Swelling, Causes, Symptoms, Diagnosis, Treatment

Swelling is a transient abnormal enlargement of a body part or area not caused by proliferation of cells. It is caused by accumulation of fluid in tissues. It can occur throughout the body (generalized), or a specific part or organ can be affected (localized). Swelling is usually not dangerous and is a common reaction to an inflammation or a bruise.Swelling is considered one of the five characteristics of inflammation; along with pain, heat, redness, and loss of function.In a general sense, the suffix “-megaly” is used to indicate a growth, as in hepatomegaly, acromegaly, and splenomegaly.

Types of Swelling

1.  Traumatic swellings – develop immediately after trauma, like a hematoma or dislocation.

2.  Congenital – swellings are present since birth, such as a hemangioma or meningocele. Some congenital swellings may not be discovered until later in life, such as a branchial cyst, dermoid cyst or thyroglossal cyst.

3.  Inflammatory swelling – may be either acute or chronic.

•  Acute -The presentations of acute swellings are redness, local fever, pain and impairment of function of the affected organ. The related lymph nodes will be affected and will show signs of acute lymphadenitis.
• Chronic inflammatory – swellings will show the signs of acute inflammatory swellings, but in subdued form. In this case, edema might not occur. Chronic swellings can be differentiated from neoplastic swellings by the fact that neoplastic swellings never recede in size, but inflammatory swellings may show occasional diminution.

Causes of Swelling

• Allergic reaction
• Cellulitis
• Contact dermatitis
• Eczema
• Hives
• Insect bite
• Insect sting
• Parasitic infection
• Skin infection
• Beri-beri
• Celiac disease
• Certain medications
• Cirrhosis of the liver
• Chronic hepatitis
• Congestive heart failure
• Edema
• Excessive IV therapy
• Filariasis
• Glomerulonephritis
• Heart failure
• Kidney failure
• Liver condition
• Lymphedema
• Lymphatic obstruction
• Malabsorption
• Malnutrition
• Nephritis
• Nephrotic syndrome
• Preeclampsia
• Pregnancy
• Premenstrual syndrome
• Protein deficiency
• Thyroid condition
• Ulcerative colitis
• Varicose veins
• Allergic reaction
• Cancer
• Lymphatic obstruction
• Sunburn
• Venous thrombosis
• Other causes, such as swelling related to a sac-shaped structure with clear fluid, blood, or pus (cyst) or a swollen gland, such as a salivary gland. For more information, see the topic Swollen Glands, Hernias, and Other Lumps Under the Skin.

Causes of generalized swelling include

• Allergic reaction – Sudden swelling of the hands and face may be a severe allergic reaction (anaphylaxis) and needs immediate medical evaluation.
• Autoimmune diseases – such as lupus, rheumatoid arthritis, and scleroderma. These diseases can cause swelling when the body produces antibodies and other cells that attack and destroy tissues in the body.
• Medicines – Some medicines change how body fluids circulate, causing swelling. Swelling may also occur as an allergic reaction to a medicine.
• Circulation problems – related to certain medical conditions, such as peripheral arterial disease, heart failure, diabetes, or kidney disease. Thrombophlebitis causes swelling of an extremity when a blood clot interrupts blood flow in a vein in the arm or leg.
• Fluid that accumulates  – in the abdomen (ascites) because of other problems, such as malnutrition, cirrhosis, or liver disease.

Symptoms of Swelling

• Feet and lower legs get larger when you sit or walk.
• Take a look at your feet, ankles and hands.  Are they swollen?  When you press on the skin with your finger, is there an indentation that stays for a few seconds?  If so, you may have “pitting edema.”
• Hands feel tight when you make a fist
• Rings are too tight
• Abdomen appears to be swelling or distended
• Shortness of breath (especially when lying down)
• Weight gain
• Aching limbs
• Stiff joints
• Discolouration of skin
• Hypertension (high blood pressure)

