Managing Nocturia: Have You Looked At Your Feet Recently?

Nancy Muller, PhD Community Member

  • One of the problems that can contribute to nocturia - routinely getting up more than once during the night to use the toilet - is swelling of the feet during the day due to the collection of fluids in lower extremities, or edema. Without intervention, it isn't until nighttime, when the body is horizontal rather than vertical, that the fluid can readily flow to be processed by the kidneys, without the influence of gravity in the face of circulatory problems.

    The Mayo Clinic tells us that edema is swelling caused by excess fluid trapped in your body's tissues. Although edema can affect any part of your body, it is most commonly noticed in your hands, arms, feet, ankles and legs1. Edema can be the result of medication such as a calcium blocker, pregnancy, or an underlying disease, such as heart failure, kidney disease or cirrhosis of the liver, the latter having an impact on circulatory action. Taking a diuretic medication, such as HCTZ, to remove excess fluid and reducing the amount of salt in your food usually relieves edema. Something as simple as compression stockings may also help substantially and often advised in combination with medication. When edema is a sign of an underlying disease, the disease itself requires separate treatment.

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    The first step is to identify the symptoms so you can bring them to your doctor's attention.
    • Visual puffiness of the tissue directly under the skin
    • Stretched or shiny skin
    • Skin that retains a dimple after being pressed for several seconds

     

    Once your doctor has assessed your edema and identified causes, if it is simple edema without evidence of an underlying disease, ask about compression therapy. It may decrease your reliance on a diuretic drug or help a drug be more effective. Compression therapy helps decrease venous pressure, prevents venous stasis that may erupt eventually into leg ulcers, and relieves aching legs with a "heavy" feeling. Compression stockings are specialized hosiery designed to help prevent the occurrence of and guard against further progression of venous disorders including edema. Left unaddressed, more serious problems may surface such as phlebitis.

     

    Compression stockings are elastic garments worn around the leg compressing the limb, exerting pressure against the legs. Compression stockings are tightest at the ankles and gradually become less constrictive towards the knees and thighs. This pressure reduces the diameter of distended, or swollen, veins. This in turn allows an increase in venous blood flow velocity and valve effectiveness to help circulate fluids otherwise trapped in tissues of extremities. Arterial pressure is increased as a consequence, which causes more blood to return to the heart and less blood to pool in the feet.

     

    There are several crucial cautionary steps that need to be taken before using compression stocking:

     

    1. Although compression stockings can be purchased online from a variety of specialty suppliers or in a retail drug store without a prescription, consult with a doctor first if you suspect edema in the feet and ankles.

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    2. A patient's ABI (Ankle Brachial Index) must be >1.0 per leg to wear compression stockings, otherwise the stockings may obstruct the patient's arterial flow. The ABI indicates how unobstructed a patient's leg and arm arteries are. Competent primary care doctors or nurses can painlessly measure and calculate a patient's ABI using a Doppler instrument2.

     

    3. It is crucial that compression stockings are properly sized. The compression should gradually reduce from the highest compression at the smallest part of the ankle, until a 70% reduction of pressure occurs just below the knee is achieved.

     

    4. For a precise fit when buying graduated compression hosiery - whether knee highs, thigh highs or hosiery - measure ankle, thigh and hips at the widest point.

     

    Nancy Muller, PhD, MBA
    Executive Director, NAFC


    1 Retrieved from http://www.mayoclinic.com/health/edema/DS01035, accessed March 30, 2012.


    2 Retrieved from http://www.vdf.org/diseaseinfo/pad/anklebrachial.php , accessed March 30, 2012.

     

    Key words: compression stocking, edema, nocturia, preventing nocturia

Published On: April 03, 2012
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