When to be alarmed about swollen hands: As the King’s puffy digits spark concern in the Caribbean, GP reveals the causes – and signs you should seek help for ‘sausage fingers’

The internet is awash with images of King Charles and Queen Camilla greeting various diplomatic figures on their nine-day tour of the Caribbean.

But there’s one particular detail that commentators appear fixated on – the monarch’s swollen-looking fingers. 

The King’s so-called ‘sausage fingers’ have been a popular topic of conversation online since the 2023 Coronation, with viral photographs appearing to show particularly puffy digits. 

Then, a documentary broadcast in December 2023 saw the King declare his own hands as sausage-like. 

Now, concerns about what this means for Charles’s health have been reignited, with Twitter sleuths drawing attention to images of the King’s hands taken over the past week.

Dr Stephanie de Giorgio, a GP based in Kent, says worries about swollen hands and feet are familiar – and something she sees often in her clinic, particularly in times of extreme heat or cold.

‘Patients come in puzzled, a little alarmed, describing puffy ankles, rings that won’t come off their fingers, or feet that seem to have expanded by the end of the day,’ she says. ‘Often they’re convinced something is seriously wrong. Most of the time, thankfully, it isn’t.

‘But knowing the difference – and knowing when to seek help – really matters.’

When the temperature cools, the body has a clever way of trying to keep your vital organs warm. The blood vessels in fingers, toes, hands and feet narrow to reduce heat loss.

But as you go back inside and warm up, the vessels rapidly widen again, leading to a rush of blood flow to the extremities that can make the hands and feet appear swollen. 

This blood rush is most prominent in those with Raynaud’s, who see exaggerated narrowing of the vessels in response to the cold, which can result in extreme swelling when blood flow returns.

Cold temperatures also alter how fluid moves between blood vessels and tissues, especially in older people – meaning you could get a build-up in the fingers and toes. 

And then there’s chilblains – which affect around one in ten Britons during the colder months. 

Sufferers find that the tips of their fingers and toes become swollen and tender, turn red or purple, and can feel like they’re burning. The unpleasant sensation can continue for days or weeks after exposure to the cold. 

It happens when the blood vessels become abnormally restricted in response to cold weather, and is most likely to happen during freezing conditions.     

Dr de Giorgio points out that women are more prone to fluid retention than men. 

‘The hormone progesterone promotes water retention, which is why many women notice swollen ankles in the two weeks before their period. Menopausal women can also be more vulnerable, as falling oestrogen levels disrupt the body’s fluid regulation.’

And being less mobile puts you at risk. Movement is actually one of the key ways your body pumps blood back from the lower limbs, so if you’re sitting for long periods, on a plane, at a desk, in a wheelchair, without moving – swelling is more likely.

Carrying excess weight is also a risk factor, as the extra tissue places more pressure on the vessels, requiring the veins in the legs to work harder to return blood to the heart.

But there’s reassuring news – for the vast majority of people, cold-related swelling is harmless. 

‘If the swelling goes down overnight or when you lie flat that is a reassuring sign,’ says Dr de Giorgio.

‘However, swelling in the legs and feet can sometimes be the body’s way of signalling something more serious. Heart failure is one of the conditions I’d want to rule out, because when the heart isn’t pumping efficiently, fluid can back up and accumulate in the hands and legs.

‘Kidney problems can cause the body to retain excess fluid too – as they can no longer filter excess sodium and water out of the blood effectively so fluid builds up and leaks into surrounding tissues.’

She adds that, in this case, swelling tends to appear in the legs, ankles and feet (due to gravity) and also around the eyes. Kidney-related swelling doesn’t resolve overnight and tends to be persistent.

‘Seek medical attention if the swelling doesn’t resolve or keeps worsening,’ warns Dr de Giorgio. 

‘If you feel short of breath, particularly on exertion or when lying flat; if you notice you are producing much less urine than usual; or if the swelling is in only one leg rather than both.

‘One-sided leg swelling – particularly if it’s red, warm to the touch or painful – could indicate a deep vein thrombosis or blood clot, and needs to be assessed urgently.’

When temperature-related swelling affects the legs, an effective immediate remedy is to elevate your feet, she adds. 

‘Lie down and prop your legs up above the level of your heart and let gravity work in reverse.

‘Staying well hydrated matters too – it sounds counterintuitive when you’re already feeling puffy, but dehydration actually causes the body to retain more fluid as a protective response (releasing a hormone called vasopressin – also known as antidiuretic hormone – which instructs the kidneys to stop excreting water and reabsorb it instead). The body essentially goes into survival mode, hoarding whatever fluid it has.’