What should I do if my legs are swollen?

Update: October 2018

Content:

  • What to do with swollen legs before going to the doctor?
  • How to reduce leg swelling depending on the cause?
  • Swelling of the feet in pregnant women
  • How are diuretics

When a person first sees swelling in his legs, the first thing
what he is experiencing is fear and desire to quickly get away from it
get rid of.

Of course, swelling often indicates severe
heart or kidney disease, but before grabbing
medications or folk remedies for edema, should be as accurate as possible
find out why your legs are swollen, and for this it is wise to turn to
to the doctor and not rush to the Internet with the request “swelling of the legs,
do”.

All edema is divided into several groups depending on
the reasons that cause them (see in detail the causes of
swelling of the legs). The main approaches to treatment depend on it.

  • Orthostatic edema due to forced positions.
  • Edema in nephrotic syndrome on the background of renal pathologies
    (glomerulonephritis, interstitial nephritis) or systemic
    diseases (amyloidosis, systemic lupus erythematosus,
    lymphogranulomatosis, diabetes), and nephropathy of pregnant women.
  • Heart swelling при недостаточности кровообращения (при
    myocarditis, heart defects, heart rhythm disturbances and
    ischemic heart disease, pulmonary heart decompensation).
  • Venous edema при варикозной болезни ног, тромбозах вен нижних
    limbs.
  • Lymphatic swelling.
  • Idiopathic edema in women.

What to do with swollen legs before going to the doctor?

Until the moment when a person manages to get an appointment to
a specialist, it is inappropriate to leave swelling without attention. But,
this does not mean that you should immediately start taking diuretics, so
as uncontrolled intake of these drugs is fraught with a number of adverse
effects that are not inferior in severity to the edema itself.

But the most simple activities that help reduce or
remove swelling of the legs, health will not bring.

  • First, leg edema can be reduced by positional
    drainage

Theseм способом хорошо устраняются отеки в результате венозного
stagnation or swelling of the situation when a large period of time
a person holds in a forced position with his legs down or
long standing. To drain properly, you need a leg from the heel to
hips raise above the level of the body at an angle of thirty to forty-five
degrees To do this, you can lie down with a rolled up blanket under your feet.
(so, by the way, you can sleep all night without any problems) or sit down
putting a pillow under your feet. Any amount of time ranging from
half an hour spent in this position can reduce swelling
feet.

  • Limit liquids and salt

Что делать, если отекают ногиAnother factor that
able to help combat edema on the legs, serves to limit
fluid consumed throughout the day (up to two and a half liters,
including soup), avoiding drinking at night and reducing salt intake.
The fact is that table salt (sodium chloride) contains sodium,
lingering in the body, it pulls water into the tissue and
provokes puffiness. Enough to start to abandon
salting ready meals, gradually reducing and adding salt when
cooking

  • Simple exercise and foot massage

Also, when puffy legs can help simple physical
exercises:

  • tiptoeing
  • alternately raising socks and heels while standing or
    sitting
  • dorsal flexion
  • spreading and squeezing the toes
  • foot massage

Self-massage of the feet and legs, which
you should start at your fingertips, stretching your feet, and do
for 2-5 minutes, alternating stroking, rubbing and kneading.
Yoga classes are also very effective because they contribute to
improvement of blood circulation, massage of internal organs,
positively affects the metabolism and the general condition
organism.

  • With magnesium deficiency in the body – taking dietary supplements and
    multivitamin

A lack of magnesium can cause swelling of the legs, especially when
of pregnancy. Therefore, the reception of Magne B6, Magnelis B6, Magnerot,
multivitamin могут значительно сократить отечность нижних
limbs. When pregnancy should not be taken alone
magnesium medications, the dosage and course of treatment prescribed only
doctor.

  • Aromatic bath or foot bath

As a solution for baths, you can use mineral
water or tonic, which diluted alcoholic beverages contained
components in soda and quinine reduce puffiness. Baths with drops
essential oils or english salt or foot baths with marine
salt also facilitate the condition. Any water treatments, bathing,
swimming gives rest and relaxation to the feet because the water pressure
prevents the expansion of blood vessels and helps reduce puffiness
feet.

How to reduce leg swelling depending on the cause?