Diagnosis of Swelling

Testing

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Cause	Common Features*	Tests†
Angioedema (allergic, idiopathic, or hereditary)	Painless swelling, most often affecting the face, lips, and sometimes tongue Sometimes itching or tight sensation Swelling that does not remain indented after being pressed (nonpitting swelling)	Only a doctor’s examination
A blood clot in a deep-lying vein in a leg (typically), an arm, or the pelvis (deep vein thrombosis)	Sudden swelling Usually pain, redness, warmth, and/or tenderness in the affected area If the clot travels and blocks an artery to the lung (pulmonary embolism), usually shortness of breath and sometimes coughing up blood Sometimes in people who have risk factors for blood clots, such as recent surgery, an injury, bed rest, a cast on a leg, hormone therapy, cancer, or a period of immobility such as a long airplane flight	Ultrasonography
Chronic venous insufficiency (causing blood to pool in the legs)	Swelling in one or both ankles or legs Chronic mild discomfort, aching, or cramps in the legs but no pain Sometimes reddish brown, leathery areas on the skin and shallow sores on the lower legs Often varicose veins	Only a doctor’s examination
Drugs (such as minoxidil, nonsteroidal anti-inflammatory drugs, estrogens, fludrocortisone, and some calcium channel blockers)	Painless swelling in both legs and feet	Only a doctor’s examination
Heart failure	Painless swelling in both legs and feet Often shortness of breath during exertion or while lying down and during sleep Often in people known to have heart disease and/or high blood pressure	Chest x-ray ECG Usually echocardiography
Infection of the skin (cellulitis)	An irregular area of redness, warmth, and tenderness on part of one limb Swelling Sometimes fever	Only a doctor’s examination
Infection deep under the skin or in the muscles (rare)	Deep, constant pain in one limb Redness, warmth, tenderness and swelling that feels tight Signs of severe illness (such as fever, confusion, and a rapid heart rate) Sometimes a foul discharge, blisters, or areas of blackened, dead skin	Blood and tissue cultures X-rays Sometimes MRI
Kidney disease (mainly nephrotic syndrome)	Widespread, painless swelling Often fluid within the abdomen (ascites) Sometimes puffiness around the eyes or frothy urine	Measurement of protein in a urine specimen
Liver disease if chronic	Widespread, painless swelling Often fluid within the abdomen (ascites) Causes that are often apparent based on history (such as alcohol abuse or hepatitis) Sometimes small spiderlike blood vessels that are visible in the skin (spider angiomas), reddening of the palms and, in men, breast enlargement and a decrease in the size of the testes	Measurement of albumin in the blood Other blood tests to evaluate liver function
Lymphatic vessel obstruction due to surgery or radiation therapy for cancer	Painless swelling of one limb A cause (surgery or radiation therapy) that is apparent based on history	Only a doctor’s examination
Lymphatic filariasis (a lymph vessel infection due to certain parasitic worms)	Painless swelling of one limb and sometimes the genitals In people who have been in a developing country where filariasis is common	Examination of a blood sample under a microscope
Normal swelling	A small amount of swelling of both feet and/or ankles that occurs at the end of the day and resolves by morning No pain, redness, or other symptoms	Only a doctor’s examination
Pregnancy or a normal premenstrual symptom	Painless swelling in both legs and feet Usually relieved to some extent by rest and leg elevation In women known to be pregnant or about to have a menstrual period	Only a doctor’s examination
Pregnancy, with preeclampsia	Painless swelling in both legs and feet and sometimes hands High blood pressure (often new) Usually occurring during the 3rd trimester of pregnancy	Measurement of protein in urine
Pressure on a vein (for example, by a tumor, pregnancy, or extreme abdominal obesity)	Painless swelling that develops slowly	Ultrasonography or CT if a tumor is suspected
*Features include symptoms and the results of the doctor’s examination. Features mentioned are typical but not always present.
†In most people with swelling, doctors do a complete blood count, other blood tests, and urinalysis (to check for protein in the urine).

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Treatment of Swelling

Non-medicine 

In the acute, or early phase, remember PRICE

• P = Protection from further damage
• R = Rest to avoid prolonging irritation
• I = Ice (cold) for controlling pain, bleeding, and edema
• C = Compression for support and controlling swelling
• E = Elevation for decreasing bleeding and edema
• Protection can mean immobilization with a brace, or a wrap, or even just staying off the body part.
• Rest means not moving the body part in a painful way. Movement is good and can increase healing, but it should be pain-free at this stage.
• Ice for the first 72 hours, 20 minutes out of every hour. Leaving the ice on longer actually reverses the effect it has and may increase swelling. Chemical icepacks should never be applied directly to the skin, or frostbite can occur. Do not use heat for the first 72 hours; heat will increase the swelling.
• Compression, with an ace wrap. Your athletic trainer or doctor can show you how to wrap the body part to minimize swelling.
• Elevation, or resting with the injury above heart level, to encourage swelling to return towards the body, instead of collecting in the extremities where it is difficult to get rid of.

