Dear Doctor, I’m 30 years old and 6 months pregnant with my first child. However, my feet swell so badly and sometimes I can’t even fit into my shoes. How can I control this? What causes it? Berna

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Dear Berna,

Is the swelling more in the mornings or evenings? Does it come after walking or standing? Is there associated swelling of the face?

As the belly swells with advanced pregnancy, it presses on lymphatics of the lower limb, causing swelling. It also slows down the circulation of blood in the lower limbs, the resultant stasis can cause swelling over the feet or pedal edema. Edema is common during pregnancy, occurring over the face, feet and ankles and even at times over the hands.  Almost 80 per cent of women suffer from it during advanced pregnancy. It does cause discomfort affecting the feet and legs and making them feel heavy; it looks ungainly but is usually harmless.  Normally during pregnancy, fluid and blood is retained in the body to make it extra soft, thus facilitating the delivery of the child later on. This retention of fluid causes swelling. Swelling related to pregnancy resolves within one or two days after delivery and should not be a cause for worry. It can be prevented or minimised by avoiding standing for long hours continuously. Keep the feet up as much as possible.  Keep legs elevated while resting, even if for a few hours. Elastic stockings, crepe bandage can be tried, but are not comfortable. Wear comfortable shoes.

If it is due to some infection or systemic disorder, it needs due attention.  As such, women are more prone to develop urinary tract infection (UTI), due to multiple reasons. This susceptibility increases during pregnancy. UTI causes swelling of the face more in the mornings and also over the feet. It is easily diagnosed by a simple microscopic examination of the urine, done after collecting the first urine passed in the morning. Treatment is by antibiotics. Prevention lies in drinking more water and improving pelvic hygiene.

It can be due to high blood pressure. Here, swelling manifests on the feet first, occurring more in the evenings or after exertion. Liver and or kidney disorders or protein deficiency can be triggered  with swelling over the face initially, which later on occurs on the feet as well. These conditions can be diagnosed by suitable investigations and have appropriate management.

The swelling of one foot always indicates a medical condition. The pain on touch is associated with swelling; it can be due to a clot in the blood vessels, a condition to which pregnant women are more vulnerable. This is an emergency needing urgent treatment.  Some injury or inflammation of the bone or supporting soft tissue or lymphatics can also cause swelling and pain in one foot or ankle. The underlying cause of swelling can be determined by Doppler and other special imaging techniques. Treatment depends on the underlying cause.                                                               

Dr.Rachna   Pande is a specialist in internal medicine.