Water Retention in the Legs: Causes, Symptoms and Treatments

Water retention, also known as edema, occurs when excess fluid accumulates in the body. One of the most common places for water retention is in the legs and feet. Leg swelling from fluid buildup can cause discomfort and sometimes indicate an underlying medical issue. Understanding the causes, symptoms, and treatment options for water retention in the legs is important for both prevention and finding relief when it occurs.

Signs of Water Retention in the Legs

Pay attention to any unexplained or abnormal swelling that develops in your lower limbs and feet. Common symptoms and signs that indicate fluid retention in the legs include:

Swelling in the feet, ankles and lower legs – Edema can create a stretched, swollen, or tight skin appearance and cause a visible enlargement of the lower limbs. Pressing on the swollen area can leave an indentation.
Obvious visible puffiness – The feet, ankles, lower legs, and calves may look significantly puffy or inflated in areas where fluid has accumulated. Noticeable swelling lasting more than several hours indicates substantial fluid retention.
Tight shoes and socks – Shoes, socks, and other clothing items may feel tighter than usual around edematous feet, ankles, and calves. Trying to put on shoes or wear socks over swollen feet can be difficult.
Aching, weary, heavy, uncomfortable legs – Accumulated fluid retention can make the legs feel heavy, fatigued, sore, or painful. Edema causes discomfort and a weighed down sensation.
Leg skin indentations – Socks, leggings or pants may leave indentations and compression marks on swollen skin that takes noticeably longer to smooth out compared to normal.
Shiny, pale, stretched appearance – In some cases the fluid-swollen skin over areas like the ankles and feet takes on a shiny, glossy look and pale color. The skin also appears very smooth and stretched looking.

What Leads to Fluid Retention in the Legs?

There are various contributing factors and health conditions that can cause swelling and edema to develop in the lower limbs:

1. Lifestyle Factors

Lack of physical activity – Being sedentary prevents proper circulation in the legs, allowing fluid to pool and swelling to occur. Even office workers who sit for prolonged periods daily are at risk for leg edema.
High sodium intake – Consuming excessive sodium causes the body to retain more fluid instead of excreting it. Many processed and prepackaged foods have high salt content.
Dehydration – Not drinking enough water disrupts the fluid balance and signals the body to retain more fluid. Daily water intake should be around eight 8-ounce glasses for proper hydration.
Alcohol consumption – Alcohol acts as a diuretic, causing frequent urination and loss of fluids and electrolytes. This leads to an imbalance that triggers the body to retain more water.
Caffeine intake – Like alcohol, caffeinated drinks such as coffee, tea, and sodas act as diuretics that increase urine output. This can result in dehydration and subsequent fluid retention.
Prolonged travel – Sitting immobile for hours during long flights or road trips promotes swelling in the lower limbs. In addition, elevated cabin pressure during air travel also influences fluid shifts in the body.

2. Hormonal Shifts

Menstrual cycle – The hormonal fluctuations that are a normal part of a woman’s menstrual cycle often lead to temporary water retention and bloating. This type of cyclical edema typically resolves after menstruation ends.
Pregnancy – The expanded fluid volume needed to support a developing fetus combined with pressure from the growing uterus commonly cause swelling in the legs and feet during pregnancy. This often resolves within a few months after giving birth.
Menopause – Declining and fluctuating estrogen levels after menopause cause shifts in fluid that can result in edema during this transition. Hormone replacement therapy can sometimes influence water retention as well.
Birth control – The hormones in birth control pills, especially those containing estrogen and progestin, can initiate fluid retention in some women.
Fertility medications – Ovulation-stimulating hormones used in fertility treatments like IVF can potentially instigate fluid buildup and swelling due to their effects on the body.

