Understanding Fluid Retention

When you think of the human body, you think of solid material like bones, skin, and muscle. Surprisingly, though, the body is composed mostly of water. In fact, when we’re infants, our bodies are around 75% water; by the time we become adults, that equalizes out to around 50-60% water. And because of this high fluid content, regulation of bodily fluids is an important process that keeps us functioning. Sometimes, however, these processes don’t function normally; one of the most common ways this manifests is fluid retention. 

What Is Fluid Retention?    

Fluid retention (or water retention) is the condition of having a build-up of excess fluid in the body tissues. Also technically known as edema (or oedema), fluid retention is often seen in the arms and legs, but it can also present generally all over the body. In addition to swelling and puffiness, the skin may feel tight or look shiny or discolored. The combination of swelling and achy joints may also make walking difficult. Symptoms can also include weight gain, bloating, coughing, or, in rare cases, shortness of breath. 

Fluids in the body can be divided into two categories: intracellular and extracellular. Intracellular fluid is all the space inside all of the cells in our body. Because this fluid represents about 40% of our body weight and is the site of most chemical reactions in the body, the volume mostly remains stable. Extracellular fluid is, by contrast, highly variable in composition and volume and makes up about 20% of our body weight. When someone is retaining water, it’s because of a change in extracellular fluid.     

Most cases of edema are actually localized to a particular area of the body rather than being seen all over the body. Indeed, the specific location of the fluid retention can help doctors tremendously in determining the underlying cause. Below are some examples of particular types of edema:  

• Peripheral edema – legs 
• Cerebral edema – brain
• Pulmonary edema – lungs

What Causes Fluid Retention?   

Fluids in the body are constantly in flux due to a number of different regulatory mechanisms that are always working toward homeostasis. There are a variety of stimuli that can disrupt homeostasis and lead to fluid retention and the associated symptoms. Below are some of the most common causes of fluid retention: 

• Gravity: For some people, simply standing or sitting in one place for long periods of time can cause a fluid buildup in the extremities. 
• Venous insufficiency: Weakness in the veins can mean trouble for the transport of blood around the body. This can result in blood and other fluid accumulating in the arms and legs. 
• Congestive heart failure: When a person has congestive heart failure, the heart is weakened and can’t pump blood properly any longer. Because of pooled blood in the heart and increased blood pressure, fluid can seep out of veins into surrounding tissue all over the body. 
• Kidney disease: Kidney disease can cause water retention because of how it disrupts the composition of body fluids. When kidney function is impaired (as it is with kidney disease), it cannot remove sufficient sodium and water from the body; the result is excess extracellular fluid.
• Liver disease: Many liver diseases cause scarring (cirrhosis) of the liver tissue. Cirrhosis-related congestion in the liver can then lead to increased blood pressure and abdominal edema.   
• Low albumin: Albumin is a special type of blood protein that helps keep fluid from leaking out of blood vessels and being retained. Having low albumin protein levels may contribute to fluid retention, especially if it is concurrent with another cause. 
• Lymphedema: The lymphatic system is an important part of immune function. Removal of lymph nodes is part of a standard cancer treatment routine, but it can also cause localized swelling and other symptoms of edema. 
• Medication: There are several types of medication that have edema as a possible side effect; examples include nonsteroidal anti-inflammatory drugs (NSAIDs), steroid drugs, estrogen, and high blood pressure medications.             

Diagnosis and Treatment      

Temporary water retention is normal for everyone from time to time, but it can become a more serious medical condition in some circumstances. A physical examination by a doctor can identify areas of swelling or a tightening of skin. Another diagnostic method used by doctors is to check for pitting. To determine whether there is pitting, the doctor presses a finger on the affected area; the severity of the edema is dependent on how long the skin takes to bounce back. In the most extreme cases, it can take over a minute for the indentation in the skin to return to normal. 

Not all types of edema will require treatment and mild cases may go away on their own. For instance, water retention is strongly associated with pregnancy and menstruation on a temporary basis. If a doctor determines that the edema is more severe, the treatment will depend on the underlying cause. Generally speaking, though, there are a few recognized categories of treatment that get used most frequently: 

• Less sodium: Excess sodium in our bodies means that we will retain more water, so one of the most important steps for treating edema is to reduce the amount of dietary sodium. Even beyond table salt, sodium is in almost every type of processed food. 
• Diuretics: Diuretics are a kind of medication that causes the kidneys to excrete more water (and sodium) than normal. This helps promote the removal of excess fluid in swollen parts of the body. Diuretics should only be used under a doctor’s supervision; overuse can lead to dehydration or kidney problems. 
• Compression wear: Edema found in the extremities can be quite uncomfortable, but the effect can be mitigated through specialized clothing like compression socks. The snug fit discourages the kind of leg swelling that often accompanies fluid retention.
• Body positioning: Mild cases of edema in the lower legs or ankles can be treated simply by elevating the limb above the level of the heart. This should ideally be done a few times a day for about 30 minutes at a time.    

The Bottom Line

When the underlying cause of water retention is something like congestive heart failure or a side effect of a cancer procedure, there isn’t really a way to prevent it. On the other hand, there are some lifestyle changes that can decrease the chances; as alluded to above, one key change is reducing your salt intake by switching to a low salt diet. Another option is to become more physically active, especially if you have a very sedentary lifestyle. The great thing about both of these is that they can also have a positive impact on other aspects of your overall health and wellbeing. 

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