Edema is an abnormal accumulation of fluid in the intercellular spaces or cavities of the body. It can be generalized, affecting multiple organs, or localized to a specific area. Common types of localized edema include cerebral, pulmonary, and lymphedema. Edema is caused by factors that increase capillary pressure or reduce plasma oncotic pressure. It is assessed by measuring circumference, volume displacement, or patient report. Treatment involves diuretics, compression garments, elevation, exercise and manual lymphatic drainage to improve circulation and remove excess fluid from tissues.

1. OEDEMA
PRESENTED BY – SHIVAM RAWAT

2. Definition
 Edema is an abnormal accumulation of fluid under the skin
or in intercellular spaces.
 Fluid accumulation can also be seen in cavities of the body or
in the body tissues.
 Puffiness caused by excess fluid trapped in the body’s tissues.

3. Classification (based on region affected)
GENERALIZED EDEMA
• This type of edema involves
whole body and multiple
organs.It commonly occurs in
case of the malfunctioning of
the heart,lungs,kidneys.
LOCALISED EDEMA
• It is organ specific edema will
occur in specific organs as part
of inflammation ,as in
pharyngitis, tendonitis
,parncretitis for instance .

4. Generalized Vs Localised Edema
GENERALIZED EDEMA LOCALISED EDEMA

5. Localised Edema
CEREBRAL EDEMA
- Cerebral edema is
extracellular fluid
accumulation in the brain
which may lead to
drowsiness ,altered
sensorium or loss of
consiousnes .
PULMONARY EDEMA
- Pulmonary edema occurs
when hydrostatic pressure
in the pulmonary
vasculature rises high or
obstruction of pulmonary
veins impairs the removal
of blood from lungs .
LYMPHOEDEMA
- In Lymphoedema
abnormal removal of
interstitial fluid is caused by
failure of lymphatic system.
This may be due to
obstruction or destruction of
lymph nodes by radio
therapy,infiltration of the
lymphatics by infection (such
as elephantiasis).

6. Pictures showing types of localised edema
Normal Brain vs Brain with
Cerebral Edema
Pulmonary Edema Lymphoedema

7. Pitting & Non-Pitting Edema
Pitting Edema
 Pitting edema can be demonstrated by
applying pressure to the swollen area by
depressing the skin with a finger. If the
pressing causes an indentation that
persists for sometime after the release of
the pressure the edema is referred to as
pitting edema.
Non-Pitting Edema
 In non-pitting edema
pressure that is applied to
the skin doesn’t result in a
persistent indentation. Non-
pitting edema includes
lymph edema.

8. Pictures showing pitting vs non pitting
edema
NON PITTING EDEMA
PITTING EDEMA

9. Grades of Pitting Edema

10. Causes of Edema -:
 Edema is caused by either systemic diseases (diseases that affect the various organ
system of the body) or by local conditions involving just the affected extremities .
 The most common systemic diseases associated with edema involve the
heart,liver,kidney ( heart failure, cirrhosis of liver ,nephrotic syndrome).
 The most common local conditions that causes edema are varicose vein and
thrombophlebitis of deep veins of the leg.

11. Mechanism
 Edema can results from the interaction of these five factors-:
1. Increased capillary hydrostatic pressure – Rise in capillary hydrostatic pressure more than the
plasma oncotic pressure decrease the reabsorption of the fluid within the capillaries.
2. Reduced oncotic pressure within the blood vessels – It tends to lose the tendency to keep the
water retained with in the vascular channels thus fluid tends to gush out of vessels.
3. Increased blood vessel wall permeability - the increase pressure wall permeability provides
reduced impedance leading to outflow of fluid.
4. Lymphatic obstruction – it tends to cause accumulation of fluid within lymphatic channels and also
tend to augment the hydrostatic pressure.
5. Alteration of the water retaining properties of the tissues may provide reduced space available for
fluid accumulation or this may cause reduction of the oncotic pressure.

