Swelling in the legs, ankles, feet

When to Get Help

Go to the emergency department or call 911 if you:

  • are coughing up blood
  • get sudden chest pain
  • have trouble breathing
  • get a fever
  • get a sudden increase in pain, swelling, warmth, or redness to your legs, ankles or feet

Swelling in the legs, ankles, and feet is called peripheral edema. It happens when your body holds on to salt and water. Peripheral edema can happen to people with cirrhosis, especially after they sit or stand for a long time. In addition to cirrhosis, it can sometimes be caused by other conditions like heart failure, infection, blood clots, or kidney disease.

Treatment

Low Sodium (Salt) Diet

Too much sodium (salt) can make your swelling worse, so it’s important to lower your sodium intake.

  • People with cirrhosis should eat LESS THAN 2,000 mg of sodium per day (as a reference, 1 teaspoon of salt, including sea salt, table salt or rock salts have 2300 mg of sodium). Much of the salt we eat is found in our packaged and processed foods and we might not even realize it’s there!
  • There can be a lot of sodium in packaged and canned foods; See this guide to sodium to help you chose which foods to eat
  • Don’t add salt to your food or cooking; herbs, spices, and marinades can help improve the flavour of food without adding sodium

For more information, check out the Nutrition in Cirrhosis Guide Book for Patients

Medications

Diuretic medicines (water pills) like lasix and spironolactone can help get rid of the fluid causing swelling. Talk with your doctor or nurse practitioner about whether these medicines would be a good option for you.

Self Care Tips:

  • Weigh yourself each morning before breakfast, before you drink anything or take medicine, and after you pee (urinate).
  • Keep track of your weight in a notebook or app on your phone.
  • If you are taking diuretics (water pills), have your blood tests done regularly to check your kidneys and electrolytes as recommended by your health team.
  • Raise your legs up when sitting down to help blood flow back to your heart. This works best if you are lying down and can get your legs above the level of your heart.
  • Take breaks from standing or sitting in one position; Remember to walk around to increase blood flow to your legs.
  • Wear support stockings in the morning and ask your doctor or nurse practitioner if they can prescribe compression stockings.

Let your healthcare provider know if you:

  • lose weight too quickly: 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR more than 7 pounds (3.2 kg) in a week
  • gain 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR gain 5 pounds (2.3 kg) in a week
  • notice more swelling in your belly, legs, or feet
  • have a harder time breathing when you’re active or lying down

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
  3. Davison SN on behalf of the Kidney Supportive Care Research Group. Conservative Kidney Management Pathway; Available from: https//:www.CKMcare.com.
  4. Runyon BA; AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013 Apr;57(4):1651-3. doi: 10.1002/hep.26359. PMID: 23463403.
Last reviewed March 15, 2021
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