Managing water retention by the body


Dr. Sylvester Ikhisemojie

Last week, we talked at length about water retention around the heart. This week, we shall be discussing the malady of having water retained around the body. Water retention is a part of the whole complex of fluid retention.

This is a problem that takes place when the body’s regulatory mechanisms for maintaining fluid levels within a certain range become disrupted or impaired so that the entire process is thrown out of order.

Therefore, the circulatory system, the kidneys, hormones, and other smaller systems around the body help in ensuring this tight, important process. And if a problem arises from any of these systems mentioned above, fluid begins to accumulate around the body leading to body swelling and discomfort arising from them.

Sometimes, such swelling occurs only in a certain part of the body and is described thereby as a local affair. At other times, it is a more generalised affair pointing towards a more serious problem. When this happens, healthcare experts call the situation oedema.

Oedema (spelt edema by the Americans) can affect any part of the body for any combination of the reasons above. More often, people would have noticed this problem around their ankles apparently as a result of prolonged sitting or standing. In other situations, it is not so innocent and can therefore be an indication of something far more serious.

When this situation arises in the hands and feet, the typical features that are obvious to everyone are the swelling, of course, the changes in the colour of the skin and the puffy nature that the tissues around those parts of the body assume. There may be aches around those parts as well and when a finger is pushed into them, the points of contact remain indented for a long time afterward.

The joints also progressively become stiff and pain can intervene. As the fluid accumulates, so it gets progressively reflected in the person’s weight. Fluid can also accumulate in the brain causing cerebral oedema as a result of retaining too much of it or producing too much.

 Cerebral oedema can occur when there has been an injury to the head also, in addition to a situation of having taken too much water. This can lead to headaches, blurring of the vision and loss of balance. Vomiting can occur as well. The person can have a convulsion or even go into a coma.

Too much production of water in the brain can cause hydrocephalus, which is commonly seen in children. It can cause any of the above-mentioned features and compress the brain so badly that it is unable to grow in size as expected. This can be life-threatening.

Water can also be retained in the lungs in a situation known as pulmonary oedema. Ditto for the sac around the heart as discussed last week causing problems like difficulty with breathing to develop, associated chest pain, inability to perform any meaningful physical tasks such as climbing a flight of stairs, cough and weakness can all occur mainly because the ability of the lungs to supply oxygen to the body is compromised.

 The causes of these problems are quite diverse but it also begins at the level in the body where the most intricate exchange of materials between the cells and tissues takes place. That area is known as the micro-circulation where you have the capillaries which deliver fluids, nutrients and oxygen to the tissues.

The spent carbon dioxide, lactic acid and other waste products also return to the capillaries from where they go to the venules and then the veins. Most people believe that when something is wrong with their limbs, the veins are to blame but this is far from the truth because the problem lies with the capillaries which actually regulate the fluid balance. If these capillaries suffer physical damage, fluid leaks out of them into the surrounding tissues and cause oedema.

Another common cause of such an incident is when certain blood pressure medicines are used. They can cause damage to the wall of the capillaries because of changes in their pressure. Leakage of fluid as described above can then occur.

Mostly, the pumping actions of the heart help to maintain normal pressure within the blood vessels. If somebody’s heart were to stop working effectively, the flow of blood around the body would slow down so that it becomes stagnant within the system. As this happens, it generates local increases in the pressure within the tissues and water can leak out from the blood into those tissues. Swelling then results.

Another closed system within the body that works in tandem with the vascular system is the lymphatic system which is a low-pressure system that carries white blood cells that constitute the first line of defence of the body against infections. However, problems like those same infections can block this system and render it ineffective as a drainage mechanism.

Cancer can similarly block its ability to carry the peculiar fluid known as lymph. As a result, the white fluid begins to accumulate in the area above the blockage. Over time, this can cause hideous swelling of the abdomen, legs, feet and even thighs.

 When the kidneys become unable to filter the blood of its waste products, such wastes will remain in the body and hold to ransom an obligatory amount of fluid to accompany them. They will, therefore, remain in the body and the person who has entered this stage of kidney failure would then realise that the legs, abdomen and face often become swollen as they wake up from sleep. Therefore, such swellings become an evident confirmation of kidney disease.

The same is true of pregnancy when as a result of hormone action and the increasing weight of the growing baby in the abdomen, there is an accumulation of fluids in the legs and the front aspect of the tummy.

The baby itself could reduce the amount of blood returning to the mother’s heart through the legs because those vessels pass across the groin where the baby’s head exerts pressure on them. This leads to the scenario described above. The other aspect is due to the effect of hormones causing the body to retain water. Usually, this is not a disease condition and often resolves after delivery.

 Inadequate physical activity, obesity and laziness are other conditions that often lead to the situation of fluid accumulation around the body. Mostly, it is because the muscles of the calf are not recruited into the necessary pumping action that helps to return blood to the heart thus allowing fluid to accumulate.

A key protein, called albumin, helps the body to maintain a certain pressure that keeps fluids within the vessels. When the body does not have enough of this protein as seen in chronic liver disease or in kwashiorkor, fluids begin to build up around the body. This is also the situation when persons go into disease states in which the protein stores are broken down and a deficiency state develops.

Lack of sufficient protein stores in the body causes the mobilisation of protein stores in the muscles and skin thereby causing a steady loss of weight and a shiny skin appearance as described in the second paragraph. Often, the recognition of what has led to such a situation makes it possible to treat those people who present with these features in the hospital.

