Treatment of Edema

Treatment

Treatment of edema is divided into causal treatment and symptomatic treatment. Causal treatment means finding and correcting the cause that triggers the edema. If causal treatment fails, symptomatic treatment is provided. Edema appears in various forms, from mild to severe, and its causes are also diverse. The prognosis of edema varies greatly depending on the underlying disease. Therefore, it is important to approach diagnosis and treatment actively.

1. Symptomatic treatment Symptomatic treatment includes restricting salt and fluid intake and, if necessary, using diuretics to help increase urination. Diuretics do not need to be used for every patient with edema. In some patients, salt restriction and simply elevating the legs can produce good results. If diuretics are used, the type of medication, route of administration, and dose are determined according to the patient’s condition.

2. Treatment of generalized edema · Congestive heart failure Treatment differs depending on whether it is acute or chronic. Acute heart failure generally refers to heart failure that suddenly occurs or worsens within about one week. It often leads to an emergency room visit, and the main goals of treatment are to identify and remove the cause or aggravating factors and improve symptoms. In chronic heart failure, the body’s compensatory mechanisms activate the sympathetic nervous system and hormonal systems excessively. This is an important cause of disease progression, so the goal of treatment is to block it and prevent gradual deterioration of cardiac function.

· Cirrhosis In patients with cirrhosis, treatment of ascites and edema consists of diuretic use and salt restriction. Ascites is a common complication of cirrhosis, and when ascites develops, the prognosis is poor. Depending on the degree of ascites, it is classified into stages 1, 2, and 3. In addition, to determine the cause of ascites, paracentesis is performed with a needle to collect ascitic fluid for analysis. In patients with cirrhosis, if ascites is stage 2 or 3, diuretics (spironolactone) are needed to treat the accompanying hyperaldosteronism. If ascites is stage 3, paracentesis is performed in addition to salt restriction and diuretic use. Even when the amount exceeds 5 liters, it is recommended to remove a large volume at one time during paracentesis. After paracentesis, albumin should be administered to replenish fluid. The best treatment for patients with cirrhosis is liver transplantation.

· Nephrotic syndrome Treatment consists of correcting the underlying disease, restricting salt, and using diuretics (loop diuretics, anti-aldosterone agents).

· Hypothyroidism Treatment consists of administering thyroid hormone; when blood thyroid levels improve, the edema also improves.

· Drug-induced edema This occurs when medications are used excessively or taken for a long time, so stopping the causative drug is the most important step.

· Idiopathic edema Because there is no identifiable cause, symptomatic treatment includes reducing salt intake and resting in a lying position for several hours during the day. People with high activity levels or frequent swelling are advised to wear elastic stockings before getting up in the morning to prevent swelling. At night, keep the legs slightly elevated while sleeping.

· Hypoalbuminemia Adequate nutritional support is the best treatment. When an appropriate diet is provided to patients with hypoalbuminemia, edema may initially worsen. This is because the meal includes a large amount of sodium, which causes more water to be absorbed; this is called refeeding edema. However, it improves over time, so there is no need to worry.

3. Treatment of local edema · Chronic venous insufficiency Treatment involves correcting the underlying disease (deep vein thrombosis, varicose veins), and if there are accompanying conditions (infection, skin ulcers, etc.), they are treated as well. Diuretics are not necessary, but they may be used selectively in some cases. Elevating the swollen leg above the heart and wearing stockings can reduce venous hypertension and edema. In addition, wearing stockings reduces edema and the occurrence of deep vein thrombosis.

· Lymphedema Prevention is most important. Because lymphedema occurs due to lymphatic vessel damage, once it develops, it does not improve easily. The best treatment identified so far is complex lymphedema therapy using lymphatic massage, compression therapy, exercise, and skin care, with medication used as an adjunct. If there is no improvement with physical therapy or medication and the condition worsens further, surgical methods may be considered, but the success rate is very low.

· Lipedema Treatment consists of weight loss and wearing compression bandages or stockings. Some people consider liposuction, but liposuction damages not only fat but also lymphatic vessels, so it may instead cause lymphedema.

· Senile leg edema There is no special treatment, but for people who are active during the daytime, wearing stockings is recommended, and at night the legs should be kept slightly higher than the heart.

So far, I have explained the treatment of edema. In the next part, we will look at gynecomastia.

Source: National Health Information Portal, Korea Disease Control and Prevention Agency