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Fluid Retention, Swelling, and Pulmonary Hypertension: Causes and Management

Medically reviewed by Steven C. Pugliese, M.D.
Posted on May 11, 2022

Causes | Management | When To Call Your Doctor | Get Support

Fluid retention in the belly (ascites) and an accumulation of fluid in the hands and feet (peripheral edema) are common symptoms of pulmonary hypertension (PH). Signs of fluid retention, or edema, include puffiness, weight gain, shiny skin, a swollen abdomen, and skin that stays depressed when pushed into (pitting).

When left untreated, fluid retention from PH can become severe and lead to trouble walking, stiffness, and a higher risk of skin ulcers and infections.

Members of myPHteam have asked questions about living with symptoms of PH, including swelling. One member shared, “I’ve been having increased edema in both feet. I’m watching my sodium intake, yet the edema doesn’t completely leave. I also elevate my legs often, and my doctor has increased my Lasix. Has anyone else experienced this or have advice?”

Another member asked, “I suffer from edema in my ankles, and my abdomen is distended. Does anyone know why?”

Once you learn how PH affects the circulatory system, it makes sense why fluid retention is so common. Here’s why you may be experiencing water retention and what you can do about it.

Causes of Swelling

Understanding the relationship between PH and swelling requires a deeper look at cardiovascular anatomy and function. The right side of the heart receives deoxygenated blood from the rest of the body and delivers it to the lungs, where the blood gets reoxygenated.

All types of pulmonary hypertension involve high blood pressure between the heart and lungs. Over time, the added pressure may weaken the right side of the heart, which could cause congestive heart failure. In one form of PH called pulmonary arterial hypertension, the blood vessels connecting the heart to the lungs are too narrow, leading to a buildup of pressure (hypertension) that impedes the normal pace of blood flow.

When the right side of the heart is weak, the heart can’t keep up with the demands of circulation. Instead, the veins leading up to the heart’s right side become flooded by a backup of unpumped blood, which then leaks fluid into the tissues. Gravity ultimately pulls this leaked fluid from blood vessels (capillaries) toward the extremities, potentially causing swelling of the feet and ankles in people with PH.

Heart failure on the right side can also cause congestive hepatopathy, a backup of blood in the liver. As a result, fluid pools in the area, adding pressure to the abdomen and creating a bloated appearance.

Managing Fluid Retention

Most people with fluid retention from PH are placed on fluid and sodium restrictions. In mild cases of peripheral edema, wearing compression stockings and elevating your feet above your heart can be helpful. Diuretics, or pills that help your body get rid of excess sodium and water, may also be used to get rid of extra fluid in the body.

Comments by members of myPHteam shed light on their real-life experiences with these treatments. For example, when asked how they manage edema, one member said, “You should ask your doctor for water pills. Also, really watch your salt intake! I am on Lasix and spironolactone. I have no more swelling. Keep your feet elevated!”

Sodium Restrictions

Sodium increases the body’s overall blood volume through a few different mechanisms, including pulling water into the bloodstream by osmosis. As blood volume goes up, blood pressure also increases.

Keeping blood pressure down is crucial for people with PH because any additional pressure can strain the right side of the heart, lead to fluid retention, and speed up progression of heart failure and heart disease. That’s why people with PH are advised to follow a low-sodium diet, which contains no more than 2 grams of sodium per day.

Tips for eating less sodium include the following:

  • Buy unsalted nuts and nut butters.
  • Choose fresh poultry, beef, and seafood rather than cold cuts or cured or processed meats.
  • Cook your own meals instead of getting takeout or eating at restaurants.
  • Fill your plate with fresh or cooked veggies prepared without salt.
  • Instead of adding salt to recipes, experiment with herbs and spices.
  • Look for packaged foods in the grocery store with “no salt added” labels.
  • Prepare dried beans instead of buying canned.
  • Snack on fresh or frozen fruit.
  • Watch out for high-sodium condiments and marinades. Use oil, vinegar, garlic, herbs, and lemon or lime juice instead.

Fluid Restrictions

Your doctor may restrict you to a maximum of 2 liters of fluid per day (and a minimum of 1 liter per day) to prevent dehydration and kidney failure. Individual recommendations may vary depending on your health status. To stay within your restricted amount, measure the amount of fluid you take in from the following sources:

  • Gelatin
  • Popsicles
  • Sherbet
  • Soups
  • Water and other beverages
  • Water taken with pills

Keeping notes on your fluid and sodium intake will help you to stay mindful of your limits. It’s also important to weigh yourself every day (preferably in the morning before you eat or drink) to watch for sudden shifts in weight that could indicate fluid retention.

Diuretics

If watching your fluid and sodium intake isn’t enough to prevent swelling, your doctor may prescribe diuretics to encourage your body to shed excess water. Although diuretics can provide quick results, these medications can also have risks and side effects. Your health care provider will want to monitor you for signs of kidney disease, electrolyte imbalances, and dehydration.

When To Call Your Doctor

Call your health care provider if you gain 3 to 5 pounds in a single day or notice steady weight gain for a few days in a row. Edema that impairs your mobility or causes significant discomfort should be addressed right away. In addition, areas with stretched skin from fluid retention are more prone to infection, so be sure to check your temperature and talk to your doctor at the first sign of a fever.

Talk With Others Who Understand

On myPHteam, the social network for people with pulmonary hypertension and their loved ones, more than 44,000 members come together to ask questions, give advice, and share their stories with others who understand life with pulmonary hypertension.

Are you living with pulmonary hypertension? Has swelling been an issue for you? Share your story in the comments below, or start a conversation by posting on myPHteam.

Posted on May 11, 2022
All updates must be accompanied by text or a picture.

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Steven C. Pugliese, M.D. is affiliated with the Hospital of the University of Pennsylvania in Philadelphia, serving as the director of the pulmonary embolism response team, co-director of the comprehensive pulmonary embolism program, and an assistant professor of clinical medicine. Review provided by VeriMed Healthcare Network. Learn more about him here
Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here

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