severity of edema, and should take place in tandem with full assessment and identification of the specific etiology: 

Regular monitoring. Patients with chronic conditions should undergo routine assessments to detect early signs of edema.¹ 

Patient education. Educating patients about lifestyle modifications, such as reducing sodium intake and engaging in physical activity, can empower them to manage risk factors effectively.¹ 

Medication review. Regular evaluation of medications can help identify and adjust drugs that may contribute to fluid retention.¹ 

Exercise. This may include not only calf pumps but also walking, pool exercises, etc.

References
1.    Goyal A, Cusick AS, Bhutta BS. Peripheral Edema. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554452/
2.    Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: diagnosis and management. Am Fam Physician. 2013 Jul 15;88(2):102-10.
3.     Francisco R, Nunes CL, Breda J, et al. Breaking of sitting time prevents lower leg swelling-comparison among sit, stand and intermittent (sit-to-stand transitions) conditions. Biology (Basel). 2022;11(6):899. Published 2022 Jun 10. doi:10.3390/biology11060899
4.    Mayo Clinic. Edema - Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/edema/symptoms-causes/sy…. Accessed March 5, 2025.
5.    InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. In brief: Causes and signs of edema. [Updated 2022 Apr 25]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279409/