3. Medications

NSAIDs – Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen sodium have water retention listed as a common adverse effect. NSAIDs change kidney function, contributing to fluid overload in some people.
Steroids – Corticosteroids such as prednisone used for inflammatory conditions can increase sodium and fluid retention, often resulting in edema. This tends to be more pronounced with higher doses.
Antidepressants – Certain selective serotonin reuptake inhibitor (SSRI) antidepressants are associated with edema. These include sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and fluoxetine (Prozac).
Chemotherapy drugs – Cytotoxic medications used to treat cancer can damage kidney tubules and alter sodium and water reabsorption, leading to fluid accumulation.
Blood pressure medications – Some antihypertensive drugs like calcium channel blockers disrupt electrolyte balance. This can potentially influence water retention and swelling.

4. Medical Conditions

Heart failure – Impaired cardiac functioning and weakening of the heart muscle leads to fluid pooling and accumulation in the lower extremities. Edema often first appears as swollen ankles and feet.
Kidney disease – Damaged or dysfunctional kidneys struggle to properly regulate fluid levels. Kidney disease allows excess water to amass and remain in tissues instead of being excreted.
Cirrhosis – Scarring of the liver causes decreased albumin production and increased pressure in the veins that supply the liver. This results in the leakage of fluid into surrounding tissues.
Venous insufficiency – Faulty valves inside the veins of the legs impair proper blood circulation and fluid drainage. Blood starts to pool in the lower extremities, resulting in swelling.
Lymphedema – When the lymphatic system is damaged from cancer treatment, infection, or other causes, it cannot adequately drain excess fluid from the limbs. Lymphedema specifically affects the arms and legs.
Blood clots – A DVT or deep vein thrombosis that develops in the deep veins of the leg can obstruct blood flow and lead to localized edema.
Chronic inflammation – Ongoing widespread inflammation releases compounds that elevate capillary permeability systemically, inducing fluid leakage out of blood vessels and resulting in generalized or localized edema.

Medications for treating water retention — Treating water retention

Treating Fluid Retention Edema in the Lower Limbs

Treatment approaches depend on the underlying reason for edema, its severity, location, and other specifics of the presentation. Some general treatment options include:

1. Lifestyle changes

Elevate legs above heart level – Use pillows to prop your feet and calves up higher than your chest when resting and sleeping. This utilizes gravity to promote downward drainage of excess fluids from the legs.
Wear compression socks/stockings – Gradient compression garments provide gentle pressure that helps prevent blood and lymph from pooling in the lower legs, improving circulation.
Reduce dietary sodium – Avoid adding extra salt to food and limit processed items high in sodium to avoid fluid overload. Potassium-rich foods can help balance
Drink more water – Staying hydrated assists your kidneys in filtering out waste and balancing fluid levels. Water intake dilutes the sodium concentration as well, minimizing fluid retention.
Lose excess weight – Carrying extra weight puts more pressure on the leg veins and lymphatics. Losing even a small amount of weight can relieve that burden and reduce swelling.
Avoid prolonged standing – Take regular breaks to sit down, recline, or walk around if you have to stand for long intervals for work. This prevents blood pooling in the legs.
Avoid crossing legs – Crossing your legs promotes fluid accumulation in the calves and ankles by restricting blood flow. Keep legs uncrossed when possible.
Apply cold compresses – Cold compresses constrict blood vessels, providing temporary edema relief by reducing leakage and fluid buildup.
Massage legs – Gentle massage movements help stimulate venous and lymphatic flow to circulate fluid out of the limbs. Perform light strokes toward the heart.

