Pitting Edema: What is it Symptoms and Causes (How to Treatment, Scale, Grading, Diagnosis)

Have you ever had swelling in your legs and noticed a curve in your fingers after pressing it? If so, the swelling in the legs is referred to as edema, whereas when the indentation remains after the swollen skin is pressed, this is called pitting edema. Learn more about Pitting Edema: What is its Symptoms and Causes (How to Treatment, Scale, Grading, Diagnosis)

Swelling of the legs that leads to pitting edema can be done with a variety of treatments. It is based on a scaled assessment of pitting edema before performing at a later stage.


What is pitting edema?

Edema is swelling of the body caused by excess fluid. It often affects the lower body, such as the feet, ankles, and can also occur in any part of the body.

If you press on a swollen area until it raises an indentation or hole and it remains, it is called pitting edema. If the swelling comes from the fluid and not due to other factors, then most of the edema will deflate by itself.

Pitting edema is caused by local problems with veins in the affected area, or systemic problems with heart, kidney, or liver function. Non-pitting edema is caused by problems with the thyroid or lymphatic system.

If you have edema, excess fluid is trapped in some tissues of the body and does not get carried away properly.


What are the symptoms?

Sometime because of edema will normally produce the skin feel tight, too thick, or tender.

Symptoms may include:

  • Tingling or burning sensation around the swelling
  • Pain and pain in swollen areas
  • Skin that feels swollen or stiff
  • Warm or hot skin to the touch
  • Numb
  • Bloating
  • Cramp
  • Unexplained cough
  • Daily fatigue or decreased energy
  • Chest pain
  • Shortness of breath and difficulty breathing

If you experience chest pain, shortness of breath, or swelling in only one particular limb, it is best to seek medical attention immediately.


What causes pitting edema?

Generally, cases of pitting edema are dependent or peripheral. Dependent edema occurs as a result of gravity pulling blood down can cause swelling of tissues. Peripheral edema occurs as a result of fluid retention in peripheral tissues, such as hands, and feet.

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Pitting edema has different causes. This may be the result of local problems with blood vessels, side effects of certain medications, or signs of other underlying conditions.


Common factors

Pitting edema is generally caused by poor circulation or excessive fluid retention. Some common risk factors that can cause this problem are sitting or standing in one position for too long, low protein levels, obesity, and pregnancy.



Certain types of drugs may increase the risk of pitting edema. Including:

  • Steroids
  • Nonsteroidal anti-inflammatory drugs ( NSAIDs )
  • Drugs that supplement estrogen
  • High blood medication
  • Thiazolidinediones, which is a medication used in the treatment of type 2 diabetes.


Venous insufficiency

Venous insufficiency is a condition of blood vessels in the legs weakening or not functioning properly. As a result, the vein is unable to return blood to the heart efficiently, so fluid is forced out of the vein and into surrounding tissues.

This can lead to a build-up of blood and fluid in the legs, resulting in peripheral edema. Varicose veins, or enlarged and twisted veins, are common risk factors for venous insufficiency.


Deep vein thrombosis

Deep vein thrombosis occurs when blood clots form in veins deep in the body, usually on the legs. Blood clots can damage veins and disrupt blood flow, which causes peripheral edema in the legs. Deep vein thrombosis can also cause venous insufficiency.

Congestive heart failure

Congestive heart failure occurs when the heart is unable to pump blood throughout the body as it should. As a result, blood accumulates in the lower limbs and causes peripheral edema.

In some cases, congestive heart failure is one of the causes of fluid buildup in the lungs, as the first step in the occurrence of pulmonary edema. Discover Pulmonary Edema: Symptoms, Type, Reasons and How To Remedy. In addition, congestive heart failure can also cause abdominal edema, known as ascites.



Cirrhosis is a liver disease characterized by permanent scarring and fibrosis of the liver, which can receive blood from the spleen and gastrointestinal organs through the portal vein. When fibrosis becomes widespread, the liver begins to fail, and blood coming from the portal vein can flow back, this can cause portal hypertension, which refers to an increase in blood pressure in the portal vein.

As a result, the fluid begins to leak and exits the portal vein, and then enters the stomach, causing ascites. This fluid can accumulate on the legs, resulting in peripheral edema. High blood pressure in the portal vein can also cause varicose veins or enlargement of veins in the esophagus or abdomen.

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Kidney disease

Kidney disease causes a build-up of fluid and sodium in the body. This can cause fluid retention so that it becomes peripheral edema in the legs.

