Swollen legs in the morning

This is either excessive accumulation of fluid in somea separate part of the body, or switching the entire body to excess fluid retention. To local edema can lead to inflammation, an insect bite, a trauma. Common swelling is always a change in the condition of the entire body.

In order for the edema to arise, twofactor: the presence of fluid and tissue that can retain this fluid. In summer, in the heat, a person always drinks more fluids, so there is no problem with it. Moreover, there are drinks that are themselves trying to stay in the tissues - salted (mineral water) and sweet fizzy ("Pinocchio", "Bell", "Coca Cola"). In certain diseases and conditions, the body tends to store fluid. According to the type of edema, there are often assumptions about the presence of a pathology in the body (edemas suffer from "cores", "kidneys", diabetics, often swelling in women before menstruation), but especially swelling worries pregnant women and their doctors.

By itself, pregnancy is a condition,It helps to keep water in the body, and it's physiologically. A person is 80% water, and in the mother's body "suddenly" for a relatively short period of time a completely new organism is formed, the water for which it is necessary to take somewhere. At a normal pregnancy, water is collected as much as 6-8 liters, 4-6 of which is outside the body tissues, and 2-3 - in the tissues. By the end of pregnancy about 3 liters of water accumulate the baby, placenta and amniotic fluid. Another three liters go to increase the volume of the mother's blood, to increase and increase the uterus and milk glands. The volume of the liquid part of the blood begins to increase very early, from 8 weeks of pregnancy. It seems that the accumulation of fluid is a phenomenon of primary importance, since the body begins to deal with this so early. And the truth: because how liquid and fluid will be blood, so quickly it can deliver nutrients for the growth of the baby, the uterus, the milk glands. And fill the whole new vascular system with blood only when there is a lot of it.

However, not always all the liquid goes only "inbusiness. "Almost any biological system possesses excessive" greed "and tries to stockpile the right resource in case of its sudden disappearance, which is why edemas are formed.

There are four degrees of severity of edema:

  • the first degree - the appearance of edema on the legs;
  • the second degree is edema of the feet, lower legs, lower abdomen;
  • the third degree - occurrence of edemas on arms or hand, occurrence of pastosity of the face;
  • the fourth degree - generalized edema (dropsy).

Most edemas develop from 30 weekspregnancy. With gestosis, edema occurs after 20 weeks. in the morning, the legs become "wadded," shortness of breath, weakness and fatigue. Because of edemas, a pregnant woman can not stay on her feet for long, shoes become tight, rings are not removed and not worn (ring symptom). When pressing on the lower leg a hole is formed, which disappears not immediately. But not always edema appears visually. About hidden hypostases says an increase in body weight of more than 300-400 g per week.

As already noted, swelling is not alwayspathology. At the end of pregnancy, the enlarged uterus presses on the lower vena cava, which creates an obstacle to the flow of blood from the veins of the lower limbs. In addition, the large uterus squeezes the ureters, as a result, fluid retention occurs. In women with varicose veins with prolonged walking or standing on the legs, the feet and shins swell by the evening. Another type of physiological edema is constitutional. They arise in women with low growth and increased body weight.

The development of pathological edema is associated withviolation of water-salt metabolism, improper outflow of blood and lymph through the veins of the legs, increased permeability of the vascular wall and thickening of the blood. This mechanism of edema is inherent in gestosis (the old name is toxicosis of the second half of pregnancy), in which there is also an increase in blood pressure and proteinuria (protein in the urine). These symptoms are not always present as a complete triad, moreover, there are "dry" gestosis, when there is no edema at all, and they are considered a more severe case of the course of the disease.

How to understand if you have edema?

The answer to several questions will help. Have not you recently begun to desperately shake your favorite ragged shoes? The engagement ring compresses the finger, leaving a mark, hardly or at all is removed from the finger? Do they leave a ribbed, long not falling track of elastic from socks and golfs? You began to gain weight above the norm (more than 300 g per week)?

Of course, obvious swelling will be noticed not only by the doctor, butand you. But there are hidden swellings, or pastosity of the tissues (the so-called fluid retention in the body), which are not conspicuous. They can be suspected only if the future mother has a large or uneven weight gain.