2. Medical and Medication Options

Diuretics – Water pills help flush out unneeded fluid and sodium through increased urination. Loop diuretics like furosemide are commonly prescribed.
Treating underlying conditions – Successfully managing related heart failure, kidney disease, hypertension, or liver conditions can alleviate associated edema.
Compression stockings – Prescription gradient compression garments provide optimal pressure levels based on your needs. 30-40 mmHg gradient pressure is typically best for edema.
Lymphedema therapy – Specialized massage techniques performed by lymphedema therapists can drain significant built-up fluid from affected limbs.
Leg elevation – Keeping the legs propped above heart level as much as possible paired with compression therapy constitutes standard treatment for chronic edema.
Venous ablation – For faulty leg veins, non-surgical endovenous ablation using laser energy or radiofrequency can minimize pooling and swelling.
Medications for heart failure – Diuretics, ACE inhibitors, beta blockers, aldosterone antagonists help control fluid retention related to congestive heart failure.
Reduce or change medications – Switching to alternative prescriptions without water retention side effects under physician guidance may be helpful. Lower steroid doses could improve edema.

3. Exercises

Calf raises – Stand with feet shoulder-width apart, raise up on your toes, then slowly lower back down. Repeat 10-15 times. Strengthens calf muscles to improve venous blood flow.
Leg swings – Hold onto something for balance and swing one leg forward and back, then side to side. Switch legs. Gets blood pumping through the lower limbs.
Ankle circles – Rotate ankles clockwise then counter-clockwise. Flexible ankles allow better venous blood flow.
Seated leg lifts – Sit upright and alternately lift each leg up, keeping it bent. Works the thigh muscles to boost circulation.
Supine leg lifts – Lie on your back and lift one leg up towards the ceiling, keeping it straight. Switch legs. Improves lymph drainage.
Walking – A simple and effective exercise, walking engages all the muscles of the legs and improves overall circulation. Start with short walks and gradually increase distance.
Yoga – Poses like Downward Dog, Legs on the Wall, and Supine Twist gently stimulate circulation while reducing stress.
Biking – Low-impact cycling engages the leg muscles. Recumbent bikes are ideal for those with limited mobility.

Aim for 30 minutes of circulation-boosting exercise most days. Consistency is key to reducing chronic edema and preventing it from returning.

4. Dietary changes

Here are some beneficial dietary changes that can help reduce leg swelling and improve circulation:

Increase potassium – Foods high in potassium like bananas, potatoes, leafy greens, mushrooms, beans, salmon, yogurt, and avocados can minimize fluid retention.
Reduce sodium – Limit processed foods and avoid adding extra salt. Excess sodium causes water retention. Aim for less than 2300mg of sodium daily.
Drink tea – Herbal teas like green, black, and dandelion tea have natural diuretic effects to reduce fluid buildup. Dandelion tea also stimulates circulation.
Eat berries – Berries are rich in antioxidants called anthocyanins that improve vein and capillary function, boosting circulation.
Increase magnesium – Foods high in magnesium like spinach, avocado, almonds, cashews, and edamame help regulate fluid balance.
Stay hydrated – Drink plenty of water, about 8 cups daily, to avoid dehydration that can worsen swelling.
Increase dietary nitrates – Nitrate-rich foods like beets, leafy greens, and citrus fruits dilate blood vessels for better circulation.
Eat ginger – Ginger contains compounds that thin the blood and promote circulation. Add fresh ginger to food and drinks.
Limit alcohol – Alcohol acts as a diuretic, causing fluid loss that can lead to swelling. Moderation is key.

Following a diet focused on whole, minimally processed foods will provide antioxidants, nutrients, and compounds that enhance circulation and discourage inflammation and edema.

When to See Your Doctor?

Consult a doctor promptly if you experience:

Sudden, severe edema – This may signal an underlying blood clot or unidentified health problem requiring urgent care.
Swelling only in one leg – Asymmetrical swelling can indicate DVT, infection, or vein or lymph obstruction.
Swelling not improving with rest, elevation – Persistent heavy edema despite conservative efforts warrants medical investigation to determine the cause.
Swelling accompanied by chest pain, difficulty breathing – These can indicate pulmonary edema or heart failure requiring emergency treatment.

Addressing the root cause is key for resolving troublesome water retention and leg edema. Once identified, following the proper treatment regimen along with lifestyle adjustments can help manage symptoms long-term.