The Fluid Retention Syndrome: Recognition, Risk Factors and Management

Abstract

A complaint of bloating or swelling of sufficient severity to lead to medical consultation is the lead symptom of a syndrome (the fluid retention syndrome) which includes affective, somatic and autonomic symptoms. These appear to have a primary origin in a neuroendocrine disturbance of limbic and hypothalamic function and form a substantial part of the work-load of a menopause clinic. The fluid retention syndrome, in turn, is one component of a spectrum of affective-somatic-autonomic disorders which comprise a significant part of the general practitioner's work load. Major risk factors for the fluid retention syndrome comprise a strong family history of swelling symptoms and/or diabetes mellitus, affective illness, including major life events, weight gain and obesity. Short term exacerbations of swelling are precipitated by emotional stress, high carbohydrate meals, alcohol, prolonged standing and exercise, high ambient temperatures and rebound oedema following the withdrawal of diuretic therapy. Management involves recognition of the syndrome, a clear explanation of its nature to the patient, the control of weight-related fluid retention by reduction to a pre-morbid target weight and the avoidance of inappropriate drug therapy. In particular, diuretics should not be prescribed for fluid-retaining symptoms. Hormone replacement therapy (HRT) should be prescribed for patients with the fluid retention syndrome if there is biochemical evidence of ovarian failure. The role of HRT in inducing rapid bloating independently of weight gain requires evaluation by a randomised controlled clinical trial. More effective management of the syndrome awaits further understanding of the neuroendocrine substrate for the disorder.