Medicine of Swelling

• Acetaminophen,
• Nonsteroidal anti-inflammatory drugs (NSAIDs):
  • Ibuprofen,
  • Naproxen,  or Naprosyn
• Aspirin (also a nonsteroidal anti-inflammatory drug), such as Bayer or Bufferin

Talk to your child’s doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine

• Elevate your feet as often as possible. (Either sitting in a chair with your feet on a stool with a pillow or in the bed or couch with feet up on two pillows)
• Do not stand for long periods of time.
• Avoid tight clothing (shoes, girdles, etc).
• Do not cross your legs.
• Reduce your salt intake if swelling is present. Avoid foods such as bouillon, potato chips, tomato juice, bacon, ham, canned soups, soy sauce, and table salt, for example.
• Try to eat a balanced diet (see eating well section).
• If your swelling is severe, consider wearing Jobst stockings or TED hose.
• Weigh yourself daily. Notify your doctor or health care provider if you have gained 5 pounds or more in a week.
• Take your medications exactly as prescribed.

Prevention of Swelling

• You may not be able to stop parts of your body from swelling. But you may be able to limit how severe it is. Severe swelling can make your legs painful and your skin tender.
• Try to eat a balanced diet so that you put on a healthy amount of weight during pregnancy. Your diet should include a small amount (between 50g and 75g) of protein such as lean meat, poultry, fish, eggs, or beans and pulses, with each meal.
• Eat at least five portions of fruit and vegetables every day. Try to have a mixture of colors in your selection of fruit and veg.
• Aim to reduce how much salt, sugar, and fat you have. Cut out pre-packaged, highly processed foods, as they are usually high in all three. Salt causes your body to hold on to more fluid.
• Drink plenty of water to stay hydrated, as this will help your body to hoard less water.

• citrus fruits
• green and red peppers
• melons
• potatoes
• tomatoes
• strawberries
• cabbage
• broccoli

Foods rich in vitamin E include:

• vegetable oils (especially corn, soy and wheat germ oil)
• sunflower seeds
• wheatgerm
• sweetcorn
• cashews and almonds
• Smoking may contribute to swelling, which is another good reason to quit during pregnancy.
• Rest as much as possible, putting your feet up above your hips. Try not to cross your legs, as this restricts your blood flow. Sit down when you can, and if your work involves standing for long periods of time, move about from one foot to the other to increase blood flow.

You can also do these simple foot exercises to reduce swelling in your ankles:

• bend and stretch your foot up and down 30 times
• circle each foot eight times one way and eight times the other way
• You can do these whether you’re standing or sitting.
• You could try placing green or white cabbage leaves on the swollen area to draw out excess fluid and relieve your discomfort. Just wipe the leaves clean; there’s no need to wash them. Cool them in the fridge first, but not in the freezer.

Wrap the chilled leaves around the most swollen parts of your legs and feet to make a compress. Leave them until they become wet, then repeat with fresh leaves until the pain is reduced. Repeat this as often as necessary until you feel more comfortable.

Complementary therapies of Swelling

Aromatherapy

Essential oils may help with swelling. Cypress oil is good for circulation and varicose veins. Lavender oil and camomile oil may ease your discomfort and make you feel more relaxed.
You can also add essential oil to a bowl of warm water and soak your feet in it.

Herbal remedies

Dandelion tea, a herbal remedy, may help to prevent fluid retention, but don’t take it if you have a gall bladder condition.
It’s best to drink herbal teas in moderation during pregnancy.

Osteopathy

Osteopathy and chiropractic treat misalignments in your skeleton, which may be placing stress and tension on specific areas of your body. However, there’s no evidence that this can ease the type of swelling that happens during pregnancy.

Reflexology

Reflexology works on the principle that your feet or hands represent a map of your body, with certain points corresponding to the body’s functions.
The evidence is mixed about reflexology and swelling. There’s limited research showing that reflexology eases swelling and discomfort. However, other research says that reflexology is not effective for treating medical conditions.

Having a reflexology session may involve putting your feet up, with gentle massage of and pressure on areas of your feet. It’s possible that these actions could help also to ease swelling in your lower legs and feet. You may find it a relaxing treatment, as long as your feet and legs are not painfully swollen.

References