Subjective systemic water retention

Specialty: General.

• perceived body swelling
• no obvious sensation of edema
• subjective fluid retention

Why it occurs

• Luteal hormonal fluctuations of the menstrual cycle (premenstrual water retention mediated by progesterone and aldosterone that subtly alters capillary permeability)
• Functional venous stasis due to prolonged orthostatic sedentary lifestyle (accumulation of interstitial fluid in the lower extremities without severe anatomical valve insufficiency)
• Diet excessively rich in sodium combined with low water intake (stimulation of vasopressin secretion and renal osmotic retention)
• Persistent mild to moderate allergic reactions or recurrent food intolerances (causing transient capillary microleaks due to local release of histamine)
• Initiation of therapy with calcium antagonists or direct peripheral vasodilators in initial doses that generate mild initial peripheral edema.

Initial workup

Urine test with dipstick to rule out proteinuria, serum electrolytes, albumin and total protein levels, renal function tests, and Doppler venous ultrasound of the lower limbs if there is any asymmetry or suspected vascular.

Standard management

• Avoid the empirical and unnecessary use of loop diuretics (such as furosemide) if there is no edema that can be observed by the doctor, to avoid hydroelectrolyte imbalances
• Gentle supportive phytotherapy such as artichoke or orthosiphon leaf extract — under control, to promote mild physiological diuresis
• Adjustment of the diet with sodium restriction to less than 2 g per day and promotion of low-impact aerobic physical activity.