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Medical Author:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• What is edema?
• What is pitting edema and how does it differ from non-pitting edema?
• What causes pitting edema?
• How does salt intake affect edema?
• Why does a patient with heart disease retain fluid?
• Why do patients with liver disease develop ascites and edema?
• Why does edema occur in patients with kidney disease?
• What is idiopathic edema?
• How does venous insufficiency cause edema?
• Which diuretics are used to treat edema?
• Are diuretics used for other purposes?
• Edema At A Glance
• Patient Comments: Edema - Signs and Symptoms
• Patient Comments: Edema - Salt Intake
• Patient Comments: Edema - Diuretics
• Patient Comments: Edema - Pitting Edema Causes
• Patient Comments: Edema - Causes
• Patient Comments: Edema - Effective Treatments
• Find a local Internist in your town
• Edema Index

Idiopathic edema is a pitting edema of unknown cause that occurs primarily in pre-menopausal women who do not have evidence of heart, liver, or kidney disease. In this condition, the fluid retention at first may be seen primarily pre-menstrually (just prior to menstruation), which is why it sometimes is called "cyclical" edema. However, it can become a more constant and severe problem.

Patients with idiopathic edema often take diuretics to decrease the edema in order to lessen the discomfort of bloating and swelling. Paradoxically, however, the edema in this condition can become more of a problem after the use of diuretics. The patients can develop fluid retention as a rebound phenomenon each time they discontinue diuretics. It is important to talk to your doctor before using any diuretics.

Patients with idiopathic edema appear to have a leak in the capillaries (tiny peripheral blood vessels that connect the arteries with the veins) so that fluid passes from the blood vessels into the surrounding interstitial space. Thus, a patient with idiopathic edema has a decreased blood volume, which leads to the typical reaction of salt retention by the kidneys.

• The leg edema in these patients is exaggerated in the standing position, since edema tends to accumulate in those parts of the body that are close to the ground at the time.
  
  
• These patients often have edema around the eyes (periorbital edema) in the morning because the edema fluid accumulates during the night around their eyes as they lay sleeping flat.

In contrast, edema around the eyes does not tend to develop in cardiac patients who keep their heads elevated at night because of shortness of breath when they lie flat. These patients characteristically experience varying amounts of edema in different parts of the body at different times of the day.

Patients with idiopathic edema often become dependant on diuretics, and this dependance is often difficult to interrupt. A period as long as three weeks off diuretics may be required to break the dependency cycle. The withdrawal from diuretics may lead to fluid retention that produces major discomfort and swelling. Furthermore, there are definite risks associated with the prolonged use of diuretics in these individuals, which are compounded by the tendency to increase the doses of the diuretics.

As a result of chronic diuretic use and abuse, patients may develop:

• a deficiency of potassium,
  
  
• depletion of blood volume in the blood vessels, and
  
  
• kidney insufficiency or failure.

Other side effects of diuretics include:

• high blood sugar (diabetes),
  
  
• high uric acid (gout),
  
  
• muscle cramps, tender and enlarged breasts (gynecomastia), and
  
  
• pancreatitis (inflammation of the pancreas).

Although withdrawal from diuretics is the most important factor in treating these patients, other medications have been used to try to minimize the fluid retention. These medications include ACE inhibitors, low-dose amphetamines, ephedrine, bromocriptine (Parlodel), or levodopa-carbidopa (Sinemet) in combination. However, their effectiveness is uncertain and side effects of these drugs may occur. For example, hypotension (low blood pressure) may be seen with the use of ACE inhibitors, especially if the patient is also taking diuretics.