Lymphoedema

What is Lymphoedema?

Lymphoedema is a chronic swelling that can occur anywhere in the body and is due to the failure of lymph drainage. It is essentially an accumulation of lymph (fluid) in the tissue spaces arising from a congenitally determined abnormality or from damage to the lymphatic structures. Lymphoedema is currently incurable but the main 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 with an insufficient lymphatic system.
• 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 or 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 later in life (Tarda).  Lymphoedema can occur in any part of the body depending on where the affected lymph structures 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 or 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.
• Skin infections.
• Constant or intermittent dull ache or pain.
• Fungal infections.
• Skin becomes very dry.
• Reduced movements of the joints.
• Experiencing fatigue.

 Lymphoedema is not a widely recognised condition. 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:

• Skin care: 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.
  • Exercise: 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 overweight can make Lymphoedema worse.
  • Compression is a fundamental component of Lymphoedema management. Compression bandages or sleeves / stockings may be prescribed for affected areas. Compression works by applying pressure to the skin and tissue, encouraging the movement of lymphatic fluid away from the affected area and preventing further build up.  Compression garments combined with exercising can enhance lymphatic drainage.
  • Massage: 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 always 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.

 

There is also a simplified form of MLD called simple lymphatic drainage ( SLD) which can be performed by the individual with guidance from your lymphatic specialist nurse. Refer to the links for more guidance.

 

 

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 throughout the West Midlands and referral can be made via your GP.