What is pitting edema and how does it differ from non-pitting edema?

Some helpful information about Edema

Edema definition and facts

  • Edema is a swelling, usually of the legs, feet, and/or hands due to the accumulation of excessive fluid in the tissues.
  • The edema that occurs in diseases of the heart, liver, and kidneys is mainly caused by salt retention, which holds the excess fluid in the body.
  • In certain liver and kidney diseases, low levels of albumin in the blood can contribute to fluid retention.
  • Heart failurecirrhosis of the liver, venous insufficiency, and a kidney disease called nephrotic syndrome are the most common systemic diseases that cause edema.
  • Excess fluid that accumulates in the lungs is called pulmonary edema.
  • Excess fluid that accumulates in the abdominal cavity is called ascites.
  • Edema of unknown cause (idiopathic edema) occurs primarily in women.
  • Varicose veins or thrombophlebitis (a blood clot in an inflamed vein) of the deep veins in the legs causes edema that is localized to the legs.
  • Therapy for edema consists of treating the underlying conditions, restricting salt intake, compression stockings, elevation of the extremity, and often using diuretics (medicines that induce urination).

 

What is edema?

The definition of edema is observable swelling from fluid accumulation in body tissues. When parts of the body are affected by edema, they are considered edematous. Edema most commonly occurs in the feet, ankles, legs, and/or hands where it is referred to as peripheral edema. Edema of the foot is sometimes called pedal edema. The swelling is the result of the accumulation of excess fluid under the skin in the spaces within the tissues.

All tissues of the body are made up of cells, blood vessels, and connective tissues that hold the cells together called the interstitium. Most of the body’s fluids that are found outside of the cells are normally stored in two spaces; the blood vessels (as the “liquid” or serum portion of your blood) and the interstitial spaces (not within the cells). In various diseases, excess fluid can accumulate in either one or both of these compartments.

The body’s organs have interstitial spaces where fluid can accumulate, and there are a number of different types of edema. An accumulation of fluid in the interstitial tissue around the air spaces (alveoli) in the lungs occurs in a disorder called pulmonary edema. In addition, excess fluid sometimes collects in what is called the third space, which includes cavities in the abdomen (abdominal or peritoneal cavity – called “ascites”) or in the chest (lung or pleural cavity – called “pleural effusion“).

Anasarca, also known as extreme generalized edema is severe, widespread accumulation of fluid in the all of the tissues and cavities of the body at the same time.

This article focuses mainly on leg and feet edema (peripheral edema), but these are other forms of edema that are typically named depending on the parts of the body affected:

  • Cerebral edema is an accumulation of excess fluid in the brain.
  • Angioedema is swelling underneath the skin. Unlike hives, which affect the surface of the skin, angioedema affects the deeper layers of the skin and often occurs on the face.
  • Hereditary angioedema is a rare genetic condition that causes the capillaries to release fluids into surrounding tissue, which results in edema.
  • Papilledema is swelling of the optic nerve of the eye that is a result of pressure inside the skull and around the brain (intracranial pressure).
  • Macular edema is a swelling of the portion of the eye that perceives central, detailed vision (the macula).
  • Dependent edema usually is edema of the legs and lower body, which is affected by gravity and is dependent on a person’s position. This edema usually occurs in the legs when a person is standing, and in the buttocks and hands if a person is lying down.
  • Scrotal lymphedema is an enlargement of the scrotum due to fluid accumulation around the testes.
  • Lipedema is a disorder of the fatty (adipose) tissue that causes swelling of the legs and hips and can lead to lymphedema.

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Leg Swelling: Symptom of Pitting Edema

Leg swelling generally occurs because of an abnormal accumulation of fluid in the tissues of the lower extremity. Persisting indentation of a swollen leg after pressure from a finger is known as pitting edema. Common causes of leg swelling include

  • salt retention,
  • cellulitis,
  • congestive heart failure, and
  • medication side effects.
What is pitting edema and how does it differ from non-pitting edema?

Pitting edema can be demonstrated by applying pressure to the swollen area by depressing the skin with a finger. If the pressing causes an indentation that persists for some time after the release of the pressure, the edema is referred to as pitting edema. Any form of pressure, such as from the elastic in socks, can induce pitting with this type of edema. This type of edema may be normal depending on the severity. Almost everyone who wears socks all day will have mild pitting edema by the end of the day.

 

What is a pitting edema measurement scale?

Some doctors may use a scale to determine the severity of the pitting edema. These scales are subjective based on either how deep the pitting is, or how long the pitting persists.

Following are two examples of edema measurement using 4-point scales, with 1 point being minor edema, to 4 points being severe edema.

In non-pitting edema, which usually affects the legs or arms, the pressure applied to the skin does not result in a persistent indentation. Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulation that may occur after a mastectomylymph node surgery, radiation therapy, morbid obesity, venous insufficiency, or be present from birth (congenitally).

Another cause of non-pitting let edema is called pretibial myxedema, which is a swelling over the shin that occurs in some people with hypothyroidism. Non-pitting leg edema is difficult to treat. Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling.

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