Dear Dr. Roach: My brother is 74 and has edema in his legs and feet. He doesn’t exercise; he basically just sleeps and plays games on his computer. His bedroom is upstairs, and he struggles going up and down the stairs. He takes a water pill (furosemide).
Is he doing more harm than good taking the pill? Is there anything he can do or take that is not a prescription? He has tried compression socks and a machine that massages his legs, but the edema keeps coming back. I have read that pineapple juice might help.
N.K.
There are both serious and less serious medical causes of swelling of the legs and feet. Among the most prominent of these are conditions of the heart, specifically heart failure, and conditions of the liver, caused by the inability to make the protein albumin.
This is a major reason why fluid stays in the vascular system. Without proteins, the fluid escapes the blood vessels and gathers where gravity pulls it. Many liver conditions impair the ability of the liver to make albumin, especially cirrhosis (of any cause).
Protein loss in the kidneys can also be impacted. (Nephrotic syndrome is the classic cause behind protein loss in the kidney.) A doctor’s visit involving an exam and a few blood and urine tests is usually enough to evaluate for these serious causes.
Most times, however, people in their 70s develop swelling in their feet due to failure of the valves in the leg’s veins. Valves help return blood to the heart, using the muscular action of the legs to send blood to the heart at a low pressure. When the valves fail, the veins develop a higher pressure and swell — visible varicose veins are one sign of this. The high pressure also forces out fluid into the tissues.
Treatment includes compression stockings and sometimes compression devices, but these won’t work well unless your brother exercises and keeps his feet above the level of his heart, ideally for at least 30 minutes three times a day. Keeping the feet down all day while playing games is practically guaranteed to cause leg swelling.
I do not recommend diuretics like furosemide. They aren’t effective as long-term treatment, and they can cause excess loss of potassium and magnesium. While furosemide is sometimes used in treating heart failure when there is swelling due to high pressures in the heart, it has no role in long-term treatment of edema due to leaky veins.
Pineapple juice contains bromelain, which has anti-inflammatory and anti-swelling properties, but it won’t keep fluid in the vein when pressures are high. Some people have such severe vein disease that lifestyle changes alone are inadequate. Referral to a specialist is appropriate after a thorough trial of conservative management. Vascular surgeons have a number of options for managing symptomatic leg swelling that hasn’t responded to conservative treatment.
An expert is also appropriate when the diagnosis is uncertain, since there are many more causes of leg swelling, such as thyroid disease, lymphedema and lipedema.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
