Q. I have had swollen ankles for several months and would like some information. I've taken blood, kidney and other tests needed to determine what the problem may be. Support stockings have been prescribed, but they are honestly not working for me. I was even given a prescription for water pills and there was no change. I am very bothered by this abnormality. I was told about the blood circulation process from the heart to the feet and was wondering if there's a procedure to drain the excess fluid.

A. It is normal to have a certain amount of fluid in the ankles. What you're experiencing is more than the normal amount. We can think of the ankle as a sink. Too much water in the ankles (or the sink) can be caused by either the production of too much water (the faucet is on too high) or the drain is draining too slow. What your doctor has been doing by checking the blood and kidney tests is trying to determine if there is a problem with the amount of fluid that is being produced or how well the drain is working. Fortunately, no cause has been found. I say 'fortunately' because oftentimes the cause of the swelling is a disease that you would really rather not have.

The fact that your doctor can't find a cause, however, is quite frustrating. Support stockings work for most people, but they are not working for you. The water pills are also not beneficial. The fact that neither of these work is actually a little bit confusing, and means that perhaps a further evaluation is necessary.

First, the most common, especially if you are over 40 and a woman, is that this is simply going to be a fact of life. That is even more frustrating, perhaps, but it is true that we oftentimes see leg swelling in women as they get older (sometimes men) and are never able to find a cause. Usually, however, this swelling responds to support stockings and water pills.

If the swelling goes away in the morning, this is a good sign. However, if the swelling is not substantially reduced in the morning, I think your doctor has to consider additional tests, such as those that would check the 'tubes' draining the sink (in this case, the tubes would most likely be within the abdomen). Basically, this would be an evaluation of the lymph nodes within the abdominal cavity.

Another possibility is that you have a problem with the veins in your legs, and there are tests that can be done to check these, too.

You can learn more about swollen ankles at: http://www.tcvsg.com/html/leg_swelling.html.

Please note that this Web site was created by some cardiovascular surgeons. Much of what they discuss will not be directly relevant to your case. However, they do provide a good description of leg swelling.

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