Often edemas in healthy pregnant women, nothaving cardiovascular or renal pathology, appear in the second half of pregnancy. Usually, first the legs swell, then the edema of the hands, abdomen, face can be added. The latter especially upsets the expectant mothers. After all, the face swells most strongly. This is due to the anatomical features of this area. There is a loose fiber, which, like a sponge, is ready to retain liquid.

In the morning swelling on the legs is less noticeable, because at nightthe fluid spreads evenly throughout the body. But in the daytime, when you spend more time on your feet, the liquid goes down, accumulating mainly in the area of ​​the ankles, on the back of the feet, on the legs, where the pressure of the finger can cause a slowly leveling fovea. Skin with swelling is pale, tense and smooth.

Simple home methods will make it possible to understand if you have concealed edemas, the presence of which must necessarily be reported to the doctor.

Possible excessive swelling is indicated by excessive (more than 300 grams per week) or uneven weight gain of the future mother.

Compare the amount of fluid andallocated urine (per day). Normally, a healthy person emits ¾ of the liquid. Suppose, if you drank 1000-1200 ml of liquid for a day (including soups and tea-coffee), urine should stand out at least 750-900 ml. The remaining quarter of the liquid is released in the form of sweat, and also during breathing. Usually it is recommended to count diuresis for three consecutive days to exclude the situation when on the eve of the study a large amount of liquid was drunk, which was excreted well on the first day of urine counting.

Measurement of the leg circumference at one level in dynamics

An increase in the ankle circumference by 1 cm or more during the week indicates a fluid retention in the body.

Western medicine considers edema during pregnancya physiological phenomenon in the absence of increased pressure, protein in the urine and concomitant diseases. Russian doctors adhere to the point of view that swelling during pregnancy is always the first signs of gestosis, which means they must be treated. Unfortunately, it is impossible to accurately predict the course of pregnancy, especially the first, so that the pregnant woman can meet both the doctor with the first and the second point of view, and most often the personal experience of the doctor and the course of the observed pregnancies play a role here.

In any case, it is reasonable to deal with the prevention of edema.

Primary prevention is a surveypregnant woman in early pregnancy, a blood test for biochemistry and examination by specialists. In the early period, when there is no edema yet and can not be, it is already possible to guess which woman the development of the pathology of pregnancy is more likely. That is why so much is said about the need for early registration and an early survey of pregnant women.

How to deal with already arisen edema?

After determining the cause of edemathere is a natural question: how to deal with pathological edema (gestosis)? First of all, you need to decide on a diet. The food should be balanced and full. Food should contain an increased amount of protein (meat, fish, chicken), as with gestosis, there is a deficiency, which leads to an increase in vascular permeability.

Do not forget about carbohydrates - thisenergy material, in the case of their lack of energy, proteins will be consumed. Fats are also needed for energy production and as a building material for the fetal organs. Restriction of fluid and salt only aggravates the development of edema. Fluid per day should be at least 1.5 liters. But pickled, marinated and spicy dishes are better to exclude. It is necessary to limit the intake of sweet and carbonated drinks (coca-cola, lemonade): they lead to fluid retention in the body, creating a vicious circle of edema development.

Avoid prolonged standing orwalk. In the morning, it is necessary to lift your legs up (in a horizontal position). A vigorous foot massage is effective. Kidney tea and other herbs can be taken only as prescribed by the doctor. Diuretics should not be taken for the treatment of edema caused by gestosis.

In the third trimester of pregnancy. when a decently increased uterus presses on all the organs of the abdominal cavity, including kidneys and kidney vessels, positional gymnastics is good, specifically, the knee-elbow position for 1-1.5 hours a day. These 1.5 hours can be typed in short "approaches to the projectile" for 10-15 minutes during the day.

If, despite prevention, swelling continuesto grow, in the urine there was a protein and the pressure crawled up - this is a clinically pronounced gestosis, which is treated only in the hospital. In severe cases, there may be a question of early delivery in the interests of the mother, and for the benefit of the child. Please do not refuse from hospitalization.

Anna Shashina,
obstetrician-gynecologist