Water Retention

WHEN TO SEE YOUR DOCTOR

* Swelling in your extremities or abdomen persists for a week and your skin dents when you poke it.

* If you're pregnant and experience sudden swelling in your legs or elsewhere, see your doctor immediately.

What Your Symptom Is Telling You

Your fingers are so puffy, you need soap to pry off your rings. Your legs are so swollen, your socks leave a rosy ring around your calves. Zippers aren't budging. Buttons are popping.

These are a few clues that your body is retaining more than its usual amount of water—a symptom doctors call edema.

Normally, your body's cells are bathed in water. There's water inside the cells and a certain amount of water around the cells. The amount of water—both inside and outside the cells—is regulated by hormones, sodium and the kidneys.

When there's too much sodium in your body—from eating a high-salt diet, for example—your blood becomes saltier and water is drawn from your cells to dilute it. Thirst prompts you to drink more water.

Steroid medications can also cause puffiness. These drugs cause the kidneys to hold on to sodium.

Some people's bodies seem to retain water for no apparent reason, according to Charles Tifft, M.D., associate professor of medicine at Boston University School of Medicine. The puffiness may come and go in cycles, he says, and may be related to hormone fluctuations. It can affect both men and women. In women it usually occurs in the week or so before menstruation. During this time, the surge in estrogen triggers the production of aldosterone. This hormone makes the kidneys retain water, which tends to collect in the breasts and abdomen. Some women gain several pounds during this time. Other women simply experience a shift in the distribution in water with no weight gain. Slacks and blouses often fit more snugly, however.

Water retention also occurs among women past menopause who take estrogen replacement hormones.

In late pregnancy, many women find that their legs feel like heavy water balloons. That's because the enlarging abdomen presses on the vein that returns fluids back to the heart. Fluids then pool in the legs.

In some cases, water retention signals something more serious. If your skin remains plump or your finger leaves an indentation when you poke your skin, you may have a problem with your heart, kidneys, liver or thyroid.

Symptom Relief

If you're often puffy, the following steps may bring relief.

Skip the junk food. Too much sodium in your blood can waterlog the tissues, so reducing your salt intake makes sense, says Dr. Tifft. Besides avoiding obviously salty fries, pepperoni pizza and convenience foods, cut down on foods containing hidden salt. These include some salad dressings, cereals and canned soups. Become a label reader.

Get your feet pumping. Walking, bicycling and tennis are all activities that help pump out water and other fluids that can pool in your legs and ankles, according to Susan Lark, M.D., director of the PMS and Menopause Self-Help Center in Los Altos, California, and author of Premenstrual Syndrome Self-Help Book and Menopause Self-Help Book.

Take the load off your legs. If you have swollen calves, elevate your legs for a few minutes each day, says Dr. Lark. Lie on the floor on your back facing a wall with your legs raised and your buttocks and hips as close to the wall as possible. Your legs should be touching the wall and extended in a wide "V" formation. Breathe easily. Hold the position for five minutes. If you're pregnant, lie on your side with your feet propped up on a stack of pillows.

Ask about your medications. Give your doctor a list of all medications you are currently taking—both prescription and over-the-counter—and ask whether any alterations are appropriate. Switching to lower-dose estrogen in your hormone replacement therapy, for example, could reduce fluid retention, says Dr. Lark. If you're taking steroids, be sure to let your doctor know about your water-retention problem.

Dig deeper for clues. If you continue to have general swelling despite these measures, you may need a blood pressure check and also kidney and liver function tests, says Dr. Tifft. If tests reveal that your problem is caused by high blood pressure, you may be given a diuretic, such as hydrocholothiazide. These drugs force your kidneys to pump water and sodium out of the tissues into the urine, thus reducing blood volume and lowering pressure. Initially, these drugs can easily drain away two pounds or more of fluid daily, but this effect tends to wear away with time. Diuretics, however, are not "casual weight-loss tools," says Dr. Tifft. "They have potent side effects and need to be closely monitored and carefully prescribed. You don't take them to lose a quick five pounds so you can fit into a dress."

Help for Premenstrual Swelling

If water retention plagues you on a monthly basis, here are several things that might prove helpful.

Pass up drugstore diuretics. Some over-the counter medications intended to relieve menstrual cramp pain also claim to help eliminate premenstrual water weight. Some of these products contain caffeine, which may work as a diuretic, according to Candace Brown, Pharm.D., associate professor of pharmacy and psychiatry at the University of Tennessee in Memphis. "The down side to caffeine, however, is that it also promotes breast pain and tenderness as well as irritability," says Dr. Brown.

Have some herbal tea. Parsley or uva-ursi tea can help flush out excess water without any harmful side effects, according to Dr. Lark. You can find these teas in most health foods stores, she adds.

Check out vitamin B₆. Taking up to 250 milligrams of vitamin B₆ daily helps reduce premenstrual water retention, says Dr. Lark. This nutrient also reduces fluid buildup caused by hormone replacement therapy during menopause. Vitamin B₆, however, can be toxic in higher doses and should only be taken under the supervision of a doctor. Ask your doctor whether a vitamin B₆ supplement is appropriate for you.

Try calcium. Researchers at the New York Metropolitan Hospital found that a daily calcium supplement provided relief from premenstrual water retention in three-fourths of the women who took it. "Your best bet is to take a 500-milligram chewable tablet twice daily at breakfast and dinner,"' says Susan Thys-Jacobs, M.D., assistant professor of medicine at Mount Sinai Hospital in New York City. Ask your doctor whether these supplements might prove helpful in your case.