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The Female Body
|Terminology: Edema (USA) is spelt Oedema (UK)
Why Are My Feet And Ankles So Swollen?
What you are experiencing is edema - also called bloating or fluid retention. It is when excess fluid accumulates in the body's tissue. The main symptoms of edema are swelling in the extremities (ankles, feet, hands and fingers) and weight gain. The difference between edema and ordinary swelling is it's pitting nature. If you press down on the swelling with your thumb for 30 seconds and then remove it, the area compressed will stay indented for longer than normal. Mild edema is very common in women, particularly before a period (PMS) and in late pregnancy (75 percent of pregnant women develop some swelling). In most instances it is quite harmless, if only a little uncomfortable. In pregnant women edema usually disappears quickly after childbirth. You may find you urinate and sweat a lot in the first few days while your body eliminates excess fluid. But, don’t panic if it takes several weeks (even a month or more) for your body to return to normal.
What Causes Edema?
The exact cause of edema in pregnancy is unknown but it is usually attributed to changing levels of estrogen and progesterone (read about the effects of estrogen). Also, your growing baby will put pressure on the veins in your pelvic area and the vena cava (the big vein on the right side of the body that carries blood back from the legs and feet to the heart). This pressure slows down the return of blood, causing excess fluids to leak from the veins into the tissues of the ankles and feet. For this reason edema tends to be more common in women pregnant with twins and those with excessive amniotic fluid (polyhydramnios). Edema also tends to be worse at the end of the day and on hot summer days.
Edema After Pregnancy
Many women experience swelling in the days after delivery - particularly in the hands, fingers, legs and ankles, but also in incision sites like their episiotomy incision or C-section incision. While a source of discomfort it is not generally anything to be concerned about. Most swelling tends to clear within a week or two, although some new mothers complain of swollen hands or fingers for some months.
When Is Edema Dangerous?
Severe edema is potentially a sign of an underlying life-threatening disorder called preeclampsia. The signs include:
• General swelling of the tissues (not just of the ankles and feet). Preeclampsia is associated with sudden weight gain (at least 2.2 pounds in a week) and swelling of the face, puffiness around the eyes and hands.
Other signs include the sudden appearance/reappearance of:
• Morning sickness.
• Abdominal and shoulder pain.
• Lower back pain.
• Headaches, may feel like a migraine.
• Before making a diagnosis your doctor will test for signs of high blood pressure (hypertension in pregnancy) and excess proteins found in your urine.
If you experience the above signs, call your doctor immediately.
Also call your doctor if you notice one leg is more swollen than the other - especially if it is tender to touch. This may be a sign of a blood clot (deep vein thrombosis, DVT), another serious condition.
Women diagnosed with heart disease during pregnancy (or before pregnancy) are more prone to developing severe edema, and so will be monitored closely.
How Is It Treated?
Assuming it is not caused by an underlying condition, less severe swelling can be relieved by:
• Restricting your intake of dietary salt (by avoiding junk food), as sodium increases fluid retention.
• Wearing maternity compression stockings if you suffer swelling in the lower limbs area. Put the stockings on first thing in the morning before fluids have a chance to pool in the legs, ankles and feet.
• Avoiding standing too long - lie down regularly (on your left side) to take the pressure off your legs.
• Elevate your legs where possible. Ideally they should be raised higher than the level of the heart for periods of 20 minutes throughout the day. Note: sitting with your feet on a footstool restricts circulation at the hips and as a result is NOT effective.
• Avoid crossing your legs, it restricts circulation.
• Drink lots of water (at least 6 to 8 glasses of water or juice) - although it may seem contradictory, it helps to flush out excess fluids by keeping the kidneys functioning normally.
• Add lemon to your water and eat cucumber, both are natural diuretics.
• Take regular exercise to boost your circulation. Water aerobics is particularly good because the water pressures pushes the excess fluid back into the veins for dumping by the kidneys. A brisk walk is another good option. Walking works the muscles helping to pump fluids back to the heart.
• If your rings feel tight, take them and put them away until after delivery. Remove them first thing in the morning after cooling your hands down in some cold water. Use a slippery soap to help ease the process.
Caring For Swollen Feet
It is important to take care of your feet if they are swollen for several reasons:
• The swelling tends to start in the feet but it can spread up the legs if you don't take care of it.
• Swelling stretches and weakens the skin so that the skin blisters and weeps (sometimes referred to as weeping edema).
• Veins weaken and can cause varicose veins (see varicose veins in pregnancy).
• Skin ulcers can form and are easily torn if bumped. Ulcers can take a year or more to heal.
How To Look After Your Swollen Feet
With all that extra fluid in your legs and feet your skin is extra fragile, so you need to mind them. Best care includes:
• Wash your feet daily and dry between your toes.
• Cut your nails straight across and never shorter than the end of your toe. Don’t cut corns or calluses.
• Avoid walking in bare feet.
• Wear shoes that are flat, soft and roomy.
• Wear maternity compression stockings.
• Avoid hot and cold temperatures (such as hot tubs, hot foot soaks, wearing light footwear in the snow).
Can I Take Water Pills?
Over the counter or prescription water pills (called diuretics) are not recommended in pregnancy and could actually harm your baby. Your doctor may prescribe them in the postpartum period if symptoms persist.
My legs, hands and ankles swelled up in the last 2 months of pregnancy and it got worse after birth for about 3 weeks. It took 4 months postpartum before it finally disappeared and I could put my wedding ring back on. I am breastfeeding exclusively so I think maybe that caused me to hold onto the fluid. But then in the last month I've been exercising, going to the gym and I’m wondering if that’s what finally kicked things into gear and caused the edema to go.
I had hardly any swelling during pregnancy but I blew up like a whale after delivery. My feet and ankles were huge. The nurse said it was because of all the IV fluids I got during the C-section. I went back down to normal after a few days but it was scary at the time.
My legs and ankles became swollen after the baby was born. They were swollen for about 4 days. I had to have an IV during labor and the doctor said that was the cause for the extra fluids in my body. When I got home I put my feet up as much as possible and that cleared it up.
P. Lauper, Charlotte
Mine were really swollen before birth and got even worse after. The doc said it was completely normal because of all the hormones. He said it would go in about 2 weeks. He was right, but it probably took closer to 3 weeks.
My ankles were very swollen when I was pregnant but it got worse after delivery and my blood pressure also shot up. I ended up being prescribed a diuretic for 6 days after I developed weeping edema. It was a weird condition - my legs became so swollen that there was nowhere for the fluid to go so it was leaking out of a scrape on my ankle. Every minute or so drips of fluid was coming out. After about 4 hours on Lasix I started to deflate :) and felt like a new woman after a couple of days.