Fluid Retention Diagnosis, Treatment, Prevention

Fluid Retention Diagnosis/Water retention or hydrops, hydropsy, edema, signifies an abnormal accumulation of clear, watery fluid in the tissues or cavities of the body. Water is found both inside and outside the body’s cells. It forms part of the blood, helping to carry the blood cells around the body and keeping oxygen and important nutrients in solution so that they can be taken up by tissues such as glands, bone, and muscle. Even the organs and muscles are mostly water.

The body uses a complex system of hormones and hormone-like substances called prostaglandins to keep its volume of fluid at a constant level. If one were to intake an excessive amount of fluid in one day, the amount of fluid would not be affected in the long term. This is because the kidneys quickly excrete the excess in the form of urine. Likewise, if one did not get enough to drink, the body would hold on to its fluids and urinate less than usual. Imbalances in this system can lead to water retention, which can range from mild and unnoticeable to symptomatic with swelling.

Causes of Water Retention

Where water retention occurs

  • Fluid rich with oxygen, vitamins and other nutrients passes all the time from the capillaries (the smallest blood vessels) into the surrounding tissues, where it is known as tissue fluid or interstitial fluid. This fluid nourishes the cells and eventually should return to the capillaries.
  • Water retention is said to occur as a result of changes in the pressure inside the capillaries, or changes that make the capillary walls too leaky (see edema and vascular permeability). If the pressure is wrong, or the capillaries are too leaky, then too much fluid will be released into the tissue spaces between the cells. Sometimes so much fluid is released that it cannot all return to the capillaries and remains in the tissues, where it causes the swelling and waterlogging which is experienced as water retention.
  • Another set of vessels known as the lymphatic system acts like an “overflow” and can return a lot of excess fluid back to the bloodstream. But even the lymphatic system can be overwhelmed, and if there is simply too much fluid, or if the lymphatic system is congested, then the fluid will remain in the tissues, causing swellings in legs, ankles, feet, abdomen or any other part of the body.

The Heart

  • The pumping force of the heart should help to keep normal pressure within the blood vessels. But if the heart begins to fail (a condition is known as congestive heart failure) the pressure changes can cause very severe water retention. In this condition, water retention is mostly visible in the legs, feet, and ankles, but also collects in the lungs, where it causes a chronic cough. This condition is usually treated with diuretics, otherwise, the water retention may cause breathing problems and additional stress on the heart.

The Kidneys

  • Another cause of severe water retention is kidney failure, where the kidneys are no longer able to filter fluid out of the blood and turn it into the urine. Kidney disease often starts with inflammation, for instance in the case of diseases such as nephrotic syndrome or lupus. Once again, this type of water retention is usually visible in the form of swollen legs and ankles.

Other Causes of Swollen legs

  • Swollen legs, feet, and ankles are common in late pregnancy. The problem is partly caused by the weight of the uterus on the major veins of the pelvis. It usually clears up after delivery of the baby, and is mostly not a cause for concern, though it should always be reported to a doctor.
  • Lack of exercise is another common cause of water retention in the legs. Exercise helps the leg veins work against gravity to return blood to the heart. If blood travels too slowly and starts to pool in the leg veins, the pressure can force too much fluid out of the leg capillaries into the tissue spaces. The capillaries may break, leaving small blood marks under the skin. The veins themselves can become swollen, painful and distorted – a condition known as varicose veins.
  • Lack of exercise is a common cause of water retention because muscle action is needed not only to keep blood flowing through the veins but also to stimulate the lymphatic system to fulfill its “overflow” function. Long-haul flights, lengthy bed-rest, immobility caused by disability and so on, are all potential causes of water retention. Even very small exercises such as rotating ankles and wiggling toes can help to reduce it.


  • Protein attracts water and plays an important role in water balance. In cases of severe protein deficiency, the blood may not contain enough protein to attract water from the tissue spaces back into the capillaries. This is why starvation often shows an enlarged abdomen. The abdomen is swollen with edema or water retention caused by the lack of protein in their diet.
  • When the capillary walls are too permeable, protein can leak out of the blood and settle in the tissue spaces. It will then act like a magnet for water, continuously attracting more water from the blood to accumulate in the tissue spaces.

Other factors

  • Certain medications are prone to causing water retention. These include estrogens, thereby including drugs for hormone replacement therapy or the combined oral contraceptive pill, as well as non-steroidal anti-inflammatory drugs and beta-blockers. Premenstrual water retention, causing bloating and breast tenderness, is common and may be related to hormone imbalances promoted by a lack of nutrients such as B vitamins or magnesium.

