Most of us experience a bit of bloating occasionally, but if your swollen stomach and puffy skin are a constant concern, there are steps you can take to help yourself. Bloating affects millions of women and most of us just put up with it. But it can be a symptom of more serious health problems. If your ankles look fuller than usual, give the flesh a little push with your thumb. If you leave an indent, it's a sure sign you've got fluid retention. The question is why?

Hot weather and inactivity can cause fluid retention no matter how healthy you are, but many women also experience bloating at some point in their menstrual cycle. And, as this affects the breasts and waist more than other parts of the body, it can mean experiencing the frustration of your favourite jeans suddenly not doing up, or your boobs feeling as if they're going to burst. "There are more than 150 symptoms of PMS. They're not caused directly by hormonal changes at this time of the month, but by the way your body reacts to these changes," explains women's health expert Dr Marilyn Glenville (www.marilynglenville.com).

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"One common reaction is a rapid change in blood-sugar levels, and this triggers other symptoms, such as moodiness and headaches, as well as fluid retention. When your blood-sugar level drops, the stress hormone adrenaline is released into the bloodstream to move sugar from your cells into your blood, in an attempt to restore balance. But as the sugar leaves the cells, it's replaced by water, which causes puffiness and bloating. To stop this from happening, eat little and often to keep your blood-sugar levels stable, choosing healthy, low-sugar foods. It's also important to drink lots of water. If you limit it, which some women do, thinking it will prevent fluid retention, it will have the opposite effect causing your body to think it needs to conserve water by hanging onto it."

Find out more about premenstrual bloating from Marilyn's book, Overcoming PMS the Natural Way (Piatkus, £7.99).

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Ready-meals may be the easy option when you're too tired to cook, but always check their salt content. The World Health Organisation recommends a maximum of 6g (1 rounded teaspoon) of salt a day. This supplies us with 2,400mg of sodium, although we need only 500mg of sodium a day to keep us healthy. Sodium is found naturally in all fruits, veg and grains and is already present in most ready prepared foods, including salad dressing, biscuits, bread, sauces and even tinned veg. Most people end up eating about 9g of salt a day and it's easy to consume too much without realising it.

One burger in a bun can contain 6g, two slices of wholemeal bread 1.2g, and a slice of cheese and tomato pizza 5.3g. Two slices of bread contain more salt than a packet of crisps!

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"Too much salt can cause high blood pressure - and reducing the amount we eat by a third could save 34,000 lives a year. But it also causes fluid retention because the body hangs onto fluid in an attempt to dilute the sodium. As salt intake goes up, fluid moves from the blood to the skin, causing puffiness, and because of a salty diet you could be carrying an extra 1.8kg (4lb) in excess weight all due to fluid," says Marilyn. "Cutting back on salt can make a huge difference. Check labels on all processed and canned foods, and be prepared to do some maths to work out how the salt in that product will fit with your daily total."

Here's 15 ways to cut down on salt

Nutritional therapist Fleur Brown (www.fleurbrownnutrition.co.uk) says that seven out of ten of her patients with fluid retention respond to cutting wheat out of their diets. "Most of these people have fluid retention all over their body often in their face and neck, too. But within two weeks of eating no wheat, they notice they can take their rings off more easily and fit back into their jeans. Wheat and other grains, or gluten generally seems to affect the body's sodium potassium pump, the mechanism that regulates fluid retention. Whereas fluids should flow in and out of our cells, the reaction to wheat causes fluid to saturate the cells but not come back out. I start by testing patients with an IgG antibody test, which detects food intolerances. You can buy a similar home test from York Laboratory (www.yorktest.com)."

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Using laxatives to control your weight can actually cause the pounds to pile on with excess fluid, and even using them for constipation can cause fluid retention if you get too carried away. "Laxatives work by loosening the bowels and if you take too many of them, and end up with diarrhoea, you'll lose too much fluid and your body will try to redress the balance by clinging onto any remaining fluid," explains Dr Catti Moss. Using laxatives can also encourage constipation if the bowel becomes dependent on their action, setting up a vicious cycle. Always talk to a pharmacist or GP about which to use and how to use it safely, or, better still, try other methods to deal with constipation such as a high-fibre diet with plenty of water.

The Pill - especially if it's a high-oestrogen one - can cause fluid retention, but studies have found that only a very small number of women will suffer this side effect. If you're one of them, talk to your GP about trying a different Pill, such as Yasmin, which claims not to cause fluid retention. "More likely to give you swollen ankles are calcium channel blockers, prescribed to treat high blood pressure," says Dr Moss. "These relax blood vessels, which can cause fluid retention." Ask your GP about trying a different type of drug such as an Ace Inhibitor or Angiotestin Receptor Blocker (ARB), which control the hormones that affect blood pressure.

We should all get our blood pressure checked regularly (at least annually if you're over 40), as there are rarely any symptoms to tell us it's too high and needs treating. But Dr Moss warns, "Fluid retention can be a sign of high blood pressure that's gone untreated for long enough to cause damage to your heart or kidneys so, if you haven't had yours checked recently, do so."

"Fluid retention with breathlessness is a serious cause for concern. It can be a sign of either anaemia, when your blood's lacking the iron needed to carry oxygen around the body, or heart failure, when the heart's unable to efficiently pump blood around the body," says Dr Moss. "This must be checked by your GP as soon as possible."

Inactivity causes blood to pool in the lowest part of your body. "This will be your bottom if you're stretched out in bed but your ankles if you're sitting or standing," says Dr Moss. Pressure in the blood vessels causes fluid to leak out into the surrounding tissue, and this causes the swelling you see under your skin. Keep active -  especially in summer when hot weather can add to the problem. "Heat causes the blood  vessels to relax and expand and this can also lead fluid to leak out, causing fluid retention."

If you're diabetic you should seek medical advice about fluid retention, which could be a sign of the kidney condition Nephrotic Syndrome (a complication of diabetes). This causes the kidney filter to break down, allowing protein to leak into the urine and fluid to be retained by the body. Untreated, it can cause high blood pressure and cholesterol, and blood clots.

Other kidney problems you may be unaware of can also cause Nephrotic Syndrome, so take any persistent fluid retention seriously. It may be the only symptom. But if you do have other symptoms, such as lack of energy, the combination could be a sign of liver damage, an under-active thyroid, or even cancer so always check it out with your GP.

● Drink plenty of water to stop your body clinging on to fluids.

● Eat plenty of fruit and veg, which contain lots of fluid to counter fluid retention.

● Use only unrefined sea salt in cooking, as it's packed with minerals that help prevent fluid retention and other health problems associated with a salt-rich diet - and avoid processed foods and table salts high in sodium.

● Don't turn  to diuretics. Although they increase the rate at which your body shifts fluid, they'll also flush essential minerals from your body.

● For premenstrual bloating, try the homeopathic remedy Natrum mur, especially if you also feel sad and irritable.

● Add natural unrefined sea salt or the aromatherapy essential oils of fennel or juniper to your bath water to help reduce puffiness.

● Use a loofah to brush your skin and help get fluid moving, or have a lymphatic drainage massage.

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