Swelling

Considerations:
This document primarily discusses overall swelling. See the specific documents listed in the definition for information that is specific to swelling in a specific location.

Slight edema of the legs commonly occurs in warm summer months.

Generalized swelling or massive edema (also called anasarca) is a common sign in severely ill people. While slight edema may be difficult to detect, especially in an overweight person, massive edema is very obvious.

Very often, widespread edema is both long-term and progressive and the causes vary significantly.

Edema may be pitting (when pressing a finger against a swollen area for 10 seconds and then quickly removing it, an indentation is left that fills slowly) or nonpitting (when pressing a finger against a swollen area for 10 seconds and then quickly removing it, no indentation is left in the skin).

Common Causes:

Note: There may be other causes of swelling. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as location, quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for swelling, occurring alone or in combination with other problems.

Home Care:
Follow prescribed therapy to treat the underlying cause of the edema. Discuss with your health care provider the options to prevent skin breakdown (for chronic edema) such as a pressure mattress, lamb's wool pad, or flotation ring.

Maintain everyday activities. Walk rather than stand. Stand or lie rather than sit. When lying down, keep limbs above the heart level, if possible, to facilitate drainage. Do not do this if shortness of breath results.

Massage swollen areas regularly, particularly if edema has formed around the hip, buttocks, or back.

Reduced sodium (salt) in the diet may be recommended.

Call Your Healthcare Provider If:

  • there is any unexplained swelling.



What to Expect:
Except in emergency situations (such as cardiac failure or pulmonary congestion), the medical history will be obtained and a physical examination performed.

Medical history questions documenting swelling in detail may include:

  • time pattern
    • When did you first notice this?
    • Is it present all the time?
    • Does it come and go?

  • quality
    • How much swelling is there?
    • When you poke the area with a finger, does the dent remain?

  • location
    • Is it overall or in a specific area (localized)?
    • If swelling is in a specific area, what is that area?

  • other
    • What seems to make the swelling better?
    • What seems to make the swelling worse?
    • What other symptoms are also present?

Diagnostic tests that may be performed include:

Intervention:
Treatment may include fluid and sodium restriction, diuretics, digoxin, and (rarely) intravenous albumin administration. In some cases corticosteroids such as prednisone or immunosuppressive medications may be given. Fluid intake and output should be monitored and the patient should be weighed daily.

Avoid alcohol if liver disease (such as cirrhosis and hepatitis ) is the problem. Vascular support hose (TED hose) may be advised.

After seeing your health care provider:
You may want to add a diagnosis related to swelling to your personal medical record.


The submandibular glands (just below the jaw) have become markedly enlarged, due to mumps. The parotid glands (just in front of the ears) are more frequently enlarged, thought many cases of mumps have no symptoms. Mumps is seldom seen today because of high levels of immunization with the MMR (measles, mumps and rubella) vaccine. (Courtesy of the Centers for Disease Control.)



This child has swelling under the jaw (submandibular), associated with mumps. The glands on the side of the face (parotid glands) are more frequently involved. Many cases of mumps have no visible symptoms. (Courtesy of the Centers for Disease Control.)



This child has significant submandibular swelling (just under the jaw) associated with mumps. The parotid glands, on the side of the face, are more frequently involved. (Courtesy of the Centers for Disease Control.)



Eosinophilic fasciitis, pitting edema - leg: Eosinophilic fasciitis is a syndrome characterized by tenderness and swelling of the extremities. The inflammation occurs when eosinophils, a type of white blood cell, infiltrate the fibrous layer surrounding the muscle, and the muscle itself. This picture shows what is called pitting edema, associated with eosinophilic fasciitis, which is characterized by a dent that remains in the skin after finger pressure.



Pitting edema occurs when fluid collects in the tissue. By pressing a thumb or finger firmly against the tissue for a few seconds, a dent can be produced. When the finger is withdrawn the dent may persist for several minutes.