Medication-caused water retention

Some medications can cause water retention, including

  • Drugs that contain estrogen – These can reduce water retention. Examples include birth control pills or hormone replacement therapy (HRT).
  • Non-steroidal anti-inflammatory drugs (NSAIDs) – These are medications with pain-reducing, fever-reducing effects. In high doses, they are actually effective in reducing inflammation. Examples include aspirin, ibuprofen, and naproxen.
  • Beta-blockers – These are used to treat abnormal heart rhythms and prevent tachycardias.

Premenstrual water retention

This can cause bloating and breast tenderness. Experts say this is due to hormone imbalances and some nutritional factors, including:

  • Malnutrition and bad diet – A poor diet low in protein result in low levels of albumin, which may also play a part in developing water retention.
  • Salt, or sodium – sodium-rich foods may cause water retention.
  • Allergies – Some foods and insect bites may cause edema in susceptible people.
  • Thyroid disease – People with a disorder of the thyroid gland commonly experience water retention.

Symptoms of Water Retention

Diagnosis of Water Retention


For most people with widespread water retention, blood tests are done to evaluate the function of the heart, kidneys, and liver. Urinalysis is usually also done to check for large amounts of protein, which can indicate nephrotic syndrome or, in pregnant women, preeclampsia. Other tests are done based on the suspected cause. For example, in people with isolated leg swelling, doctors may do ultrasonography to look for blockage of a vein in the leg.

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Causes water retention

Common Features


Some times itching or tight sensation

water retention that does not remain indented after being pressed

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


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

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


Usually echocardiography

Infection of the skin (cellulitis)

An irregular area of redness, warmth, and tenderness on part of one limb

Water retention

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


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 water retention, doctors do a complete blood count, other blood tests, and urinalysis (to check for protein in the urine).



Treatment of Water Retention


In the acute, or early phase, remember PRICE

  • P = Protection from further damage
  • R = Rest to avoid prolonging irritation
  • = 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 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 Water Retention

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.

Home Remedies of Water Retention



  • Dandelions are very high in potassium that can act as a natural diuretic. A big reason why many of us suffer from water retention is that we eat a diet that is too high in sodium and too low in potassium. While sodium makes your body hold on to water, potassium encourages it to release excess fluids. Drinking dandelion tea can make you pee more often and reduce water retention. But the most effective way to use dandelion as a diuretic is to take concentrated dandelion supplements.



  • Asparagus has been used as a natural diuretic for centuries. This plant contains an amino acid called asparagine which is especially effective in treating water retention due to menstrual cycles and rheumatism. After eating asparagus, you might notice that your pee smells funny. This is because after you eat asparagus, it gets broken down into sulfur compounds that cleanse your body of toxins and makes you pee more frequently.


  • Parsley is a popular medicinal herb and had extensive uses in traditional medicine. A herbal tea made by steeping fresh parsley leaves in boiling water was often used as a natural remedy to treat water retention. Studies on the diuretic effects of parsley conducted on rats did find that rats urinated more frequently after ingesting parsley. While studies on humans haven’t been conducted yet, there’s plenty of anecdotal evidence to support parsley’s diuretic powers.


  • Caraway seeds are small, brown seeds that look very much like cumin. In Eastern traditional medicine, caraway seeds were often used to soothe digestive issues and reduce water retention. Studies conducted on rats found that after being fed caraway extracts, rats urinated a lot more frequently than usual. The lack of studies on humans, however, means that we don’t know just how much caraway is required to reduce water retention. You can start using caraway seeds by adding it as a spice to your meals or boiling it with water and drinking the tea along with the seeds.



  • Both green and black tea have strong diuretic properties that can help reduce water retention. However, it’s important that you drink it black and with no sugar as dairy and white sugar can aggravate water retention. Interestingly, studies have shown that tea is most effective as a diuretic when a person doesn’t drink it on a regular basis. Drinking tea everyday can make you develop a tolerance for it which can affect its diuretic properties. So if you’re a coffee drinker, it’s best you switch to tea on days when you feel extra puffy.


  • Horsetail is one of the most powerful natural diuretics known to us and is available in the form of a tea and as a supplement. One study found that taking horsetail supplements were as effective as certain commercial diuretics. But while horsetail can dramatically reduce water retention in the short run, it can cause harmful side effects if you use it for too long. Horsetail can also be dangerous if you already have kidney disease or diabetes.



  • Cucumbers are almost entirely water themselves, so it isn’t surprising that eating them will make you pee more. Cucumbers contain sulfur and silicon which can help your kidneys function better and remove excess uric acid from them. They are also very high in potassium which helps your body release water. You can even use cucumbers topically to reduce symptoms of water retention. If your eyes get puffy when you have water retention, placing cool slices of cucumber over them can reduce the swelling.


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