Q: If I exercise or it is a hot day, my hands get really puffy. They also feel a bit uncomfortable. I notice also that the same happens to my feet. I am a woman in my mid 40s, have a fairly healthy diet and exercise regularly — although I am a bit overweight at the moment. I noticed it also when I was slim. Is this something I can fix?
Dr Grant replies: When it comes to arm/leg swelling my first question always to ask would be — is the swelling present first thing in the morning? If the answer is no, and your limbs are almost back to normal in the morning time, then it’s most likely a physiological variant of normal. My second question would be — is there a family history of this complaint? Some people find that towards the end of the day there is mild ankle/foot/hand swelling, particularly in people who spend much of their day standing.
This is often a shared common familial trait known as dependent oedema. With prolonged sitting/standing, the effect of gravity causes fluid to accumulate more. It is exacerbated by taking certain medication, going on a long flight, hot weather, eating a high salt diet or by being overweight or pregnant. Some women notice this as a regular premenstrual symptom. For anyone who has a history of trauma/surgery to a limb, there is an increased risk of swelling in the affected limb due to minor damage to the venous and/or lymphatic drainage.
The best way to combat dependent oedema is to elevate the limb when possible, wear compression socks to the knee level or ideally tights, and to ‘pump your calf muscles’ by contracting them as much as possible during the day. The latter you can do by simply pointing your foot upwards and downwards when sitting. An even better way to improve your venous and lymphatic drainage of your legs is to go for a walk during the daytime or engaging in any form of exercise.
Additional lifestyle changes such as reducing salt intake, managing stress and losing weight can improve the swelling in your limbs. In some cases attending a physiotherapist for simple lymphatic drainage, commonly taught self-help manoeuvres can help.
More severe ankle swelling, particularly if present first thing in the morning and associated with other symptoms such as fatigue, loss of appetite, weight gain or shortness of breath may have an underlying medical condition. Mild forms of failure of important organs (heart, liver, kidney) or glands (thyroid) can be underlying factors.
If you have an element of organ failure, you might be finding it difficult to sleep on just one pillow at night, instead preferring to use two or three pillows to prop you up as this helps you to breathe more easily. You might notice a cough, shortness of breath or wheeze in your chest due to fluid collecting in the lungs. Any organ failure can lead to fatigue, loss of appetite, reduced ability to exercise or weight gain due to fluid redistribution. Other conditions such as varicose veins or lymphoedema may be considered.
By attending your GP you can get blood tests to assess your heart, liver, kidney and thyroid function and your doctor can perform a physical examination to assess for signs of any of the conditions mentioned above. By putting your clinical history, your blood results and physical examination findings together, your doctor will have a good understanding of the potential underlying cause.
Dr Jennifer Grant is a GP with Beacon HealthCheck