The human body consists of 70 percent of the water that exists inside and outside of the body cells. Water retention in our body occurs when the fluids accumulate in the body cavities, body systems or tissues. Water retention is medically termed as edema or fluid retention. Water is an essential ingredient of blood plasma and helps maintain oxygen supplementation to different organs, glands, and tissues of the body. Water is naturally present in bones, muscles, and glands to aid in nourishment and helps in performing their function.

What causes fluid retention?

There are multiple causes of fluid retention in our bodies.

• Impact of Prostaglandins on renal salt

The human body regulates the water levels by prostaglandins that are hormone-like substances. Renal prostaglandins modulate renal salt and water excretion. Kidneys excrete the excess water in the form of urine to maintain the water level, blood plasma and pH. Disturbance in this system could lead to edema or fluid retention.

• Underlying medical condition

It could be associated with an ongoing medical condition like ischemic heart disease, renal disease, or endocrine disorder like thyroid disease. The failure of cardiac muscles to generate the required cardiac pressure to pump the blood to the entire body may cause alteration in the blood pressure leading to water retention.

• • Malfunction of kidneys

Kidneys absorb all essential or filtered substances that can be reused in the bloodstream and excrete all waste in the form of urine by rich renal capillary network and tubular system. Failure of kidney function may lead to retention of unwanted fluids and excess water.

• • Elevated intra-capillary pressure

Increased intra-capillary pressure could lead to retention of interstitial fluid that supplies nutrients to the cells and tissues. This can also occur due to damaged capillary walls, causing the interstitial fluid to accumulate in the intercellular spaces of tissues and organs, causing swelling or edema.

• • Lymphatic system

The blockage in the lymphatic system can cause a decrease in the lymphatic fluid pressure, which may lead to lymph accumulation within the lymphatic drainage pathway around the tissues and organs, causing swelling. Such scenarios are primarily seen in the lower abdomen, ankles, and limbs area.

• • Chronic infection

Prolonged infection or inflammation causes the release of histamine, which causes retention problems.

• • Diet

Malnutrition and improper diet can also cause fluid retention. Food high in sodium and magnesium content also leads to retention.

• • Lifestyle

Eating large amounts of salt, sitting or standing for prolonged periods can also lead to fluid retention.

• • Pregnancy

Some women experience water retention during pregnancy or before their monthly period.

 

What are the symptoms?

• Stiffness in joints

• • Discoloration of skin

• • Increased body weight

• • Joint and muscle tenderness

• • Joint pain

• • Swelling in joints, hands, and legs

• • Pitting edema- is the most crucial characteristic in identifying water retention.

• • Edema in the lungs due to fluid accumulation may lead to cough and breathing difficulties.

• • Psychological factors like low emotions, depression, anxiety, or stress may cause water retention in the body.

• • The premenstrual period leads to bloating and water retention.

The main risk factors

• • Salt rich diet

• • Sedentary lifestyle

• • Immobility when an extremity is in a dependent location

• • Severe lung disease like emphysema

• • Obesity

• • Multiple pregnancies

• • Heart diseases

• • Side effects of medications 

• • Lymph node surgery

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Drugs that cause water retention

Many medications or drug intake presents water retention as a side effect. Some of them are described below:

● NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain, fever, chronic inflammation, blood clot prevention, and injuries or muscle disorders. Consumption of these drugs has been shown to cause fluid retention in some people, triggering other congestive cardiovascular diseases or symptoms.

Heart patients should use these drugs carefully and consume only on recommendation by physicians. Some drugs like Ibuprofen, mainly used for headaches and chronic pain. Aspirin is also used for pain and blood clots or cardiovascular trigger prevention, Naproxen, Indomethacin, Diclofenac for toothache. Celebrex is used mainly in arthritis, or menstrual pain etc. These are some good examples of NSAIDs.

● Corticosteroids

Corticosteroids are drugs that belong to the class of steroid hormones. These are formed by the adrenal cortex of the kidneys. There are various analogs of these hormones which are used for different medical conditions. Corticosteroids are divided into two main groups, namely: Glucocorticoids and Mineralocorticoids.

Glucocorticoids are also called cortisol and help maintain the stress and psychological balance, blood sugar levels during hypoglycemic conditions by metabolizing fat, proteins and carbohydrates in the liver during low sugar concentration. These hormones also maintain the body's electrolyte balance and are associated with fluid retention as a side effect leading to weight gain.

● Oral contraceptive

Other popularly known medications that cause fluid retention are oral contraceptives that are commonly called birth control pills. These are the combination of female hormones; estrogen and progestogen, which help prevent pregnancy by inhibiting ovulation. However, these are seen to cause fluid retention and swelling.

● Diabetic drugs

Glitazones, namely Thiazolidindiones, are used for the treatment of diabetes mellitus Type 2. These drugs increase the number of fatty acids in the body's fat cells, thus decreasing the amount of free fatty acids in the blood. This increases the activity of the use of stored carbohydrates in the cells for energy. The most common side effect associated with this class of drugs is water retention, followed by reducing the drug dosage intake. Some examples of this group are Pioglitazone, Rosiglitazone, Troglitazone, Rivoglitazone etc.

●​​​​​​​ Anti-hypertensive drugs

Commonly used antihypertensives like beta-blockers, namely Labetalol, Metoprolol, Atenolol, Carvedilol, etc., and some ACE inhibitors like Captopril, Ramipril, Benazepril are also known to cause water retention.

Diuretics are the class of drugs used to reabsorb sodium, chloride and water into the bloodstream in kidneys leading to water retention or edema. Some of the diuretics are Furosemide, Indapamide, Torsemide etc.

 

Complication of Edema

Sometimes edema could cause serious complications, such as:

• • Pain in the skin due to stretching and infection

• • Joint pressure from swelling

• • Stiffness of joints and soreness

• • Itchy and dry skin over the edematous area

• • Difficulty in walking

• • Infection and open sores in edematous areas

• • Lowered blood flow to the affected area 

• • Shortness of breath

• • Pain in the chest (pulmonary edema)

• • Consciousness and behavior change (cerebral edema)

• • Edema associated with chronic conditions can lead to severe problems

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How to reduce water retention in the body?

1. Salt restricted diet. It is advised to take a sodium-rich diet as sodium can bind to water in the body, and decreasing your salt intake may help reduce water retention.

2. Intake of magnesium-rich food. Magnesium is involved in many enzymatic reactions essential for body functions and helps in reducing water retention.

3. Increase Vitamin B6 Intake has been shown to reduce water retention for premenstrual.

4. Increased intake of potassium-rich food like avocado, banana, and tomatoes is advisable.

5. Intake of dandelions that are herbs used as a natural diuretic is recommended.

6. Avoid refined carbs as they have processed sugars and grains that increase insulin levels in the body leading to higher fluid volume.

7. Daily exercise and physical activity help in improving water retention.

8. Use of compression socks or leggings can prevent water retention.

9. Consulting physicians while starting on medications for underlying medical conditions.

 

Recent researches

• • A recent study conducted on diabetic macular edema patients in Apr 2021 shows an improvement in the clarity or sharpness of vision by using the Bevacizumab drug.

• • A recent study was performed in August 2021 on patients with macular swelling post-cataract surgery. As per data, the use of Nonsteroidal anti-inflammatory drugs (NSAIDs) eye drops alone also work well compared to its effect when used in combination with steroids to prevent swelling of the macula (the macula is part of the retina at the back of the eye).

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