12. Assessment
 Edema is often an early sign of significant fluid retention.
 A variety of methods have been available to assess edema
 1.) PERIPHERY CIRCUMFERENCE
2.) VOLUME DISPLACEMENT
3.) PATIENT’S SELF REPORT

13. Assessment
a) Periphery Circumference b) Volume Displacement c) Patient Self

14. Management
 A) Medical Management
 B) Physiotherapy Management
 A) Medical Management
More severe edema may be treated with drugs that help your body expel
excess fluid in the form of urine the most common diuretics is furosemide,
hydrochlorothiazide etc.

15. Aims & Objectives -:
 To Reduce fluid accumulation- The primary goal of treating edema is to reduce the
accumulation of fluid in the affected tissues.
 To Improve circulation- Improving blood and lymphatic circulation can also help to reduce
edema.
 To provide symptomatic relief- Edema can be uncomfortable and painful.
 Prevent complications- Severe or chronic edema can lead to complications such as skin
ulcers, infections, and blood clots.

16. Physiotherapy Management
 Movement –moving and using the muscles in the part of your body affected by edema
especially in your legs,may help pump the excess fluid back toward your heart.
 Elevation-hold the edemic part of your body above the level of heart several times a day.
 Massage- Stroking the affected area toward your heart using firm but not painful pressure
may help to move excess fluid out of that area.
 Compression – compression garment and stocking keep pressure on edemic part to
prevent further collection of fluid.Protection –keep the affected area clean moisturized and
free from injury.
 Cryotherapy is helpful as it reduces the metabolic activity and thus reduce the blood flow
to the region.

17. Physiotherapy Management
 To improve circulation- Active exercise
Rhythmic contraction of muscle
Isometrics of the affected extremity.
 Compression garments,intermittent sequential pneumatic compression pump,elastic
bandage,low stretch bandage.
 Compression garments work by creating a pressure gradient causing the flow of fluids away
from the area where they are accumulating.

18. Physiotherapy Management
• Short stretch compression
bandage
• Compression Garments of Different
sizes and parts

19. Various Modalities to reduce Edema
• Intermittent Sequential pneumatic compression pump. • Elastic Stockings

20. Physiotherapy Management
 Individualized exercise program-:
a) Active ROM (pumping exercise)
b) Flexibility exercises
c) Low intensity resistance exercises
d) Cardiovascular conditioning
e) Rest of the limb in antigravity position.
 Venous return can be improved by raising the legs or by providing support(with
an elastic stocking).

21. Manual Lymphatic Drainage
 Manual Lymph drainage (MLD), is a light, skin-stretching massage that helps promote
the movement of lymphatic fluid out of the swollen limb.
 MLD is specifically focused on the lymph vessels to help the flow of lymphatic fluid.
 The intention behind MLD is to augment the rhythmic contractions and stimulate the
lymph nodes to improve their activity in order to reroute stagnant lymphatic fluid.

23. Other exercises
 Rest of the limb in antigravity position-elevating legs over the level of heart.
 Antigravity position helps to increase the venous return from the periphery towards
center.
 20 to 30 min resting period daily with the legs at angle 30° are sufficient to reduce the
edema.
 Pneumatic compression therapy – It is a device which include an air pump and
inflatable auxiliary sleeves ,gloves or boots in a system designed to improve venous
circulation in the limbs of patients who suffer edema.
 This therapy is used to provide the external pressure so as to counteract the venous
hypertension by facilitating venous return towards the heart and improving venous
circulation and lymphatic drainage.

24. Prevention of Edema
 Avoid static dependent positioning of the lower extremities(crossed leg sitting,
prolonged sitting or standing).
 Avoid wearing clothing that restricts circulation, do not wear tight jewelry such as
rings and watches.
 Wear compressive garments while exercising.

25. Thank You
FOR NOT RAISING ANY DOUBTS.