Questions and answers

Dear doctor, thank you for the good work you’re doing for humanity. May the Almighty Lord bless you and your family. Amen. I would like to seek your advice regarding the result of the investigation carried out at one of the diagnostic centres. The result/report is attached below. Thank you. Yours sincerely. [email protected]                                                

Thank you very much for your words of appreciation and prayers. Good morning to you as well. The key things to know about haemorrhoids, also called piles, are as follows;

.Does it bleed? The endoscopy you did says there’s evidence of recent bleeding.

. Does it come out of the anus?

. If it comes out, does it go back by itself or do you have to push it back in?

If the answer to these questions is NO, then it can be managed with dietary changes and medications. If the answers are YES, then you will have to see a general surgeon for further examination and advice on available treatment options. Furthermore, this particular haemorrhoid is staged as a second degree. The endoscope could also have been used to “burn” the bleeding vessel and the matter would have ended for good. Since that’s not the case, you may have to make do with changes in your diet plus the use of Daflon, a medication that helps to limit bleeding from piles.

Dear doctor, to God, be all the glory. Thanks so much for your column in the Sunday PUNCH. Your advice of July 10 on stammering wasn’t fully expatiated as you spoke ONLY as a professional and did not include the faith angle which I understand, as science does not have regard for faith healing even though there are hundreds of testimonies to buttress this. Yes, doctor, there’s no medical cure for stammering but faith does and speech therapists will also do to reduce the degree of missed words. Advise the stammerer to learn how to speak slowly. Never should he or she be in a hurry to pronounce words. In fact, years ago while I was in the UK, GPs often recommended a “hand pace” which the patient holds and clicks on as he speaks. That slows him down and over time most of them improve and others are “cured.” Thanks once again and enjoy your week. God bless [email protected]                         

 Thank you very much for your comments. Thank you also for your prayers. Your question was about treatment and cure and it was important to make it clear that none was available. But that’s different from faith healing with which I have no training and with behavioural therapy which does not have consistent results. In teaching stammerers to slow down their speed of speaking, things might initially look good until they suffer some emotional challenge or a fit of anger, and everything they previously learnt unravels.

Dear doctor, thanks for the good work you are doing for the public. Recently, I have been finding it difficult to sign any document before I gain consciousness. I am 55 years old and I want to know what can cause it. Is there any drug sir? 0805xxxxxxx

Thank you very much for your kind words. If you are the one who typed this message by yourself, then you can definitely sign your documents. However, your reference to your state of consciousness is not at all clear. You could be suffering from some kind of craft palsy but you will need to be examined properly by a doctor to confirm or exclude this diagnosis. Once you have done so and the diagnosis is clear, there will be treatment available to treat you and you can then get to use the drug you have asked about.                                                         

Dear doctor, my left eye is closed and the left side of my mouth is stiff. So I mean that my left eye is not as wide open as my right eye and my mouth on the left side is not functioning well. What can I do? 0802xxxxxxx

All of these depend on how long you’ve had this problem. Did you recently observe it? Are you on treatment for hypertension? How old are you? And what is your sex? The answers to the above questions will help us determine what might have happened to you and why you now have these observations. You could have had a stroke in which case you are probably on anti-hypertensive medications but will benefit additionally from physiotherapy. If on the other hand, this problem has been there from an early age, it may have resulted from an accident or a viral infection. Either way, you will need some physiotherapy rather than drugs.

Dear doctor, thank you so much for providing solutions to people’s problems. Please, sir, my mother is 80 years old and a week ago she fell down at home and had a fracture in her wrist. She is with plaster of Paris now. She has had hypertension for more than 25 years and is presently on Busoprolol 2.5mg daily and Coveram plus 10mg/2.5mg/10mg daily also. She has recently been vomiting too even though she says she does not feel sick. The blood pressure now is 230/105 mmHg. I know that my blood pressure is too high. What should we do now? And what is the normal blood pressure for her age? 0802xxxxxxx

Thank you very much for your kind words. First, she must be reviewed as a matter of urgency by her doctors to increase the dose of those medications or change them completely. Second, she must be monitored closely to ensure she actually takes those medicines as they ought to be used. The vomiting she now experiences may be due to pressure changes within the brain caused essentially by blood pressure that has gone out of control and that’s another reason for an urgent visit to her doctors. At her age, the blood pressure should be a minimum of 70-90 mmHg for the diastolic (lower reading) and a maximum of 95-145 mmHg systolic (upper one), so it is a wide range on either side.

Dear doctor, I woke up two days ago and found that I have serious pain in my throat. I think that is what is called sore throat. I cannot swallow anything at all and though I have been using Strepsils and Loratadine, there has been no improvement. The pain is serious. What should I do please? 0802xxxxxxx

These are the features of an upper respiratory tract infection and are probably due to tonsillitis. However, while you would most likely benefit from the use of an antibiotic and pain relief, it is wise for you to have your throat examined by a doctor for confirmation before you choose an antibiotic to use. Not all of them are good for an infection of this nature and not all will be suitable for your use either.

Dear doctor, I am the one who told you about the swelling and pain in my wife’s thigh who also has a pregnancy of 11 weeks presently. We eventually went to a teaching hospital at Ilishan where she was admitted when a diagnosis of deep vein thrombosis was made and she was started on heparin and other drugs. All specialist doctors attending to her are physicians, obstetricians and cardiothoracic surgeons as I was informed. We are told that the treatment will take some time, maybe months. I just want to thank you for your prompt advice because we were told that if the thing had broken off from the leg, it could have been fatal. God bless you, sir. 0812xxxxxxx

Thank you for your feedback and for not delaying. Yes, typically, because of her current status it was necessary to involve all those experts you mentioned. This kind of treatment is called a multi-disciplinary approach to treatment and it gives you the best perspective. God bless you too and I wish you both well.

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