Check Out That Butt

Paul D. Thompson, MD
2 min readDec 5, 2023

If There’s Fluid in the Butt, There’s Fluid in the Gut

Isaac Newton is credited with the discovery of gravity; I’m convinced that Isaac was onto something, and most people agree. Gravity exists. So why do nurses, medical students, residents, fellows and some experienced clinicians only report that a hospitalized patient has “no peripheral edema”. Many hospitalized patients do not have peripheral edema because bed rest and gravity have redistributed the fluid to their sacral areas. So, in hospitalized patients check for peripheral edema, but more importantly, check for sacral edema. That helps you know they may need more diuresis. But that’s not the only issue.

Sacral edema also suggests that there is bowel edema. Bowel edema interferes with drug absorption, and if the patient cannot absorb their oral diuretics and are discharged, “they’ll be back”, to paraphrase Arnold Schwarzenegger as The Terminator. So avoid discharging patients to an oral diuretic regimen until all their sacral edema is gone.

So, here are three rules:

· #1- Always examine for sacral edema in hospitalized patients, before deciding they have no “peripheral edema”:

· #2- If there’s fluid in the butt, there’s fluid in the gut:

· #3- Sir Isaac was probably onto something.

Paul D. Thompson, MD

Chief of Cardiology, Emeritus, Hartford Hospital

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This piece is from my “500 Rules of Cardiology”, not really rules, not really 500, and quite presumptuous on my part, but they are simple sayings and principles I have used clinically and in teaching. Please share them with trainees and colleagues. I send them out to an email list so if you send me your friends’ email, I will add them to the list. I also publish them on my blogs on Medium and on Substack. Both are free. I am shifting over to Substack so use that one if possible. Medium has the longer list of prior emails.



Paul D. Thompson, MD

Chief of Cardiology — Emeritus & Director of Sports Cardiology, Hartford Hospital