Also indexed as: Bloating, Fluid Retention, Lymphedema, Water
Retention
Puffiness in your legs or other limbs may be caused by a buildup
of excess fluid underneath the skin. What can you do to remedy water retention? According to
research or other evidence, the following self-care steps may be helpful:
- Try a diuretic
- Pick up an herbal diuretic containing goldenrod, corn silk,
horsetail, juniper, or dandelion
- Fill up on flavonoids
- Try these natural plant pigment supplements to reduce symptoms of
edema associated with venous or lymphatic conditions; take 2,000 mg a day of
hydroxyethylrutosides or a daily combination of diosmin (900 mg) and hesperidin (100 mg)
- Check out butcher’s broom
- For edema caused by venous or lymphatic disorders, take 300 to 450
mg a day of this plant extract in combination with hesperidin and vitamin C
- Take time for a checkup
- Visit your healthcare practitioner to determine whether your edema
is caused by a treatable medical condition
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full edema article for more
in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and
lifestyle changes that may be helpful.
About edema
Abnormal accumulation of fluid beneath the skin is known as edema. This leads to a puffy
appearance, often in a limb, most commonly a leg.
There are many causes of edema. In some cases, the underlying problem (for example, congestive heart failure or preeclampsia of pregnancy) must be medically treated
in order for the edema to resolve. In other cases (such as chronic venous insufficiency, edema following minor trauma, or lymphedema resulting from damage to
lymphatic vessels caused by surgery and other medical treatments), it is possible with both
conventional and natural approaches to focus specifically on the edema. Unless edema is
clearly due to minor trauma, it should never be treated until the underlying cause has been
properly diagnosed by a healthcare professional. The discussion below deals only with
situations in which it is safe to focus on the edema itself and not the underlying cause.
Product ratings for
edema
What are the symptoms?
People with edema may notice that a ring on their finger feels tighter than in the past, or
they might have difficulty in putting on shoes, especially toward the end of the day. They may
also notice a puffiness of the face around the eyes, or in the feet, ankles, and legs. When
edema is present, pressure on the skin, such as from the elastic band on socks, may leave an
indentation that is slow to disappear. Edema of the abdomen, called ascites, may be a sign of
serious underlying disease and must be immediately evaluated by a doctor.
Medical options
Over-the-counter diuretics containing
caffeine (Diurex®) may be used to relieve symptoms related to edema or water
retention when taken five to six days before menses. More severe edematous conditions require
medical attention.
Treatment of edema with prescription medications is limited to the use of diuretics, commonly referred to as “water
pills.” Agents often used include the
thiazide diuretics, such as hydrochlorothiazide (HydroDIURIL®), indapamide (Lozol®), and metolazone
(Zaroxolyn®); loop diuretics including
furosemide (Lasix®), bumetanide (Bumex®), and torsemide (Demadex®); and
potassium-sparing diuretics, such as
spironolactone (Aldactone®),
triamterene (Dyazide®, Maxzide®), and amiloride (Midamor®).
Commonly, treatment consists of managing the underlying condition, which may include
inadequate nutrition; liver, heart, and kidney
disease; or obstruction of blood or lymph flow. In some cases, a salt-restricted diet may be recommended.
Dietary changes that may be helpful
High salt intake should be avoided, as it tends to lead to water retention and may worsen
edema in some people. A controlled trial found that a low-salt diet (less than 2,100 mg sodium per day)
resulted in reduced water retention after two months in a group of women with unexplained
edema.1
Lifestyle changes that may be helpful
If the edema is affecting one limb, the limb should be kept elevated whenever possible.
This allows fluid to drain more effectively from the congested area. To decrease fluid buildup
in the legs, people should avoid sitting or standing for long periods of time without
moving.
Vitamins that may be helpful
Several double-blind trials2 3 4 5 have found
that 400 mg per day of coumarin, a flavonoid
found in a variety of herbs, can improve many types of edema, including lymphedema after
surgery. However, a large double-blind trial detected no benefit using 200 mg coumarin twice
daily for six months in women who had arm edema after mastectomy (surgical breast
removal).6 (Coumarin should not be confused with the anticlotting drug Coumadin®.)
A group of semi-synthetic flavonoids, known
as hydroxyethylrutosides are also beneficial for some types of edema.7 One
double-blind trial found that 2 grams per day of hydroxyethylrutosides reduced ankle and foot
edema in people with venous disorders after four weeks.8 Another double-blind trial
found that 3 grams per day of hydroxyethylrutosides significantly reduced lymphedema of the
arm or leg and lessened the associated uncomfortable symptoms.9
A combination of the flavonoids diosmin (900 mg per day) and hesperidin (100 mg per day)
has been investigated for the treatment of a variety of venous circulation
disorders.10 However, in a double-blind trial, this combination was not effective
for lymphedema caused by breast cancer
treatments.11
In a preliminary study, individuals with
lymphedema of the arm or head-and-neck region were treated with approximately 230 mcg of
selenium per day, in the form of sodium selenite, for four to six weeks. A quality-of-life
assessment showed an improvement of 59%, and the circumference of the edematous arm was
reduced in 10 of 12 cases.12
Because coumarin, hydroxyethylrutosides, and diosmin are not widely available in the United
States, other flavonoids, such as quercetin,
rutin, or anthocyanosides (from bilberry),
have been substituted by doctors in an attempt to obtain similar benefits. The effect of these
other flavonoids against edema has not been well studied. Also, optimal amounts are not known.
