Dependent
Edema
by
Patti Jo Erickson
Swelling in the arms
or legs is often a problem for people who have impaired mobility.
This might occur with paralysis, multiple sclerosis, Parkinson's
disease, or after a stroke. Pumping of muscles is an important
factor in the body's process of continually returning fluids to
the blood circulatory system. In the absence of this important
muscle pumping, swelling, or "edema" may form.
In the medical community
this type of swelling is termed "dependent edema". If a body part
is lower than the heart, it is said to be in a position dependent
to the heart. In a dependent position, gravity contributes to fluid
accumulation in areas of the body farthest from the heart (arms
and legs). The effects of gravity combined with lack of muscle
pumping is what causes dependent edema.
At first the swelling completely goes away with elevation. For example,
in the morning when a person rises from bed their arms and legs have
been at the same level as their heart. So, when they get up in the
morning there is no swelling. But as the day goes by, the effects
of gravity and lack of muscle pumping cause the fluid to reaccumulate
and swelling occurs. Sitting in a chair for many hours and bending
at the hips also contribute by impeding the flow of fluids.
In the blood circulatory system, arteries carry fluid away from
the heart. Fluid is always leaving the arteries to bring oxygen,
nutrients and other vital substances into the body tissues. Most
of that fluid returns to the blood stream through the veins. The
fluid not taken up by the veins is picked up by lymphatic vessels
and filtered in lymph nodes. Veins and lymphatic vessels have muscles
in their walls to move fluid, but also rely on movement of the body
to function.
If the swelling no longer
goes away with elevation, such as when a person arises from bed
in the morning, it indicates that lymphatic transport is overwhelmed
by the amount of fluid in the soft tissues. When this occurs, the
body's immune system is greatly impaired because cellular debris,
bacteria, viruses, toxins, and other molecules are not being effectively
filtered out by the blood and lymph circulatory systems. This makes
a person more prone to infections such as cellulitis or fungal,
and wounds are slower to heal.
Swelling may become so
extreme that it is difficult to find shoes and clothing that fit
over the swollen areas. It may also further impair one's functional
mobility. The swelling may also become achy or painful.
Occupational & physical
therapists with special training in lymphedema treatment may treat
dependent edema. Treatment components normally include special
bandaging techniques, compression garments, and manual lymph drainage
(MLD). MLD is a skin touch technique performed to direct fluid
toward lymph nodes. Bandages are typically applied at night, and
compression garments worn during the day. Often compression garments
are custom made to ensure a comfortable, proper fit. Compression
garments fit better and are more comfortable once the swelling has
been reduced with bandaging and MLD.
Lymphedema therapists
may teach their patients or their patient's caregivers how to apply
bandages and compression garments, and perform simple. MLD for
home management of swelling. Sometimes non-elastic binders may
be used instead of bandaging if this facilitates independence in
home management by the patient or their caregiver.
For more information regarding lymphedema therapy for dependent
edema, please call Patti Jo Erickson at the Fairview-University Medical
Center Lymphedema Treament Center: 612-273-5377.
