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FAMILY MEDICINE® COLUMN

SUPPORT STOCKINGS AND WALKING MAY HELP READER'S SWOLLEN LEGS

Question: I have a problem with my legs swelling. My left is somewhat worse than my right -- perhaps because I broke my left hip nine years ago. What is causing the swelling in my legs and what can I do about it?

Answer: Leg swelling can develop because of several conditions that alter circulation. The commonly used model of circulation portrays the system in a way that doesn't explain leg swelling. I'll review the simple model that you probably remember from health class. In this model the left side of the heart is viewed as a pump that pressurizes the arteries. Blood flows from the arteries into fine branches, the capillaries, that empty into veins. The veins return blood to the right side of the heart to be pumped through the lungs, and from there the blood returns to the left side of the heart to start its journey over again.

This general view is accurate, but it portrays the arteries, capillaries and veins as simple conduits -- like the pipes in your house plumbing -- when in reality they are more complex. Unlike a water pipe, your arteries stretch when your heart beats and forces blood through them. After the peak pressure is reached, your arteries recoil. This prevents your blood pressure from getting too high when your heart beats or dropping too much between beats. In other words, it helps maintain a more constant pressure level.

Capillaries are more than just the smallest branches of arteries -- they are the place where oxygen is passed into the tissues and the blood picks up waste products and carbon dioxide. You can think of them as the location where the features that make "circulation" essential for life occur. And consequently, you might accurately guess that they are involved in some types of leg swelling.

If only slightly more fluid leaks into the spaces around the capillaries than is pulled back into the vein side, the affected tissues will swell. This can happen because of diseases that damage the capillaries, from decreased concentration of proteins in the blood, and other disorders. This type of swelling is called lymphedema, and it probably is not the reason your legs are swelling.

The most common cause for leg swelling is due to a subtle problem with veins. Gravity produces a relentless tug on us, including upon our blood. It tends to pull blood to the lowest parts of the body, and that is usually into the legs. Any mild impediment to the return of blood to the heart will cause swelling within the legs. This is probably the reason you have leg swelling.

You probably have a bit more trouble with swelling in your left leg because you previously broke it and this made a subtle change in circulation either from the fracture itself or from the surgery that was necessary to repair it.

If your leg swelling is due to "bad veins," then the most effective treatment is wearing support hosiery whenever you are awake. The pressure provided by the stockings helps the blood flow back to the heart without "pooling" in the legs. Avoiding prolonged periods of sitting with your legs hanging down also helps. Standing is also a problem, but walking isn't. You see, the rhythmic contraction of leg muscles during walking tends to help "pump" blood back to the heart and, thereby, reduce leg swelling. Check with your doctor. He or she will help you determine the cause of your leg swelling and then recommend diet, exercise, medicine, support stockings or other treatments that can help you.

"Family Medicine" is a weekly column.

SOURCE:By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at www.fhradio.org/fm.

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