However, in one study, quercetin in amounts of 30–50 mg per day corrected abnormal
capillary permeability (leakiness),13 an effect that might improve edema. A similar
effect has been reported with rutin at 20 mg three times per day.14 Doctors often
recommend 80–160 mg of a standardized extract of bilberry, three times per day.
Whereas vitamin B6 is sometimes recommended
for reducing edema, no research has investigated its effectiveness.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
A double-blind trial found that a formula containing butcher’s broom extract, the flavonoid hesperidin, and vitamin C, which is used in Europe to treat venous and
lymphatic system disorders, was superior to placebo for reducing lymphedema.15 The
amount of butcher’s broom extract typically used is 150 mg two or three times per
day.
Herbs that stimulate the kidneys were traditionally used to reduce edema. Herbal diuretics
do not work the same way that drugs do, thus it is unclear whether such herbs would be
effective for this purpose. Goldenrod (Solidago cnadensis) is considered one of the
strongest herbal diuretics.16 Animal studies show, at very high amounts (2 grams
per 2.2 pounds of body weight), that dandelion
leaves possess diuretic effects that may be comparable to the prescription diuretic furosemide
(Lasix®).17 Human clinical trials have not been completed to confirm these
results. Corn silk (Zea mays) has also long been used as a diuretic, though a human
study did not find that it increased urine output.18 Thus, diuretic herbs are not
yet well supported for use in reducing edema.
Aescin, isolated from horse chestnut seed,
has been shown to effectively reduce post-surgical edema in preliminary trials.19
20 A form of aescin that is injected into the bloodstream is often used but only
under the supervision of a qualified healthcare professional.
Horsetail has a diuretic (urine flow
increasing) action that accounts for its traditional use in reducing mild edema. Although
there is no clinical research that yet supports its use for people with edema, the German
government has approved horsetail for this use. The volatile oils in juniper cause an increase in urine volume and in this
way can theoretically lessen edema;21 however, there is no clinical research that
yet supports its use for people with edema.
Cleavers is one of numerous plants
considered in ancient times to act as a diuretic.22 It was therefore used to
relieve edema and to promote urine formation during bladder infections.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
References:1. Ponce P, Mello-Gomes E. Idiopathic edema, tubular metabolism of water
and sodium. Acta Med Port 1991;4:236–41 [in Portuguese].
2. Becker HM, Niedermaier G, Orend KH. Benzopyrone in the therapy of
postreconstructive edema. A clinical double-blind study. Fortschr Med
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3. Casley-Smith JR, Morgan RG, Piller NB. Treatment of lymphedema of the
arms and legs with 5,6-benzo- [a]-pyrone. N Engl J Med 1993;329:1158–63.
4. Chang TS, Gan JL, Fu KD, Huang WY. The use of 5,6 benzo-[alpha]-pyrone
(coumarin) and heating by microwaves in the treatment of chronic lymphedema of the legs.
Lymphology 1996;29:106–11.
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1993;307:1037–41.
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women with lymphedema after treatment for breast cancer. N Engl J Med
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pharmacology, and therapeutic efficacy in venous insufficiency and related disorders.
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in the treatment of lymphedema (secondary to conventional therapy of breast cancer).
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12. Micke O, Bruns F, Mucke R, et al. Selenium in the treatment of
radiation-associated secondary lymphedema. Int J Radiat Oncol Biol Phys
2003;56:40–9.
13. Griffith JQ. Clinical application of quercetin: preliminary report.
J Am Pharm Assoc 1953;42:68–9.
14. Shanno RL. Rutin: a new drug for the treatment of increased capillary
fragility. Am J Med Sci 1946;211:539–43.
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lymphedema of the upper limb with CYCLO 3 FORT. Lymphology 1996;29:29–35.
16. Tyler V. Herbs of Choice: The Therapeutic Use of
Phytomedicinals. New York: Pharmaceutical Products Press, 1994, 74 [review].
17. Racz-Kotilla E, Racz G, Solomon A. The action of Taraxacum officinale
extracts on the body weight and diuresis of laboratory animals. Planta Med
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combined diuretic effects of four Vietnamese traditional herbal remedies (Zea mays, Imperata
cylindrica, Plantago major and Orthosiphon stamineus). J Ethnopharmacol
1994;36:225–31.
19. Dini D, Bianchini M, Massa T, Fassio T. Treatment of upper limb
lymphedema after mastectomy with escine and levo-thyroxine. Minerva Med
1981;72:2319–22 [in Italian].
20. Wilhelm K, Feldmeier C. Thermometric investigations about the
efficacy of beta-escin to reduce postoperative edema. Med Klin 1977;72:128–34
[in German].
21. Tyler V. Herbs of Choice: The Therapeutic Use of
Phytomedicinals. New York: Pharmaceutical Products Press, 1994, 76–7 [review].
22. Mills SY. Out of the Earth: The Essential Book of Herbal
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