Friday 18 October 2019

Dear Dr Nina: My ankles have been swollen since pregnancy - please help

Oedema is a condition where fluid gathers outside the normal blood vessels of the body
Oedema is a condition where fluid gathers outside the normal blood vessels of the body

Nina Byrnes

Question: I am in my forties now and slightly overweight as I am in the process of trying to lose weight after my last baby. The problem is that I have swollen ankles. They were extremely swollen when I was pregnant, and now, a year later, they have gone down, but are not back to normal. I would always swell on a plane as well as in the heat and, in my younger days, after a lot of alcohol. What is this and why does it happen?

Dr Nina replies: Oedema is a condition were fluid gathers outside the normal blood vessels of the body. It is most obvious when it occurs in the ankles and legs, causing swelling, but it can also occur in other areas of the body. Ankle swelling occurring after a flight or prolonged standing may last but a few hours, however, underlying weakness of the veins or pressure from the pelvis may prolong symptoms.

Varicose veins are a common cause of lower-leg swelling that could cause the symptoms you have. This may affect one or both legs, depending on the extent of the veins involved. Ankle swelling may disappear at night but during the day gravity plays its role and fluid gathers towards the ankles. There are many effective surgical options for varicose veins or for those for whom surgery isn't an option - support socks and tights applied first thing in the morning may help.

Varicose veins may occur or flare in pregnancy due to the pressure into the pelvis. They can be quite uncomfortable and unfortunately don't always settle once pregnancy is over.

Other causes should also be considered. A simple injury can lead to quite dramatic oedema, which often occurs quite quickly. There may be pain, bruising and redness of the area too. An ankle sprain is a common cause of this kind of swelling. This is isolated to the area of injury and goes away as healing occurs.

A clot in the lower leg may also cause swelling of one leg or ankle. This may be more common after surgery or prolonged periods of rest, such as long journeys or illness. There may be pain on the affected side, along with tenderness and firmness of the calf concerned. This warrants urgent medical review as a clot in the leg can travel to the lung, causing a life threatening pulmonary embolus.

An infected bite or cut may lead to swelling on the affected side. The skin may be red, tender and there may be a slight pimple or cut nearby. Antibiotic tablets may be required and steroid creams may reduce swelling and irritation.

Inflammation, a cyst or growth occurring in the pelvis can be an easily missed cause of lower-leg swelling. If your clothes feel tighter, or you have abdominal pain or constipation, an ultrasound or further assessment is required.

Swelling of both legs together points to a more central cause. Heart failure can lead to fluid retention and ankle swelling may be a sign of this. If your ankle swelling is associated with fatigue, lack of appetite, shortness of breath, chest pain or palpitations you should seek medical advice.

Finally, many medications can cause ankle swelling. These include anti-inflammatory painkillers, hormonal medication, such as the contraceptive pill, certain blood pressure or heart medications, some antidepressants, steroids and diabetic medication. I would advise discussing your symptoms with your GP. An examination may help ascertain their cause and hopefully start you on the road to recovery.

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