What Is Lymphedema?

Lymphedema, lymphoedema, or lymphatic obstruction is a chronic (long-term) condition in which excess fluid (lymph) collects in tissues causing edema (swelling). Lymphedema can be very debilitating. In short, lymphedema is edema due to lymphatic fluid; a blockage of the lymphatic system. The lymphatic system is an important part of our immune and circulatory systems.

Lymphedema commonly affects one of the arms or legs. In some cases, both arms or both legs may be affected. Some patients may experience swelling in the head, genitals or chest. It is often a consequence of surgically removing the lymph nodes in the armpit (axilla) or groin, or their damage caused by radiotherapy. The normal drainage of lymphatic fluid is faulty. Lymphedema can also be caused by a tumor which presses on lymphatic vessels.

What are the signs and symptoms of lymphedema?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. Lymphedema signs and symptoms include:

Swelling of either part or the whole leg or arm, may include the fingers or toes. Some patients experience just slight changes in limb size, while others have severe swelling. Some people may find it difficult to wear jewelry, watches or fit into clothes or shoes.

Sometimes the head or neck may swell

The arm or leg feels heavy

The arm or leg feels tight

The range of motion of the limb is restricted (affected limb loses some of its mobility)

Discomfort in the affected limb

The affected limb may ache

There may be a tingling sensation in the affected limb, much like pins and needles

Recurring skin infections in the affected limb

The skin may thicken and harden on the affected limb; blisters or wart-like growths may develop on the skin

Severe fatigue

What are the causes of lymphedema?

Causes of primary lymphedema - experts say it is caused by mutations in some of the genes that are involved in the development of the lymphatic system. These faulty genes interfere with the lymphatic system's development, undermining its ability to drain fluid properly.

A significant number of patients with primary lymphedema have a close relative who has/had the same condition. However, this does not necessarily mean that the offspring of somebody with lymphedema will develop the disorder themselves. Primary lymphedema is more common in females than males.

Causes of secondary lymphedema - this type of lymphedema has several possible causes, including:

Cancer surgery - cancer may spread through the body through the lymphatic system. Sometimes surgeons remove lymph nodes to stop the spread. There is a risk the lymphatic system may be affected, leading to lymphedema. Surgery for breast cancer, skin cancer, vulval cancer, cervical cancer, some other female cancers, bladder cancer and penile cancer carry a significant risk of subsequent lymphedema.

Radiation therapy (radiotherapy) - the use of radiation to destroy cancerous tissue can sometimes damage nearby healthy tissue as well. When radiotherapy is used to destroy cancerous cells that are or may be present in the lymph nodes or vessels, there is a risk of node/vessel damage, with subsequent damage to the lymphatic system, resulting in lymphedema.

Infections - severe cellulitis infection, a type of skin infection, may damage tissue around the lymph nodes or vessels. This may lead to scarring, increasing the risk of lymphedema. Some parasite infections which occur in tropical parts of the world can also increase the risk of lymphedema.

Inflammatory conditions - some conditions which cause tissue to swell (become inflamed) may permanently damage the lymphatic system, such as rheumatoid arthritis, dermatitis or eczema.

Cardiovascular diseases - these are diseases that affect blood flow. Some patients with cardiovascular diseases have a higher risk of developing lymphedema, such as those with DVT (deep vein thrombosis), venous leg ulcers and varicose veins (very rare).

Injury and trauma - more rarely, severe skin burns or anything which results in excessive scarring may raise the risk of developing lymphedema.

What are the treatment options for lymphedema?

Lymphedema is incurable. However, there is treatment which can help reduce swelling and pain.

Complex Decongestive Therapy (CDT) - this is known as the recommended treatment for lymphedema and has four components (listed after the end of this paragraph). It starts with an intensive therapy phase, during which the patient receives daily treatment and training which may be six weeks long. This is followed by the maintenance phase, when the patient is encouraged to take over their own care using techniques that have been taught to them. This will be followed by regular six monthly follow-up meetings.

The four CDT components are:

MLD (manual lymphatic drainage) - the lymphedema therapist uses special massage techniques to move fluid into working lymph nodes, where they are drained. It is crucial that this is done by a fully trained lymphedema therapist, and not just a regular masseur. The therapist needs a thorough knowledge of the lymphatic system for this to work.

The lymphedema therapist also teaches several massage techniques that can be used during the maintenance phase.

Patients who have a history of heart disease, deep vein thrombosis or kidney disease may not be suitable for MLD.

MLLB (multilayer lymphedema bandaging) - muscles surrounding lymph vessels and nodes move the fluid through the lymphatic system. Unlike the circulation of blood there is no central pump (heart). The aim here of bandages and compression garments is to support the muscles and encourage them to move fluid out of the affected body part. MMLB is utilized after MLD to stop fluid from building up again in the limbs.

Patients will also be taught how to apply their own bandages and compression garments correctly so that MLLB can continue during the maintenance period.

Compression garments may include long sleeves or stockings which compress to encourage the flow of the lymph fluid out of the affected limb. Even when swelling is reduced, the doctor may recommend that the patient continues wearing them to prevent recurrence of swelling. It is important to get garments that fit properly.

Remedial exercises - these are light exercise aimed at encouraging movement of the lymph fluid out of the limb. The exercises involve moving the affected limb. It is important that the exercise not be strenuous or tiring. They should focus on gentle muscle contractions. Each patient is given his/her own personalized exercise plan. This is done with a fully qualified physical therapist (UK: physiotherapist).

Skin care - good skin care reduces the risks of skin infections, such as cellulitis. Patients are taught how to keep their skin clean, and also how to check for cuts, abrasions and signs of infection.

Surgery - surgery has historically had disappointing results, compared to non-surgical therapies for lymphedema. However, a new surgical technique using liposuction has proved more successful. It removes fat form the affected limb, resulting in less swelling. Patients have to wear a compression garment for at least one year after the procedure is done.










 

Sign And symptom

Bandage

Manual Treatment

Select Language English Russian French German Italian Japanese Korean Portuguese Spanish Greek Dutch Hindi