Important
This article is a reference overview summarizing information from open sources. The information is for informational purposes only and does not replace consultation with a specialist.

What are edemas and why do they occur? Types of edemas

Edemas (edema, swelling) are the pathological accumulation of fluid in the interstitial (intercellular) space, leading to an increase in the volume of tissues and organs. Depending on the mechanism, several main types of edemas are distinguished:

1. Venous edemas — arise due to impaired venous outflow caused by weakness of venous valves, vein dilation, or obstruction of blood flow (varicose disease, chronic venous insufficiency, post-thrombotic syndrome). Elevated hydrostatic pressure in the veins forces fluid into the surrounding tissues — especially noticeable in the lower extremities toward the end of the day.
2. Lymphatic edemas (lymphedema, lymphostasis) — result from impaired lymphatic drainage due to congenital or acquired insufficiency of lymphatic vessels and nodes (after surgery, mastectomy, radiation therapy, trauma, infections). Lymph stagnates, tissues gradually harden, and fibrosis develops.
3. Lymphovenous (mixed) edemas — the most common form in adults, where both venous and lymphatic outflow are simultaneously impaired. Venous stasis worsens lymphatic insufficiency and vice versa — leading to a more persistent and pronounced edema.
4. Orthostatic / gravitational edemas — develop due to prolonged standing or sitting, when gravity and the lack of active muscle pump action cause fluid accumulation in the lower leg regions. Common in sedentary lifestyles, pregnancy, overweight, and hot weather.
5. Post-traumatic and postoperative edemas — occur after injuries, surgeries on veins, joints, or soft tissues due to local inflammation, vessel damage, and temporary disruption of lymphatic and venous drainage. Usually localized and resolve with proper treatment.
6. Edemas in lipedema — associated with pathological increase in adipose tissue (mainly in women), which compresses lymphatic and venous vessels, causing chronic pastosity and swelling of the lower extremities. Unlike regular obesity, fat distribution is uneven and responds poorly to diets.
7. Cardiac, renal, hepatic edemas — systemic edemas occurring in heart diseases (weakened pumping function), kidney diseases (sodium and water retention), or liver diseases (decreased albumin levels). Fluid accumulates symmetrically on both legs and often extends higher.

Edemas most commonly localize in the lower extremities (calves, ankles, feet), less frequently in the arms (post-mastectomy lymphedema), face, or abdomen. Toward evening the edema intensifies, tissues become soft and pasty, and pressure leaves a pit (pitting sign). Accompanied by heaviness, bursting sensation, fatigue, sometimes pain.

In which edemas is apparative pressotherapy effective?

Apparative pressotherapy (intermittent pneumatic compression, IPC, sequential pneumatic compression) is most effective precisely in edemas caused by impairment of local venous and/or lymphatic outflow. Below is a table showing the correspondence between edema types and the appropriateness of the method (types and order identical to the previous section):

The method is particularly valuable in home settings for daily or regular support when compression stockings are difficult to wear continuously or a quick effect is needed after heavy load / workday.

Why does pressotherapy effectively eliminate edemas?

Under normal conditions, the outflow of venous blood and lymph from the lower extremities is ensured by the body’s natural “pumps.”

Muscular (venous) pump works through contractions of the calf, thigh, and foot muscles during walking, running, or even simple movements. During contraction, the muscles compress the veins located within them and between the fascia, pushing blood upward toward the heart. One-way venous valves prevent backflow, and during relaxation the veins refill from distal segments. This rhythmic cycle of “contraction – relaxation” effectively overcomes gravity and maintains low venous pressure in the legs during movement.

Lymphatic pump combines external (passive) forces — tissue compression by surrounding muscles, arterial pulsation, respiratory movements — and internal (active) contractions of smooth muscle cells in the walls of larger lymphatic vessels (lymphangions). These contractions create a peristaltic-like wave that propels lymph against the pressure gradient toward central collectors and the venous angle.

In cases of low physical activity, prolonged standing/sitting, muscle weakness, or damage to lymphatic pathways, the natural pumps function insufficiently — fluid stagnates, edema increases, tissues harden.

Apparative pressotherapy physiologically imitates exactly these natural mechanisms. Multi-chamber cuffs create a sequential “pressure wave” from foot/hand proximally (gradient compression). Rhythmic cycles of “compression – pause” reproduce:

• compression of veins and lymphatic vessels as during muscle contraction;
• expulsion of interstitial fluid and blood/lymph in the proximal direction;
• alternation of pressure and unloading, stimulating refilling and further outflow.

