Edema refers to swelling. If you press a swollen area and it leaves an indentation, it’s considered to be pitting edema. The degree of pitting is measured on a scale of 1 to 4.
Edema is swelling in the body caused by excess fluid. It often affects the lower body, such as the legs, feet, and ankles, but it can occur anywhere. If you press on a swollen area and an indentation or pit remains, it’s called pitting edema. If there’s enough fluid, and the swelling is from fluid and not something else, then most edema will pit.
Pitting edema is either caused by a localized problem with veins in the affected area, or a systemic problem with your heart, kidneys, or liver function. Edema without pitting is more likely to be caused by issues with your thyroid or lymphatic system.
Either way, if you have edema, it means that excess fluid is trapped in some of your body tissues and it’s not being properly carried away.
If you have pitting edema, it’s important to work with your doctor to determine the cause.
Swelling in your body can cause your skin to feel tight. The swollen limb may also feel heavy due to extra fluid collecting in it. In addition to the swelling, pitting edema may be accompanied by:
- abnormal cough
- chest pain
- shortness of breath
- heart murmur
- low blood protein, especially if the swelling is in your abdomen
- decreased stamina
Symptoms occur case by case, depending on what’s specifically causing the edema.
Pitting edema is a general problem caused by a variety of issues such as:
- heart valve problems
- low protein levels
- deep venous thrombosis (DVT) — blood clots, usually in the legs
- severe lung disease
- congestive heart failure
- venous insufficiency
- liver disease
- kidney failure
- obesity
- pregnancy
- administration of intravenous fluids
- medications
- hot weather
Pitting edema in pregnancy
In many cases, pitting edema in pregnancy is not cause for concern. However, you should still talk to your doctor about your symptoms. They may want to evaluate you to check that the swelling is just a symptom of pregnancy and not caused by abnormal liver function, kidney problems, high blood pressure, or loss of protein in the urine, which may be a sign of preeclampsia.
People of all ages can get pitting edema because the risk factors are mostly related to diet and lifestyle. The main risk factors are:
- eating too much salt
- a sedentary lifestyle
- immobility when an extremity is in a dependent location
- emphysema or other severe lung disease
- heart disease
- obesity
- multiple pregnancies
- lymph node surgery
Pitting edema is a non-specific complaint. That means you’ll need a comprehensive evaluation to diagnose the cause. Your primary care provider may begin some testing, and they may refer you to a cardiologist or a varicose vein specialist. Diagnostic testing for pitting edema can include:
- examination for signs of water retention elsewhere in the body
- chest X-ray
- blood work
- echocardiogram
“You should get a medical evaluation if the edema is a new finding and if it persists and interrupts your daily life,” says Charlotte Bai, MD, a cardiologist and assistant professor at Rush University.
Edema scale
To determine the extent of the pitting edema, your doctor will push on your skin, measure the depth of the indention, and record how long it takes for your skin to rebound back to its original position. They will then grade it on a scale from 1-4.
| Grade | Depth | Rebound time |
| 1 | 2 millimeter (mm) depression, or barely visible | immediate |
| 2 | 3-4 mm depression, or a slight indentation | 15 seconds or less |
| 3 | 5-6 mm depression | 10-30 seconds |
| 4 | 8 mm depression, or a very deep indentation | more than 20 seconds |
Depending on the cause, treatments can include:
- elevating the swollen limb
- venous vascular procedures
- compression stockings if the cause is chronic and your doctor recommends them
- diuretics if the cause is due to congestive heart failure, liver, or kidney disease
Over time, your skin around the swelling may change and develop a “woody” appearance due to scarring. If the edema is from varicose veins, those may worsen.
Prolonged edema increases your risk of developing an infection in the tissues that are swollen, especially if there is skin cracking.
Staying active can help. Avoid sitting for extended periods of time. If you work at a desk, set a timer to remind yourself to stand up and move around for a few minutes every hour. Exercise encourages blood flow, which may help reduce swelling. Talk to your doctor before starting any new exercise routine, however.
Pitting edema is common and can be medically treated and reversed. It shouldn’t cause long-term problems, but it’s important to see a doctor for a proper diagnosis and treatment plan.