Ask the doctors: Temporary edema is often harmless
Q: After a few days of standing in long lines at an amusement park, my ankles swelled up. We were on vacation, and salty food, wine and carbs were involved. It took a few days to get better, so now I'm a little worried. Does this mean something may be wrong, or am I overreacting?
A: Swollen ankles are often associated with serious health conditions, so it makes sense that you would be concerned. They can occur in a range of disorders, including heart disease, kidney disease and circulation problems. The good news is that ankle swelling can have benign causes as well. These include the variables your vacation included.
The swelling you experienced is a condition known as edema. It occurs when excess fluid gets trapped in the tissues. We tend to think of our blood vessels as a closed system. However, the tiniest of these, known as capillaries, are porous. This allows the exchange of fluid that brings nutrients to cells and carries away cellular waste. Capillaries are always releasing fluid that contains oxygen, nutrients and other compounds into the spaces between cells. Much of it gets reabsorbed, along with waste products from the tissues.
Edema can occur almost anywhere in the body. But thanks to the pull of gravity, it is most common in the ankles, feet and calves. Symptoms include the visible swelling you noticed. It can also cause skin to feel tight and look shiny.
Severe edema can lead to a condition called pitting. This is when pressure applied to the swollen area creates an indentation that is slow to fade. Depending on the underlying cause, edema can also be associated with abdominal swelling, shortness of breath, elevated heart rate and chest pain.
The circumstances you described include several factors that can contribute to edema. Veins in the legs work against gravity as they return blood to the heart. With prolonged standing, blood can begin to pool. That backup increases pressure within the networks of capillaries in the lower legs.
This, in turn, can impede the reabsorption of the fluids they have delivered and lead to swelling. Excess sodium causes the body to hold onto water. So can carbs through a different pathway and to a lesser degree. That means your vacation diet may have also played a role.
The fact that the swelling went away when you returned to your normal diet and activity is reassuring. This is consistent with edema that is situational and temporary. Risk factors for temporary edema include being overweight, older age, pregnancy, venous insufficiency, hot temperatures and certain medications.
There are certain signs that edema should be looked at by a healthcare provider. These include swelling that persists, recurs or gets worse; one limb more affected than the other; or swelling that occurs with shortness of breath or chest pain. It is especially important to see your healthcare provider if you have these symptoms with edema.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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