Pitting Edema

Pitting edema is a type of swelling where pressing on a swollen body part leaves behind a dent or “pit” that takes time to refill. The deeper the dent and the longer it takes to refill, the more severe this swelling is. It’s usually a symptom of chronic conditions that affect your circulatory system.

Pitting edema is most likely to affect your extremities. That usually means your legs and feet, but your arms and hands are also likely places to see it. Pitting edema can happen anywhere on your body under the right circumstances.

What pitting edema looks and feels like

The main symptom of pitting edema is a left-behind dent or pit after pressing on the swollen area. That dent slowly fills back in once you stop pressing on the area. One easy way to see pitting edema is if you take off your socks and you see a deep, ring-like dent all around your leg where the top of the sock was.

There are other things you might notice with pitting edema. They include:

• Affected body parts looking or feeling bigger
• Skin over the affected area looking shiny or stretched
• Pain, discomfort, tenderness or soreness in the affected area
• Having trouble walking or moving around if the swelling makes your legs or feet feel heavy
• Rings being difficult to put on or take off if the swelling affects your hands
• Gaining weight, usually slowly, from fluid that stays in your body
• Coughing or having trouble breathing because of fluid buildup in your body

What are the most common causes of pitting edema?

Pitting edema happens because of fluid overload. That means there’s too much fluid trapped with nowhere to go. Fluid overload usually happens because of a combination of factors and causes. They include:

• Underlying medical conditions: Pitting edema is a common symptom of heart failure. It can also happen with a weakened immune system, blood clots or lung, liver, kidney or thyroid diseases.
• Weakened valves in your veins (venous insufficiency): When valves in your veins weaken, it’s harder for blood to flow back to your heart. That can cause fluid buildup in your legs. It’s also why varicose veins happen.
• Medication side effects: Pitting edema can sometimes be a side effect of some medicines.
• Gravity: If you spend a lot of time sitting or standing in one place for too long, fluid naturally sinks down into your lower arms, hands, legs and feet (dependent edema). This can also make edema from underlying medical conditions worse.
• What you eat: If you eat a lot of foods high in salt (sodium), fluid can build up in different parts of your body.

What is edema grading?

Edema grading uses a scale to check how severe pitting edema is. The grading also lets providers estimate how much fluid has built up in your tissues. To find the grade, they’ll use a pitting test.

To do this test, they’ll gently press their finger on a swollen area of your skin for five to 15 seconds. If you have edema, a pit or dimple will remain on your skin when they pull their finger away. They grade edema based on how deep the pit goes and how long it takes for the pit to fill in (rebound) and return to being flat skin.

The grades are:

• Grade 1: Immediate rebound with a 2 millimeter (mm) pit
• Grade 2: Rebound in under 15 seconds with a 3 to 4 mm pit
• Grade 3: Rebound in between 15 and 60 seconds with a 5 to 6 mm pit
• Grade 4: Rebound within two to three minutes with an 8 mm pit

The pitting test only works if you have pitting edema. It’s also possible to have nonpitting edema. Whether you have pitting can help providers narrow down what’s causing your edema.

How is pitting edema treated?

Pitting edema treatments mainly depend on the cause. For example:

• For edema from chronic heart failure: Your provider will recommend lifestyle changes to treat your condition by monitoring your weight, fluid intake and salt intake. Your provider might also prescribe medicines that can help or recommend cutting back on your alcohol intake.
• For edema from kidney disease or failure: Your provider may prescribe medications that help your kidneys work better or get rid of some extra fluid.
• For edema that’s a side effect of medication: Your provider might stop or lower the dosage of your medication to resolve the swelling. Don’t stop taking your medication unless your provider tells you to.
• For tobacco-related edema: If you have a lung disease, like emphysema or chronic bronchitis, and you use tobacco products (including vaping), your healthcare provider will recommend quitting.

What you can do about pitting edema

There are several things you can do to manage your edema. Taking steps to manage it can make your edema less severe and ease the effects. Things you can do include:

• When you are sitting or lying down, raise your legs. Ideally, your feet should be above the level of your heart. You can put a pillow under your legs to elevate them.
• Move around. Don’t sit or stand for long periods without moving or going on short walks.
• Wear compression or support socks, stockings or sleeves. They put gentle pressure on your body, which keeps fluid from building up. You can buy these over the counter, but always check with your provider before using them.
• Switch to the right footwear. There are special edema shoes for people who need adjustable footwear for swelling.
• Lower your salt intake. Salt makes you retain fluid, which makes it easier for parts of your body to swell.

What are the possible complications or risks of not treating pitting edema?

Some of the potential complications of pitting edema are:

• Poor circulation in affected body parts
• Venous ulcers (wounds)
• Pressure injuries (wounds in body parts you sit or lie on)

Poor circulation can also slow wound healing. That makes infections and even amputations more likely.

When should edema be treated by a doctor?

It’s very important to see your healthcare provider if you notice pitting edema. This is especially true if it either happens unexpectedly or without an obvious cause. Edema can stretch your skin, and if not treated, swelling could increase and cause serious health problems.

Call your healthcare provider immediately if you experience pitting edema and:

• Pain or discolored skin in a swollen area
• An open sore on a swollen area
• Shortness of breath
• Swelling of only one limb
• Difficulty walking or having trouble moving

Even when you feel healthy, you should still see a primary care provider once a year for a checkup. These visits can often catch conditions that cause pitting edema early. That can help you manage edema when it develops or even avoid it.