Systemic lupus erythematosus (SLE) is an autoimmune disease that effects organs throughout the body. A common and frustrating symptom is swelling in the joints and extremities which causes pain, discomfort, and can be a blow to the self esteem of a person with lupus. Often, this is actually bodily fluids, mostly water, that the body is holding onto for some reason. It is not unusual for the body to leak some excess fluid – which is not blood but can have some blood particles in it – into the surrounding tissues. Usually, these fluids are reabsorbed or moved elsewhere in the body by the lymphatic system. However, sometimes conditions in the body or in the bloodstream cause the fluid to stay in the tissues of the body. This is known as fluid retention.
Fluid retention in the limbs is often very visible, but there are other symptoms to look out for when it is more subtle.
- Tightness of the skin
- feelings of fatigue or tiredness
- feelings of strain on bones, ligaments, and joints
- difficulty breathing
- difficulty swallowing
- irregular urination
- weight gain
It can also exacerbate cutaneous lupus as the body tries to remove the excess fluid by pushing it through the skin, creating a moist environment that can lead to skin infections, worsen lesions, and make medications less effective. Read more about preventing infections with lupus here.
Swelling – also known as ‘edema‘ – that is related to fluid retention can also show up in other parts of the body, such as the eyelids or abdominal area. The skin can seem stretched and shiny, over puffy or swollen areas. Usually, this occurs in the extremities, but it can occur in the face, eyes, and stomach. Sometimes, the skin above the swollen area will retain its shape when pressed, known as pitting.
Swelling can have a serious effect on self-esteem and body image, but it also can damage nerves, tendons, and joints in the effected parts if the pressure is too much.
What Causes Fluid Retention?
Fluid retention can be a symptom of lupus nephritis. The kidneys are responsible for filtering the blood and keeping the right balance of fluid, salts, unable to do their job properly of filtering and balancing the proportions of water, salts, red blood cells, and the many other substances that are a part of blood. They also help to control blood pressure by monitoring the blood and controlling the production of certain hormones. When the kidneys are damaged, excess fluid isn’t filtered out properly or released to the bladder and urinary tract as urine. Instead, it remains in the bloodstream.
When there is too much fluid, the small blood vessels, known as capillaries, leak to compensate for the higher pressure and are unable to take back the fluid. The excess fluid will stay in the bodily tissues themselves, causing them to swell. You can read more about diagnosing and treating lupus nephritis here. Gout, which can be caused by lupus nephritis, also causes pain and swelling in the joints and, especially, in the feet as uric acid builds up in the body.
Too much fluid in the body leads to high blood pressure, as well as swelling in areas where gravity makes it more difficult to move fluid around the body, such as the legs, ankles, and feet. Swelling can be painful, make it difficult to move, and put pressure on joints, enhancing lupus symptoms already present. Read more about pain and lupus here.
Fluid retention and swelling can also be a potential symptom of cardiovascular issues, where the circulatory system can’t keep up. If the heart isn’t strong enough to circulate all of the fluid in the body, excess fluid can accumulate in the extremities, particularly the feet and legs, causing swelling. Read more about cardiovascular disease and lupus here.
The lymphatic system, which is an integral part of the immune system, can also cause fluid retention when it fails to reabsorb and redistribute fluid.
Pregnancy, low physical activity due to mobility issues, and being overweight can also put stress on the circulatory system and make fluid retention and swelling worse. Some medications, including birth control pills and certain lupus medications can also cause fluid retention and swelling. It might also be a good idea to check with your doctor about whether your medications are encouraging fluid retention and swelling. Predisone in particular is notorious for causing swelling, as well as other side effects. Heat can also make it worse, as can natural hormonal cycles.
How to Reduce Fluid Retention
Changes to diet and one’s lifestyle can help reduce fluid. In particular, eating foods with high salt or sugar content can cause the body to hold onto water more readily. So eating a healthy, balanced diet low in salt and sugar – added or otherwise – will help. Fruit juices, while a source of water and important vitamins, are often too sugary on their own. Cranberry juice is an exception, as it encourages urination and can help clear out infectious bacteria in the bladder and urinary tract. It is also a great source of vitamin C, vitamin E, and other antioxidants. Some of these antioxidants, called proanthocyanins, end up in the urine and can help cleanse the bladder.
Cranberry juice is astringent, and many brands add sugar to adjust the taste – if you are avoiding sugar, only choose brands that don’t add sugar. Also, talk to a doctor before drinking cranberry juice if you are taking blood thinners. You can read more about why people with lupus should cut back on sugar here.
Rest, regular cardio-strengthening exercises, and mobility exercises such as yoga can also help the body better regulate its fluids.
Ironically, increasing your water intake can bring down fluid retention, possibly because proper hydration helps everything in the body run better overall, or it helps encourage urination and clear out excess salts and sugars in the bloodstream. Caffiene, on the other hand, is a bit of a mixed bag, as it can encourage urination but also can cause dehydration if you take in too much of it.
Exercise, particularly walking, leg lifts, and other mobility exercises, helps to encourage proper blood flow, and there are many other additional benefits.
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