A sign of fluid buildup or inflammation of joint and tissue, ankle swelling is also called ankle edema. It can also result from serious infections, trauma or circulatory disorders, cardiac disorders or any other abnormal processes. Mild ankle swelling is common after standing for a long period of time. Painless swelling of the ankles is a common problem among older people. Swollen ankles may indicate potentially serious disorders such as congestive heart failure, deep vein thrombosis and liver failure. Ankle swelling could also occur during pregnancy, being overweight or vascular problems or some orthopedic conditions such as bone fracture or a sprained ankle.
Swelling can also be caused by injury involving surgery in ankle. Long car rides and flight travel can lead to ankle edema. Many women notice ankle edema during pregnancy. It is complicated by Preeclampsia, a serious condition that includes high blood pressure and swelling. Certain medications, like antidepressants, calcium channel blockers, and hormones like estrogen and testosterone and steroids can cause swelling. Ankle swelling is common in those who are overweight, suffer blood clots in the leg or those who suffer leg infections.
Swollen legs are also often a sign of failure of heart, kidney and liver. This is an indication of too much fluid in the body. Gout is caused by accumulation of uric acid crystals within the fluid of the ankle. Those suffering from gout exhibit abnormal accumulation of uric acid within joints leading to inflammation and resultant swelling. Ankle arthritis is another degenerative change is the joint, though less common, which can be quite painful and could cause swelling. Blood clot, known as DVT, is a common vascular obstruction of blood flow which can cause swelling around the ankles and can also extend further up to the legs.
Since swollen ankles could be due to serious diseases and injuries, seek treatment without delay. Treatment depends upon the analysis of the underlying disease condition and its diagnosis.
When deep slumber at night is regularly disrupted by an urgent feeling of urination, it is a condition called nocturia. It is common in older adults, both men and women, usually in the age group of 55 and 84 years. Nocturia is different from enuresis or bed-wetting wherein the person does not wake up from sleep but involuntarily empties the bladder. Nocturia affected person experiences sleep loss due to an urgent need to urinate. Mild nocturia is characterized by a need to urinate two to three times and in severe cases it can be anywhere between five to six times on a particular night, occasionally or daily.
Nocturia types and causes
Besides the normal aging process, nocturia is also linked to other causes. In women, besides age, childbirth or pelvic organ prolapse and menopause are often contributing factors to nocturia.
There is an overproduction of urine at night. In a 24-hour cycle the urine volume may be greater than 40 ml/kg or if the volume of urine passed at night exceeds one-third of the total daily urine output. The main feature of nocturnal polyuria is that more urine is produced during sleep which in turn induces more nighttime urination.
All fluids or even certain foods like salads, vegetables, fruits, rice and pasta with high water content can cause nocturnal polyuria. Diuretics, cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene and excessive Vitamin D medication can lead to frequent urination. Ankle swelling is another common cause of nocturnal polyuria. Congestive heart failure, venous stasis, hypoalbuminemia or excessive salt intake are other causes for fluid retention.
In adults, the normal urine production is 1 to 2 liters. Polyuria is characterized by urine output that exceeds 2500 ml/24 hours during the day as well as at night. Polyuria is common in people with diabetes mellitus and diabetes insipidus. Other conditions causing polyuria are Polycystic kidney disease, Sickle cell disease, Pyelonephritis, Amyloidosis, Sjogren syndrome and Myeloma. Vascular disease, restless leg syndrome, thyroid disorder and congestive heart failure are some causes for increased urinary output at night by the kidneys. Polydispisia or excessive thirst that compels drinking lots of water can cause polyuria. The thirst center or hypothalamus is affected due to anxiety, stress or psychiatric illness and leads to excessive thirst. Intravenous saline drip excessively administered can lead to polyuria. Hypercalcemia and hypokalemia lead to abnormal levels of electrolytes that can result in excessive urination.
Inadequate bladder storage
The urinary bladder has the capacity to hold as much as 600 ml of urine. But the desire to urinate is experienced when the level reaches about 150 ml. There are various reasons and conditions that lead to inadequate bladder storage. Bladder obstruction, bladder infection or recurrent urinary tract infection, bladder inflammation, pain in the bladder, bladder cancer can reduce bladder storage capacity. Stroke and Parkinson's disease can also lead to reduction in its storage capacity thus inducing an urgent need to empty the bladder.
A combination of nocturnal polyuria with reduced bladder capacity is termed as mixed nocturia.
Diagnosis of Nocturia
Basic diagnostic procedure is to record the frequency, volume and timing both daytime and nighttime for a minimum of 1-3 days. Certain diagnostic tests like urine analysis, urine culture or an ultrasound are done. Accordingly, the treatment procedure is determined. Treatment options include making dietary changes, behavioral changes with a combination of medications.
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Bibliography / Reference
Collection of Pages - Last revised Date: November 22, 2019