Lymphedema is a medical condition that occurs when the lymphatic system is impaired or blocked. The National Lymphatic Network describes lymphedema as an accumulation of lymphatic fluid in the interstitial tissues. It is usually characterized by marked swelling of one or more extremities or swelling in other parts of the body such as the trunk. The swelling develops as the affected extremity becomes clogged or congested with an excess of protein-rich lymphatic fluid. Lymphedema can be very painful and even disfiguring, Lymphedema is not the same as edema which occurs from excess tissue fluid.
There are many causes of lymphedema. The patient may have been born with a defective lymphatic system as a result of genetic changes. This is known as primary lymphedema. Other medical diseases and conditions can cause secondary lymphedema, such as surgical removal of the lymph nodes, which occurs at times in persons with cancer. Radiation therapy also can damage lymph nodes or lymph vessels. Infections and inflammation in certain parts of the body can also be responsible for causing a blockage of lymph fluid. Certain diseases that affect the veins can also cause lymphedema, such as deep vein thrombosis or varicose veins. Injuries or accidents such as burns and resultant scar tissue can also lead to lymphedema due to damage of lymph vessels or lymph nodes.
What is the lymphatic system?
To best understand lymphedema it is best to have a basic knowledge of the lymphatic system. Your lymphatic system is a separate circulatory system from that which carries blood. The system itself is made up of lymph fluid, lymph vessels and lymph nodes. The lymphatic system has several functions, the main ones include 1) helping the body maintain fluid balance, 2) filtering waste products from the tissues of the body and 3) producing cells known as lymphocytes which the body uses to fight infection. The lymph vessels form a network throughout the entire body and the lymphatic system drains fluid from the tissues and returns it to the bloodstream.
If you have lymphedema you will probably first notice that one of your arms or legs is swelling out of proportion to the other. You may notice a weight gain from the increased fluid and may feel excessively fatigued. These are perhaps some of the initial symptoms you report to your doctor. As the swelling progresses over time, you may notice that the skin in the affected extremity becomes firm and thick and may look rough like an orange peel. You may also suffer from skin infections when the excessive swelling causes the skin surface to crack.
Treatment of lymphedema
Lymphedema cannot be cured, thus treatment is geared towards comfort. According to the Mayo Clinic, treatments goals are to reduce swelling and minimize pain. Diuretics cannot reduce the swelling caused by lymphedema. Treatment, therefore, has to be achieved through other means. Your physician will choose the best method of treatment for you based on the underlying medical condition which led to your lymphedema. You may also be referred to a Physical Therapist or Occupational Therapist who will help you with your treatment regime. The following are some of the more common treatment methods for lymphedema.
1. Elevation and exercise
The affected limb needs to be kept elevated as much as possible to help promote drainage of the fluid from the swollen tissues. There are certain exercises that can also be done to mobilize the fluid back towards the trunk of the body that your physician or therapist can teach you. You should avoid over-exerting yourself during these exercise periods as it might actually cause the swelling in the limb to increase and may increase pain.
2. Manual lymph drainage
A technique known as manual lymph drainage is a massage technique that is very beneficial for lymphema. Your physician or therapist can teach you how to do this. It is geared towards using your hands to move the fluid so it has a chance to drain. There are some contraindications to this form of treatment, for example, persons with congestive heart failure or skin infections should not do manual lymph drainage.
3. Use of bandages
Wrapping compression bandages around your swollen limbs is another treatment that can be helpful for lymphedema and has been found to be as effective as compression therapy when done correctly. The bandage system consists of multiple layers made of different materials. According to Lymphedema People, the compression occurs from the thickness more so than from the tightness. It does take time to learn to wrap the bandages. Also, care must be taken to assure that they are not applied too tightly.
4. Compression Garments
Elasticized stockings and sleeves and other body garments are used to help reduce lymphedema. The stockings and sleeves are designed to provide gradual compression to the affected limb. These garments do a good job in keeping the swelling under control but the patient needs to assure they are fitting properly. Over time, they may stretch out of shape and may need to be replaced.
5. Compression Devices
Another type of compression that is frequently used is the Pneumatic Compression Device. Using a compression pump is often done after more conservative forms of treatments have been unsuccessful. This device consists of a sleeve or stocking that is connected to an automated pump. The device is designed to express the lymph fluid from the arm or leg back into the lymphatic system. There are a variety of compression pumps and the doctor will prescribe the best type of pump for you.
The machine comes with a disposable sleeve that covers your arm or leg or both arms and legs. The older models of the sleeve may have one single chamber but there are now models which contain multiple chambers which inflate sequentially. These devices are designed to apply air pressure in a sequential manner from your foot and ankle area up towards your heart. Some machines have gradient compression, which means it gives more pressure distally at the foot and hand area (further away from the body) and lesser pressure as it gets closer to the body. The arm or leg is usually elevated during treatment. The frequency of the treatments is prescribed by your doctor.
In closing, lymphedema is a chronic medical condition which effects a patient’s comfort and lifestyle. There is no cure for this condition but several treatment regimes have proven to be effective. It is important for you to adhere closely to the treatment regime to keep the swelling as controlled as possible.
MedicineNet.com: “What is lymphedema?”
Zuther, Joachim. Lymphedema management: the comprehensive guide for practitioners. Thieme Medical Publishers, Inc., 2005.
Lymphedema Today: “Compression therapy”
About Compression Stockings: “Sequential Compression Device: What You Need to Know about Lymphedema Pumps”
Northwest Lymphedema Center Online: “Components of Lymphedema Management”.