Fluid Leakage: Causes by Body Area

Fluid leakage by body area

Leaking fluid in pregnancy

It can be hard to tell amniotic fluid from urine or normal pregnancy discharge.

• Amniotic fluid is usually clear or pale straw-colored, has little smell, and keeps leaking, often more when you stand or move. It cannot be stopped by squeezing pelvic floor muscles.
• Urine smells of urine and usually comes with coughing, sneezing or a full bladder.
• Discharge is thicker, white or creamy.

If you think your waters may have broken, call your maternity unit or doctor. Fluid that is green or brown (meconium), bloody or foul-smelling, or leaking before 37 weeks, needs urgent assessment. See premature rupture of membranes.

Urine leakage

Leaking urine is very common, particularly in women after childbirth and around menopause.

• Stress incontinence: leaks with coughing, laughing, sneezing or exercise from a weak pelvic floor.
• Urge incontinence: a sudden, strong urge followed by leakage.
• Overflow: constant dribbling from a bladder that does not empty, more common in men with prostate enlargement.

Pelvic floor exercises help most stress leakage. See urinary incontinence for more.

Nipple discharge

Milky discharge from both breasts outside breastfeeding is usually caused by hormones or medicines and can be checked with a prolactin blood test. Discharge that is bloody, clear and watery, from one duct, or happens without squeezing needs a breast examination and imaging, because it can rarely signal a papilloma or cancer. See nipple discharge.

Clear fluid from the nose or ear

Most clear nasal drips are ordinary rhinitis. A cerebrospinal fluid (CSF) leak is rare but important: a constant, watery, salty drip from one nostril or ear, worse when leaning forward, often after head injury, sinus or skull base surgery, or sometimes without a cause. It may come with a headache that is worse when upright. The risk is meningitis, so it needs urgent assessment. See CSF leak.

Fluid leaking from the skin

• Blisters from friction, burns or sunburn contain clear serous fluid.
• Eczema and contact dermatitis can weep and crust.
• Leg edema: when legs are very swollen from heart failure, vein disease or lymphedema, the stretched skin can leak clear or yellow fluid (lymphorrhea). This needs medical care to reduce swelling and prevent infection.
• Wounds leak clear or pink fluid while healing. Cloudy or smelly fluid suggests infection. See wound discharge.

Joint fluid: the wrist and other joints

Joints are lined with a membrane that makes synovial fluid, a lubricant. After an injury or strain, such as carrying a heavy crate, the joint lining and tendon sheaths can become inflamed and produce extra fluid. This "leaks" into the joint or tissues, causing swelling, not fluid coming out of the skin.

Common causes of fluid-related wrist swelling are:

• Wrist sprain or strain from lifting or a fall
• Tendon sheath inflammation, such as De Quervain's tenosynovitis on the thumb side
• Ganglion cyst: a sac of thick joint fluid that has leaked out through a weak spot in the joint capsule, forming a smooth lump
• Arthritis or gout flares

What helps a swollen wrist after lifting

• Rest from heavy lifting and gripping for 1 to 2 weeks
• Ice wrapped in a cloth for 15 minutes several times a day for the first 48 hours
• A wrist splint or support
• Over-the-counter pain relief, following the label dose
• Gradual return to activity and strengthening once pain settles

See a doctor if the swelling is severe, the wrist looks deformed, you cannot move it, it is hot and red with fever, or it has not improved after 1 to 2 weeks. An X-ray or ultrasound can rule out a fracture and identify fluid collections. Ganglion cysts often go away on their own; they can be drained or removed if painful.

How doctors assess fluid leakage

The doctor will ask where and when the leak started, its color, smell and volume, and about injuries, pregnancy, surgery, medicines and other symptoms. Depending on the site, tests may include a vaginal fluid test (for amniotic fluid), urine tests, a swab, a prolactin level, breast imaging, beta-2 transferrin testing of nasal or ear fluid (to confirm CSF), ultrasound or X-ray.

Frequently asked questions

How can I tell if I am leaking amniotic fluid or urine?

Amniotic fluid is usually clear or pale yellow, has little or a slightly sweet smell, and keeps leaking regardless of what you do. Urine smells like urine and often leaks with coughing or a full bladder. Empty your bladder, wear a pad and lie down for 30 minutes; if fluid keeps pooling, call your maternity unit.

What does clear fluid leaking from the skin mean?

Usually it is serous fluid from a blister, graze, burn or eczema, which is normal. Clear fluid weeping from swollen legs suggests significant edema or lymphedema and needs medical care. Fluid that turns cloudy, thick or smelly, or comes with redness and pain, may be infected.

What causes synovial fluid buildup in the wrist?

Extra synovial fluid builds up when the joint lining or tendon sheaths are irritated by a sprain, overuse such as carrying heavy loads, arthritis or gout. A ganglion cyst forms when joint fluid escapes into a sac. Rest, ice, a splint and pain relief help most cases settle.

Should I worry about clear fluid dripping from my nose?

Usually not. Colds, allergies, cold air and spicy food commonly cause a clear runny nose. Worry if the drip is constant, from one side only, salty, worse when bending forward, or started after a head injury or surgery, because it could be a CSF leak.