After a thorough diagnosis of edema and
their true cause is revealed, the doctor prescribes a particular scheme
treatment. The duration of therapeutic measures depends on
origin of edema:

Orthostatic swelling

Such edema is treated with postural drainage. They may also
turn up effective cold foot baths. For this leg up
knees immersed in a container with cool water for fifteen or thirty
minutes

Nephrotic swelling

This is a more serious situation that requires systemic
approach. Since in this case, the cause of swelling of the legs becomes
impaired renal filtration, the first thing to do is reduce
load on the kidneys. For this purpose, a diet is prescribed:

  • limiting fluid up to 2 liters per day
  • salt up to 3 grams per day
  • protein up to 90-60 grams

Further, depending on the reasons for the development
nephrotic syndrome, treatment of the main
diseases.

  • So, glucocorticoids are prescribed for glomerulonephritis.
    (prednisone), cytostatics (cyclophosphamide, chlorambucil,
    cyclosporine, azathioprine), penicillin antibiotics.
  • In the post-streptococcal process and ACE inhibitors in the case of
    with hypertension (enalapril, ramipril).
  • Systemic lupus erythematosus, rheumatoid arthritis are also treated with
    the use of hormones and cytostatics.
  • Nephropathy on the background of diabetes requires the appointment of insulin or
    hypoglycemic drugs such as sulfanilurea (glibenclamide,
    gliclazide, glycvidone, glimepridine), biguanides (metformin),
    thiazolidinediones (rosiglitazone), alpha-glycoidase blockers
    (acarbola).

The edemas themselves are resolved by prescribing diuretics
(furosemide, indapamide). With the ineffectiveness of conservative
events appoint dialysis, that is, hardware blood purification,
which replaces the natural function of the kidneys.

Heart swelling

Heart pathologies leading to edema of the legs also require
complex treatment. Begin treatment with a diet (restriction
water-salt load). You also need to adjust the weight and reduce
risks for the development of atherosclerosis by balancing the vegetable diet
and animal fats and taking atherosclerotic drugs (see
statins for lowering cholesterol – vazilip, simvastatin,
astorostatin, rosuvostatin). Smoking is contraindicated
vessels and alcohol which has a direct toxic effect on
a heart.

Chronic heart failure is treated with
using:

  • means of increasing myocardial contractility – cardiac
    glycosides like digoxin, strophanthin
  • drugs that reduce vascular tone:
    • ACE inhibitors – burlipril, enalapril, diroton,
      ramipril
    • angiotensin receptor blockers – losartan, valsartan
    • nitrates – nitrosorbid
  • diuretic – hypothiazide, spironolactone, indapamide,
    furosemide
  • means that reduce the load on the heart: beta-blockers –
    metoprolol, betalok ZOK, bisoprolol, carvedilol, nebivalol

Heart defects are subject to surgical correction, with weakness
sinus node put artificial pacemakers, and when
coronary artery disease and after suffering a heart attack
coronary artery bypass surgery.

Venous edema

Venous edema – одна из самых частых разновидностей swelling of the feet.
Their cause may be hiding in varicose veins or venous thrombosis.
(see thrombophlebitis: symptoms, treatment).

With venous insufficiency, the first events that
help eliminate puffiness – this is a drainage position and
compression bandaging of legs. Today, instead of bandages often
apply specialized compression stockings (see
compression underwear for varicose veins). Both bandaging and stockings need
apply in the morning without getting out of bed in the prone position until blood
not yet stagnated in the veins on the background of daily load.

Since the cause of venous stagnation may be an increase
vnutribrushnogo pressure, you should avoid lifting weights and fight
with constipation. Diet for the pathology of veins should not contain spices,
pepper, it is advisable to give up alcohol and smoking (see treatment
varicose veins at home).

Among the medications recommended:

  • Venotonics (Venitan, Antistax, Troxevasin), rutoside
    (venolan, venoruton, ginkor forte), saponins (escuzan), diosmin,
    detralex
  • With complete failure of the veins they are turned off from the bloodstream with
    using venosclerotic drugs (hepatrombin or
    ethoxy sclerola), which are injected into the veins or removed
    promptly.
  • Even with venous pathologies, improvement is recommended.
    capillary blood flow using pentoxifylline and low molecular weight
    dextrans
  • Thrombotic complications are treated with direct anticoagulants.
    (heparin) or indirect (fenindione, coumarin derivatives)
    actions.
  • In acute thrombosis in the surgical hospital
    heparins are introduced with the subsequent transition to warfarin or
    an operation is being performed.
Lymphatic swelling

Lymphatic swelling (лимфедема) – это результат нарушения
lymphatic vessels drainage. They accompany congenital anomalies or
lymphatic vascular occlusion, malignant tumors. Wherein,
as a rule, one leg swells.

