Importance of knowing the causes of leg swelling-By Dr Harold Gunatillake

This is a common condition that is most prevalent in your 60s and over. If you observe the condition you may need to see your health provider for investigation and treatment.
Swelling can occur in one leg and foot, or both. If one limb is involved the cause is local in the leg itself, such as lymphatic gland blockage near the groin, blood vessel blockage due to deep vein thrombosis (DVT), skin infections, cellulitis and so on.
Deep vein thrombosis is a serious condition that occurs when blood clots form in the calf and thigh veins.
Early detection and treatment are required before a clot moves from the leg into the lung referred to as
pulmonary embolism.
The commonest cause is when you sit frequently without much leg movements as travelling on a plane, the venous blood flow slows down and cause clot to develop.
Pain tenderness and swelling in the calf muscles is the earliest symptom, skin can get discolored.

Today our main talk is on swelling of legs and feet in both legs simultaneously
Common causes of swelling in the legs and feet includes vein disease, Lymphatic disease, Inflammation, Heart disease, Kidney disease, fluid retention and certain medications
You could have a fluid build up simply being overweight, being inactive, or sitting on one position for a long time as on a plane journey.
Let us discuss the causes of leg and feet swelling due to lymphatic stasis. Lymph in Latin is water and is the fluid that flows through the lymphatic system.
Lymphatic system is comprised of a network of minute threads in the body with intervening lymph glands. It is
akin to the railway lines and the railway stations.
Like the blood vessel system, lymphatic system also return fluid from the tissues to the central circulation.
Lymph is found between blood vessels and cells and is referred to as the interstitial fluid. The function of this fluid is to collect waste products discharged out of cells due to metabolic activities within the cells. Centrally, lymph is drained into the blood vessels Lymphedema is abnormal swelling that can develop in your legs after lymph nodes have been removed or injured.
This occurs in the upper arms after radical mastectomy for cancer of the breasts, where axillary lymph nodes are
removed.
Metabolic abnormalities like underactive thyroid gland called myxedema can give rise to swelling of your legs
in addition to swelling in the face and tongue.
Let us discuss what Pitting edema is?
Swelling of your legs could be brawny or nonpitting which we have discussed in brief.
The other type of swelling is referred to as ‘pitting edema’ Swelling of legs and feet could occur due to excess fluid collection in the intercellular compartments of the limb other than lymph.
This fluid is different to lymph collection, it is differentiated by pressing on the swollen area and an indentation
or pit remains, it is called pitting edema.
If pitting edema due to both lower limbs affected it is a systemic problem with your heart, kidneys, or liver
function.
With pitting edema, you need to see your doctor soon to determine the cause.
Following are the causes of general pitting edema.
• heart valve problems
• low protein levels
• deep venous thrombosis (DVT) — blood clots, usually in the legs
• severe lung disease
• congestive heart failure
• venous insufficiency
• liver disease
• kidney failure
• obesity
• medications
• hot weather
Congestive Cardiac Failure
This is the most common condition where early pitting edema may be present in your legs.
It is important to get annual checkups to check on your blood pressure, coronary heart disease and heart valvular
defects.
You need to check your blood pressure at home frequently when you are 60 and over.
If the pressure is high means that your heart is on stress mode due to the excessive force and pressure.
If your blood pressure is not controlled your early symptoms are a regular thud in your head causing a headache,
breathlessness, congested eyes, nose bleeds, dizziness are early indications.
So, it is vital to regularly check your blood pressure to ensure your numbers stay within the normal healthy range.
Coronary artery disease is quite common, and if neglected you may detect pitting edema around your ankles, a
sign that the heart is failing.
Heart failure is not that the heart has failed but going into a failing situation unless prompt remedial measures
are taken.
Heart failure is known as congestive heart failure, occurs when your heart muscle does not pump blood as well
as it should.
Lifestyle changes-such as exercising, reducing salt in your diet, managing stress, and losing weight can improve
the situation.
In addition to pitting edema is the legs, shortness of breath is common when you lie down. This is because fluid
seem to collect in the lungs due to back pressure from the failing heart.
You may get a wheeze with white or pink blood-tinged phlegm.
Do not think this is bronchial asthma but see your health provider soon.
Leg swelling in kidney failure.
Uncontrolled diabetes is the commonest cause of chronic kidney failure. During the terminal stages of this
disease, due to reduced amount of urine excreted fluid collects in both legs and feet.
You need to tightly control your sugar level in your blood to prevent this situation.

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