About our service
The lymphoedema service consists of a team of clinical Nurse Specialists experienced in the prevention, treatment and management of lymphoedema. The service, which covers all of Birmingham, Solihull and Sandwell, provides care for patients in a clinic environment, domiciliary visit or community hospital environment as deemed necessary.
The lymphoedema service aims to ensure that every person at risk of or with lymphoedema receives an accurate diagnosis, the correct advice, and optimum level of care.
What do we do?
- Identify people at risk of or with lymphoedema to ensure that patients receive high quality education and life long care.
- Empower people at risk of or with lymphoedema to take control of their condition.
- Work to agreed standards for comprehensive ongoing assessment, planning, education, advice, treatment and monitoring.
- Provide high quality clinical care for people with cellulitis.
- Provide compression garments for people with and where warranted at risk of lymphoedema.
- Refer any people at risk of or with lymphoedema for multi-agency support from health and social services when required.
- Work in partnership with other health care providers to ensure that all patients’ needs are met.
What is Lymphoedema?
Lymphoedema is a chronic swelling that can affect anywhere in the body and is due to the failure of lymph drainage. It is essentially an accumulation of lymph in the tissue spaces arising from a congenitally determined abnormality or from damage to the lymphatic structures. It is essentially incurable but major symptoms, namely swelling and cellulitis can be improved and controlled.
How does lymphoedema occur?
Lymphoedema can occur for various reasons and can develop at any age. There are two types of lymphoedema:
- Primary lymphoedema when the person is born without sufficient lymph nodes
- Secondary lymphoedema when the lymphatic system becomes impaired during life. This maybe due to surgery for cancer treatment, radiotherapy, infection, damage to the veins in the leg (venous disease), reduced mobility, injury / trauma or being overweight.
Primary lymphoedema is often more common in women. It may be present at birth (Milroy’s), develop during puberty (Praecox) or develop later in life (Tarda). Lymphoedema can occur in any part of the body depending on where the affected lymph nodes lie.
What are the signs and symptoms of lymphoedema?
Signs and symptoms vary from person to person and develop at different rates. People with lymphoedema may describe any of the following:
Shoes / clothes/ jewellery becoming tight
Feeling of tightness, skin stretching and heaviness in the affected area
Swelling that does not go away after sleeping in bed overnight
Spontaneous skin blisters leaking clear fluid
Constant / intermittent dull ache / pain
Skin becomes very dry
Reduced movements of the joints
Fatigue often sets in
Lymphoedema is not a widely recognised condition and can be difficult to diagnose if it’s not particularly related to cancer treatment. The assessing practitioner should take a detailed medical history, noting the symptoms the person reports and take note of the physical signs present.
All people suffering with lymphoedema should have access to a lymphoedema specialist for management of their condition.
How is lymphoedema treated?
At present there is no cure for lymphoedema and it requires an ongoing commitment to treatment, but in partnership between the practitioner and person the condition can be managed well. The key to a successful outcome is early diagnosis and prompt treatment.
Treatment may consist of a combination of the following:
As the lymphatic system is not working properly waste products are not being removed efficiently and proteins build up in the tissues. This causes the skin to become dry and can lead to infection which makes the swelling worse. Good hygiene and application of a moisturiser is needed to keep the skin in good condition.
Regular, gentle exercise is important to help move the fluid away to another unaffected part of the body. Keeping a normal body weight is also important as being over weight can make lymphoedema worse.
Special support bandages or sleeves / stockings may be prescribed for affected areas and need to be worn every day and removed at night.
A special form of massage called manual lymphatic drainage (MLD) maybe used to move fluid from a congested area to an area that can drain more freely. This massage is only suitable in certain circumstances and should only be carried out by a suitably trained therapist. The trained therapist can also teach the person with lymphoedema a simplified version of MLD to help manage their condition themselves.
The role of the lymphoedema specialist
The lymphoedema specialist will help you to understand the cause of your swelling and devise a treatment programme which might include:
How to care for your skin.
How to do gentle exercises.
A specific lymphatic massage (Lymphatic drainage through massage).
Deciding what compression treatment is most appropriate for you.
The most appropriate ongoing care for your condition.
Referring you on to other professionals when needed.
There is a network of lymphoedema services through the West Midlands and referral can be made via your GP.
How to refer
Referral to the service should be made by a health professional and uses an agreed standard for triaging referrals and allocating appointments.