  • With this form of edema, the condition is somewhat easier with
    using:

    • position drainage
    • compression dressings or underwear
    • foot massage
  • Also appointed physiotherapy and methods
    physiotherapy effects:

    • Pneumatic massage comes down to the fact that
      special apparatus over the area of ​​impact i am formed
      rising wave of high pressure which affects from 1
      up to 7 minutes and drives the lymph from the periphery of the limb to the central
      ducts.
    • When kinesiological taping in the projection of lymphatic
      the vessels are superimposed by a network of adhesive tape. Which raises
      patches of soft tissue, stimulating lymph drainage.

Contraindications to physiotherapy are acute infectious and
skin processes, tumors, blood diseases. There are
surgical techniques for restoring lymphatic drainage
by creating fistula between lymphatic and venous
systems.

Swelling of the feet in pregnant women

The legs of a pregnant woman carry double load, therefore
all conditions for venous stagnation are created. The situation is getting worse
compression of the inferior vena cava in the pregnant uterus, and
hindered ventilation of the lungs and increased work requirements
hearts. Therefore, often in healthy pregnant women after a whole day,
especially if it is held on the feet, shod in narrow shoes, swell
feet or ankles of the feet. It’s usually enough to lie down for a while
putting a blanket under your feet so that the puffiness would sleep.

It becomes more serious when edema in a pregnant woman
the result of preeclampsia or nephropathy (see preeclampsia during pregnancy). These
situations require observation by a doctor and timely medical
correction. Often such women are offered hospitalization in
obstetric hospital, which should not be neglected to
keep the pregnancy. After all, if the future mother’s legs are swollen,
to do, should be solved by a competent doctor, which will fall
responsible for the health of the baby.

How are diuretics

Diuretic, also called diuretics, is a group
drugs that facilitate the removal of fluid from the tissues and
increasing urine output. When treating edema of the feet, these remedies
very important. They are divided into several classes depending on
chemical structure and on which part of the kidneys act
more active (see also folk diuretics).

The basis of the kidney is the nephron, which includes vascular
the glomerulus, its capsule and the system of the adductor and adducer tubules,
connected by a loop. The discharge channel goes into collective
tubule flowing into the renal pelvis. The glomerulus filters plasma
blood and turns it into primary urine. Throughout the tubules
part of the water, as well as ions of sodium, potassium and chlorine are partially absorbed
back.

Different diuretic classes are preferred for different reasons.
swelling of the feet.

  • Saluretics are called diuretics, the effect of which is based on
    removal of potassium and magnesium ions. These include:

    • thiazide (hypothiazide, cyclomethiazide)
    • sulfonamides (indapamide, chlorthalidone, clopamide)
    • loop (furosemide, lasix, torasemide, ethacrynic acid,
      bumetanide)
    • carbonic anhydrase inhibitors (diacarb, acetazolamide).
  • Osmotic diuretics (urea, lures) work by
    the difference in osmotic pressure in the tubules, which prevents
    reverse water absorption.
  • Diuretic potassium-sparing (amiloride, triamteren,
    spironolactone, veroshpiron, eplerenone) work in the diverter
    tubule, interfering with potassium losses.
By efficiency
  • Diuretics are strong – furosemide, lasix, triphas, uregit,
    brinaldix, clopamd, ethacrynic acid
  • medium strength – hypothiazide, hygroton, cyclomethiazide,
    oxodoline
  • weak -verhspiron, diakarb, triamteren
For the duration of action
  • Long-term work (up to four days) eplerenone, chlorthalidone,
    veroshpiron
  • Medium-term (up to 14 hours) are diacarb, hypothiazide,
    clopamide, triamteren, indapamide
  • Diuretic with a short action (up to 8 hours) – it attracts,
    lasix, furosemide. Torasemide, ethacrynic acid
By the speed of the onset of action
  • release fast diuretics (begin to act through
    half an hour): furosemide, ethacrynic acid, torasemide,
    triamteren
  • medium (after 2 hours): amiloride, diacarb
  • медленные (через 2 суток): veroshpiron, эплеренон

Diuretics are selected as follows:

  • In chronic heart failure and nephrotic
    Loop diuretics are preferred.
  • Osteoporosis requires the appointment of thiazides.
  • Indapamide is used for metabolic disorders and sugar
    diabetes.
  • Spironolactone is indicated for increased secretion of aldosterone.
    adrenal glands.
  • Hypertension is treated with thiazides and
    indapamide.
  • Severe swelling of the legs on the background of heart failure requires
    парентерального введения лазикса или furosemide.

It should be remembered that the treatment of edema should not begin with the reception
diuretics, and with a trip to the doctor, as soon as possible to establish
the true cause of edema and get adequate recommendation that
do when the legs swell.

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