The following are other factors that cause pitting edema:

  • Flight
  • Poor circulation
  • Obesity
  • Pregnancy
  • Dehydration
  • Low protein content
  • Trauma or injury


Is Pitting Edema dangerous?

Although pitting edema alone may not be so serious, the underlying condition that causes it can harm the person experiencing the symptoms. So, it is important to diagnose and treat it correctly first.

Over time, if pitting edema is left untreated, swelling that occurs in the body can cause long-term tissue damage so that over time the skin becomes stiff and cracked, as well as an increased risk of infection of the affected tissue.



Pitting edema is frequently identified with a physical exam. The doctor will apply pressure on the swollen skin for approximately 15 seconds to check for curves that can last a long time.

To correctly identify the underlying cause, the doctor can take a detailed medical history and ask about the medications. They can then refer the person to a doctor who specializes in problems related to blood vessels or circulatory systems.

Tests that can help in the diagnosis of pitting edema include:

  • Physical examination
  • Imaging tests, such as X-rays, can show fluid retention and problems in the lungs
  • Blood test
  • Urine test
  • Echocardiogram, which is a cardiac ultrasound scan


Pitting vs non-pitting edema

Pitting edema occurs when you press on a swollen area, it will leave a hole in the skin. In non-pitting edema, when pressed the skin will return to its swollen form after the pressure is removed.

Pitting Edema: What is it Symptoms and Causes (How to Treatment, Scale, Grading, Diagnosis)

Risk factors

Pitting edema can attack anyone. Certain factors can increase a person’s risk, such as:

  • Sedentary lifestyle
  • Living in a warm climate
  • Diets that are too rich in sodium
  • Obesity
  • Multiple pregnancies
  • History of lymph node surgery
  • Thyroid condition
  • Lung diseases, such as emphysema
  • Heart disease


Scale and Grade Rating Pitting Edema

Pitting edema is distinguished by depth and indentation duration. Here’s the scale and grade of pitting edema assessment to see the severity:

  • Degree 1: The pressure exerted by the doctor leaves a 0–2 millimeter indentation that immediately bounces off. This is the mildest type of pitting edema.
  • Level 2: Pressure leaves a 3-4 mm indentation that bounces in less than 15 seconds.
  • Grade 3: Pressure leaves a 5-6 mm indentation that takes up to 30 seconds to rebound.
  • Grade 4: Pressure leaves indentations 8 mm or deeper. It takes more than 20 seconds to rebound.
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Knowing the seriousness of edema will help physicians to identify the underlying causes and the ideal treatment.


How to Treatment Pitting edema?

To deal with pitting edema, it’s very important to diagnose and treat the underlying causes. Additional treatment for pitting edema depends on the severity. Most cases of mild pitting edema will heal on their own but can be facilitated by removing the affected limbs.

In more severe cases or if pitting edema is caused by critical conditions, such as congestive heart failure, liver disease, or kidney damage, diuretic drugs can be prescribed to help eliminate excess fluid through urine.

Common methods that can be done to overcome the underlying causes of pitting edema include:

  • Lifting swollen limbs above heart level
  • Wear compression stockings to encourage circulation.
  • Undergoing vascular surgery
  • Increase blood protein levels
  • Taking diuretics to remove excess fluid

When to see a doctor?

You should see a doctor immediately if you experience swelling, stretched and shiny skin, or skin that does not return to its original state when pressed so that it appears to be bulky and concave.

If you have been sitting for a long time, such as on a long flight, then experience leg pain and swelling that never goes away, contact your doctor immediately. Persistent leg pain and swelling may indicate a blood clot deep in the blood vessels (deep vein thrombosis, or DVT).

How to prevent pitting edema?

  • Stay active by doing various activities.
  • Avoid sitting for long periods.
  • If you work at a desk, set a timer to remind you to stand up and move for a few minutes every hour.
  • Exercise can encourage blood flow, which can help reduce swelling. However, talk to a doctor before starting a new exercise routine.



If not treated immediately, pitting edema can cause:

  • Increasingly painful swelling
  • Difficulty walking
  • Stiffness
  • Skin stretches, which can become itchy and uncomfortable
  • Increased risk of infection in swollen areas
  • Scars between layers of tissue
  • Reduced blood circulation
  • Decreased elasticity of arteries, veins, joints, and muscles
  • Increased risk of skin ulcers


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