As a result:

• excess interstitial fluid is mechanically displaced toward central collectors;
• venous and lymphatic outflow accelerates 2–4 times compared to rest;
• tissue and hydrostatic pressure in the extremities decreases;
• microcirculation and rheology of blood and lymph improve;
• vascular endothelium is stimulated (release of nitric oxide), local inflammation decreases;
• tissue fibrosis in prolonged edema is prevented.

The effect is noticeable already after 1–3 sessions: volume decreases, heaviness disappears, legs/arms become lighter and visually slimmer.

Examples from clinical practice

Example 1 (edema and pain after prolonged standing at work)

cross-over study in workers with standing load. IPC significantly reduced pain and calf/ankle circumference (objective edema markers) without adverse events.

Source: PubMed https://pubmed.ncbi.nlm.nih.gov/34260560/ ; PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC8284752/

Example 2 (home use for edema of the lower extremities)

pilot randomized controlled trial of home IPC in 50 patients with edema and reduced mobility. After 1 month — significant edema reduction, improvement in functional parameters and quality of life.

Source: PubMed https://pubmed.ncbi.nlm.nih.gov/29909855/ ; ScienceDirect https://www.sciencedirect.com/science/article/pii/S2213333X18301306

Example 3 (long-term therapy of lower limb lymphedema)

long-term use of high-pressure IPC in lower limb lymphedema. The method is safe and enables sustained reduction in limb volume.

Source: PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC4062105/

Example 4 (comparison of high vs. low pressure in phlebolymphedema)

IPC with high pressure showed superior efficacy in limb volume reduction in primary lymphedema and phlebolymphedema compared to low pressure.

Source: PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC4603726/

Example 5 (advanced APCD system in lipedema and edema)

advanced pneumatic compression reduced leg volume, subcutaneous fat tissue thickness, edema symptoms, and improved quality of life in women with lipedema.

Source: MDPI https://www.mdpi.com/2075-1729/15/5/725

Safety of pressotherapy in edemas

Apparative pressotherapy is considered one of the gentlest and best-tolerated methods for treating edemas. With correct pressure selection (usually in the comfortable range of 60–120 mmHg with gradient from feet/hands upward) and adherence to recommendations, the procedure is perceived as a pleasant rhythmic massage. Most people feel only mild warmth, tingling, or sweating under the cuffs during the session — these sensations disappear immediately after completion.

The method is widely used at home and in clinical practice with good tolerance. However, as with any physiotherapeutic procedure, there are situations in which pressotherapy application requires prior consultation with a specialist. These include:

• suspicion of acute deep or superficial vein thrombosis (sudden severe pain, asymmetric edema, redness, local heat);
• active inflammatory processes or infections in the treatment area;
• severe arterial insufficiency of the lower extremities;
• unhealed wounds, purulent or inflammatory skin changes in the cuff area;
• decompensated heart diseases (especially in systemic edemas).

In the absence of the listed conditions and with comfortable sensations during the session, the method is usually well tolerated and yields positive results.

Conclusion

Apparative pressotherapy is a convenient, pleasant, and scientifically grounded method for the rapid reduction of edemas of venous, lymphatic, and lymphovenous origin. It helps break the vicious cycle “edema → drainage impairment → progression of tissue changes,” restores lightness to the limbs, reduces volume, and improves quality of life.

The effect is felt already after the first sessions (legs/arms become slimmer and lighter), and with regular use (courses or maintenance) lasting edema control and complication prevention are achieved.

Sources

• ESVS 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease
• Intermittent pneumatic compression for prolonged standing workers with leg edema and pain (PMC8284752)
• The Effectiveness of Intermittent Pneumatic Compression in Long-Term Therapy of Lymphedema of Lower Limbs (PMC4062105)
• An Advanced Pneumatic Compression Therapy System Improves Leg Volume… in Lipedema (MDPI 2025)
• Comparison of efficacy of the intermittent pneumatic compression with a high- and low-pressure application… (PMC4603726)
• NICE and Cochrane reviews on IPC in lymphedema and venous edemas
• Additional studies 2024–2025 on the efficacy of APCD and IPC in lymphedema and edemas (ScienceDirect, PMC, MDPI)