Written by Dr.M.D.Mazumdar, MD
Swollen ankles and feet (edema) are a common feature in late pregnancy. It is more common in late pregnancy than in the first two trimesters. when it appears, it generally remains until childbirth.
Edema affects about 75% of all pregnant women.
It is usually worse by the end of the day, when you have been on your feet for some time and much better in the morning after you've been lying in bed the whole night.
Ankle edema can also occur more often if there is excessive increase in weight during the pregnancy.
Causes of Swollen Ankles
Pressure by the Enlarging Uterus: As the uterus increases in size, it presses on the veins carrying blood back from the legs to the heart. This causes the blood in the legs to stagnate. Fluid leaks out of the blood vessels into the extracellular space and collects at the ankles and feet as they are the lowermost part of the body.
Increased blood volume: During pregnancy, the blood volume increases to accomodate for the growing oxygen needs of the baby as well as the other body tissues. While blood vessels are quite capable of handling large volumes of blood flow, there may still be some amount of leakage of fluid outside the vessels.
Together with blood, the water content in the body will increase about 6.5 liters, or up to 15 pounds, by term. This water goes towards the growing fetus, placenta, amniotic fluid and maternal blood volume.
Excess weight gain: Excessive weight gain can put more pressure on the veins than normal leading to edema or swollen ankles.
Retention of Water:
Pregnant women retain more water than normal. This can add to the ankle swelling.
Serious Conditions: Some serious conditions like PET (Pre-eclamptic toxaemia) and DVT ( Deep vein Thrombosis) is also accompanied by edema.
Symptoms of Ankle Swelling
Tightness of shoes and slippers.
Shiny appearance of the skin.
Swelling of the ankles.
Leaving a pit on the skin when pressed with one finger.
What you can do about Swollen Ankles
Inform your doctor as soon as you notice that your ankles and feet are beginning to swell. Swelling of the ankles may be one of the first signs of an increasing blood pressure and if your blood pressure is increasing, the earlier it is diagnosed, the better. Sudden or severe swelling of the ankles and hands are particularly dangerous and can be due to a serious condition known as Pre-eclamptic toxaemia (PET).
Swelling in only one leg is also dangerous. If it is accompanied by pain or tenderness in the calf or thigh, it could indicate a blood clot or other underlying condition.
Lie down whenever you get a chance and rest your feet on a pillow raised at a height higher than your body. This will help your blood to flow back from the legs under the effect of gravity.
When you sleep at night, lie on your left side. This removes pressure from the inferior vena cava (the main vein carrying blood from your legs to the heart), and helps in blood flow.
Decrease your salt intake. Increased salt in the pregnancy diet has been known to help in movement of fluid from inside the blood vessel to the extracellular space where the fluid tends to collect.
Wear maternity support stockings. This will support the veins of the legs and help in blood flow.
Avoid too-tight elastic-top socks or stockings. Your goal is to let blood and fluids flow as freely as possible. Socks that leave an indentation mark around your leg are likely too tight.
Exercise can help decrease the swelling to some extent though not totally.
Dehydration Drink plenty of water - 10 cups (2.3 liters) of fluids a day - as dehydration can cause more swelling. Keeping well hydrated helps the blood to flow better.
Clothing Maternity Clothing should be loose and comfortable. Avoid clothes which prevent easy movements of the body. Do not wear shoes or sandals with tight- fittiing straps.
When sitting, do not cross your legs - it can constrict the blood vessels at the level of the knees. Also, use a footrest as much as possible.
When to See the Doctor:
While edema is usually not serious, in some cases it may point to a dangerous condition like PET (r pre-eclamptic toxaemia) or DVT - clots in the veins of the calf muscles. Danger signs include:
High blood pressure
Swelling of the feet
when only one leg is swollen and red
Sudden swelling of the face and hands
Continuous headache
Difficulty in vision
Rapid Weight gain
Presence of protein in the urine.
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