Bilateral Leg Edema: Causes, Symptoms, and Treatment Options

Bilateral leg edema?

Hello, doctor.
About three weeks ago, I started noticing mild swelling in both of my legs.
A week ago, the condition worsened, and I gained 3 to 4 kilograms.
I feel better upon waking, but my eyelids are puffy, and my scalp feels swollen.
I spend most of the day sitting at work, which exacerbates the swelling in my legs, although the swelling in my eyelids and scalp tends to decrease over time.
This has been quite bothersome, so I visited a family medicine clinic.

After blood and urine tests, it was found that my kidney function is normal, but I have elevated urine protein and signs of urethritis (though I do not experience discomfort or frequent urination when I go to the bathroom; the urine test was conducted on the last day of my menstrual period).
My cholesterol levels are high, and while my liver function tests show normal GOT levels, GPT is slightly elevated.
The doctor prescribed diuretics and medication for urethritis.
After taking the medication, I noticed an increase in urination for a few days, but sometimes I do not feel that way, leading me to doubt the effectiveness of the diuretics.
The swelling has only slightly improved.

Due to the high cholesterol and swelling, I changed my diet this week to primarily whole foods, avoiding salty and sweet foods, and I drink at least 2000 ml of water daily.
I take walks for exercise (the doctor advised against vigorous exercise).
However, after taking the medication for about a week, there has been no significant improvement in the swelling, so I am seeking further consultation.
I am unsure if this could be related to stress or if additional physiological examinations are needed.
Thank you.

In the past, my lifestyle included very little junk food, but I often eat out and exercise very little (mostly walking).
I do not drink enough fluids, and I consume sugary drinks about once every two weeks.
I usually experience high work-related stress, especially in the past month, where I have been particularly focused on my work progress, which has noticeably increased my stress levels.

Yuu, 20~29 year old female. Ask Date: 2020/07/01

Dr. Wu Zongying reply Family Medicine

Hello,
Thank you for your inquiry regarding the causes of edema.
There are many potential causes of edema, including heart failure, kidney disease, liver cirrhosis, the use of certain medications, and pregnancy.
Additionally, mild edema can be triggered by factors such as prolonged sitting or maintaining a certain position for too long (especially common in individuals who are overweight), as well as consuming excessively salty foods.

Medications that can cause edema include antihypertensives, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, estrogens (such as female hormones and contraceptives), and some antidiabetic medications.
If you are taking any of these medications, they may also contribute to edema.

Please review whether you have any of the aforementioned conditions; edema may resolve once these factors are addressed.
You mentioned that your GPT levels are elevated; if you are overweight, it may be important to consider whether you are sitting for extended periods or maintaining a specific posture for too long.
Additionally, please check if you have recently taken any of the medications listed above, as you may have received NSAIDs or corticosteroids if you sought medical attention for a cold or pain.

If you remain concerned or if the edema does not resolve, it is advisable to visit a hospital outpatient clinic for further evaluation.

Wishing you good health.

Sincerely,
Director of Family Medicine,
Wu Zong-Ying

Reply Date: 2020/07/01

More Info

Bilateral leg edema, or swelling in both legs, can be caused by a variety of factors, and understanding the underlying causes, symptoms, and treatment options is essential for effective management. Based on your description, it appears that you have been experiencing this condition for about three weeks, with a notable increase in weight and swelling, particularly after prolonged periods of sitting. Additionally, you mentioned that your eyelids and scalp also feel swollen, which can be indicative of systemic fluid retention.

Causes of Bilateral Leg Edema
1. Fluid Retention: This is often due to a variety of factors, including dietary habits (high salt intake), hormonal changes, or certain medications. In your case, the increase in weight and the swelling that worsens after sitting could suggest fluid retention, possibly exacerbated by your lifestyle and dietary choices.

2. Kidney Function: Although your kidney function tests came back normal, the presence of protein in your urine (proteinuria) can indicate that your kidneys are not filtering properly. This could be a sign of kidney disease or other systemic issues that might require further investigation.

3. Heart Issues: Congestive heart failure can lead to fluid accumulation in the legs. While your symptoms do not directly suggest heart problems, it is important to consider this, especially if you have risk factors such as high cholesterol.

4. Liver Function: Elevated liver enzymes (like GPT) can indicate liver dysfunction, which can also lead to fluid retention. Although your GOT levels are normal, the elevated GPT could warrant further evaluation of liver health.

5. Venous Insufficiency: This occurs when the veins struggle to send blood back to the heart, leading to pooling in the legs. This is often exacerbated by prolonged sitting or standing.

6. Hormonal Changes: Hormonal fluctuations, particularly during menstruation, can lead to temporary fluid retention. However, since you mentioned that the swelling persists beyond your menstrual cycle, this may not be the primary cause.

Symptoms
The symptoms you are experiencing, including bilateral leg swelling, eyelid swelling, and scalp fullness, can be indicative of generalized edema. The fact that your symptoms improve upon waking suggests that gravity plays a role in your fluid retention, which is common in cases of venous insufficiency or fluid overload.

Treatment Options
1. Diuretics: Your physician has prescribed diuretics, which are intended to help your body eliminate excess fluid. While you have noticed some increase in urination, it is not uncommon for diuretics to take time to show significant effects on edema. It may also depend on the dosage and type of diuretic prescribed.

2. Dietary Changes: Reducing salt intake is crucial, as sodium can exacerbate fluid retention. Your decision to eat whole foods and avoid processed foods is a positive step. Additionally, maintaining adequate hydration is important, but be cautious with fluid intake if you are on diuretics.

3. Physical Activity: Regular movement can help improve circulation and reduce swelling. While your doctor advised against vigorous exercise, gentle activities like walking or stretching can be beneficial.

4. Compression Stockings: These can help reduce swelling by promoting better blood flow in the legs.

5. Stress Management: Since you mentioned increased work-related stress, finding ways to manage stress through relaxation techniques, mindfulness, or counseling may also help alleviate some physical symptoms.

Further Evaluation
Given that your edema has not significantly improved with initial treatment, it may be worthwhile to follow up with your healthcare provider for further evaluation. Additional tests, such as an ultrasound of the legs to check for venous insufficiency or further kidney function tests, might be necessary to rule out other underlying conditions.

In summary, bilateral leg edema can stem from various causes, and while initial treatment with diuretics and lifestyle changes is a good start, ongoing monitoring and possibly further investigation may be required to address the underlying issues effectively. Always consult with your healthcare provider before making any changes to your treatment plan or if your symptoms worsen.

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