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Q. I would occasionally get some swelling in my legs. But now I notice it by late afternoon every day. I otherwise feel fine. Should I be worried?
A. It sounds like you have edema, swelling in your legs due to fluid in the soft tissues beneath your skin. This usually occurs when pressure from the fluid inside your veins is high, which forces water out of the blood vessels and into the surrounding tissues.
The most common cause is leaky valves in your veins. Doctors call this venous insufficiency.
There are one-way valves in your veins that help keep the blood flowing in the right direction. Ordinarily, as you walk around, your leg muscles squeeze the veins, which pumps the blood through these valves up toward the heart. When the muscles relax, the valves prevent blood from draining back down the vessels.
If these valves become leaky, the blood gets propelled upward, but much of it drops down again when the leg muscles relax. The result is an accumulation of blood — and an increase in pressure — within the veins. The higher pressure pushes fluid out of the veins, causing leg swelling.
It's less likely your edema is due to some other medical problem. But you should make an appointment with your doctor to be sure.
Your doctor will ask if you have shortness of breath, fatigue, or pain in your legs, and whether one leg is more swollen than the other. Depending on your symptoms and your doctor's physical exam, he or she might order blood and urine tests to evaluate your kidney and liver health. It's also possible you might need an echocardiogram to make sure your heart function is normal, or a leg ultrasound to look for blood clots.
Some medications also can cause fluid retention in your legs. This can happen with high doses of ibuprofen (Advil, Motrin), naproxen (Aleve), and other nonsteroidal anti-inflammatory drugs. Leg swelling is a common side effect of certain calcium-channel blockers, especially nifedipine (Procardia XL) and amlodipine (Norvasc).
To help minimize the swelling, raise your legs whenever you sit down. Even better, try to schedule 20 to 30 minutes during the day when you can lie down with some pillows under your feet to raise your legs above heart level. This way, gravity becomes your ally, not the enemy.
You also might consider compression stockings. They help counter the pressure from within the veins and prevent fluid from seeping out of the blood vessels. Usually, the knee-high versions are sufficient. It's best to put on the stockings each morning before you get out of bed, and then take them off at night.
— Howard LeWine, M.D.
Editor in Chief, Harvard Men's Health Watch
Image: © Maridav/Getty Images
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