Swollen legs: warning signs, causes and what to do

Swelling of the feet, ankles and legs (edema) is fluid building up, and gravity makes it most noticeable in the lower body. According to MedlinePlus, it is common and usually painless, especially in older adults.

If both legs are newly swollen, especially with weight gain, shortness of breath or a swollen belly, it can be a sign of a heart, kidney or liver problem, and you need an evaluation that same week.

According to MedlinePlus, the most frequent causes are:

• Long hours standing or sitting, and long flights or car rides
• Varicose veins or veins that don’t return blood well to the heart (venous insufficiency)
• Excess weight and age
• Medicines: some for high blood pressure (calcium channel blockers), anti-inflammatories (NSAIDs), steroids, hormones such as estrogen or testosterone, and some antidepressants
• A leg infection (cellulitis): red, warm, painful skin. See skin infection
• An injury or surgery on the leg, ankle or foot
• Pregnancy: some swelling is common, but severe or sudden swelling can be preeclampsia and needs care right away
• The heart, kidneys or liver: see high creatinine and fatty liver

If you have none of the warning signs, MedlinePlus recommends:

• Lying down with your legs on pillows, above the level of your heart
• Moving and exercising your legs
• Eating less salt
• Wearing support stockings (sold at pharmacies)
• On trips longer than 4 hours, the CDC advises getting up and walking every 1 to 2 hours
• Avoiding tight clothing around your thighs
• Not stopping any medicine you think is causing swelling without talking to a doctor first

You see Dr. Diana Nieves Castro, a Puerto Rico-licensed general practice physician with several years of emergency-department experience, in English or Spanish. She asks whether it is one leg or both, since when, whether it improves when you raise your legs, whether you traveled or had surgery recently, whether you are short of breath, and which medicines you take. On camera she asks you to show her your legs.

If she suspects a blood clot or a heart problem, she tells you clearly and sends you to the ER: that cannot be ruled out by video. If the cause looks like something else, we evaluate, diagnose and treat. We review your medicines and, if needed, give you a lab order for a lab near you: a blood count, blood chemistry (kidney and liver) and a urine test. If you need an ultrasound, an ECG or another in-person test, we refer you. If appropriate, the doctor prescribes and we send your prescription to your pharmacy.

An online doctor visit costs US$79, the same price for every age. If you are visiting the island and your feet swelled after the flight, see care for visitors.