BCHC staff treating an adult patient

Services

Lymphoedema Service

Lymphoedema

Lymphoedema is a chronic swelling that can occur anywhere in the body and is due to the failure of lymph drainage.

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 is 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 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/ 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 / intermittent dull ache / 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 over weight 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 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 below 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.

Skin care

Maintaining skin integrity with a thorough daily regime is crucial for effective management of the skin and reducing the potential for infections and other complications.

  • Wash legs daily using a soap substitute or a non-soap-based cleanser. Many moisturisers can also be used as soap substitutes (always read instructions).
  • Apply moisturiser after removing any compression garments at the end of the day.
  • There are numerous moisturisers available to buy however the products that should be used are dependent on an individuals skin type and clinical presentation.
  • Moisturisers should be PH neutral with no added perfume, preservatives, or parabens, allergens. For clarity seek help from your pharmacist, GP or Lymphoedema nurse.
  • It is recommended that a small patch test on the skin should be undertaken when using any new products.
PocketMedic

Resources

 

Infection and cellulitis management

  • Cellulitis is a bacterial infection of the skin.
  • Patients with Lymphoedema are at higher risk of developing cellulitis.
  • Cellulitis most commonly occurs in one limb.
  • Symptoms include:
    • Redness,
    • Pain,
    • Heat
    • Increased swelling.
    • In severe cases blistering may develop and possibly flu like symptoms.
  • Medical attention should be sort for treatment with antibiotics.
  • Once treatment has commenced, compression garments should be reapplied as soon as they can be tolerated, usually within 24 to 48 hours.
  • The British Lymphology society guidelines recommend a two-week course of antibiotics.
  • Continue to follow your Lymphoedema management plan 
The Lymphoedema Support Network
PocketMedic

Resources

 

Cellulitis can lead to sepsis if not treated.

Compression garments

  • Compression garments are easier to put on when you first get out of bed, before swelling occurs (particularly for legs).
  • Ideally compression should be worn all day (applied in the morning when getting up and removed before bed).
  • For advice on application and care of garments please refer to the advice booklet.
  • Wearing compression is usually a lifelong commitment as part of your lymphoedema management plan. 
PocketMedic

Resources

 

Hosiery application

Hosiery applicators can assist with donning and doffing of compression hosiery and reduce the strain to other parts of the body. Some applicators can be prescribed but  many others are available to buy privately. 
The following is not an exhaustive list and is without endorsement.

Magnide

Easy Slide

Arm Butler

 
Melany

Resources

 

Footwear and clothing

Footwear

Footwear can be challenging to find when dorsal/foot swelling is present. Good fitting footwear ensures management of swelling and stability when mobilising.


Many mobility shops often sell a range of wider fitting shoes. There are numerous companies who sell extra wide footwear, and the list highlights some of those suppliers. This is not an exhaustive list is and is without endorsement. 

 

Bras

Breast swelling relies on a good fitting bra to manage the condition. There are numerous retailers that offer bra fitting and measurement services. They also sell a wide range of post-surgical bras.

Holiday information

There are certain issues that people with lymphoedema should consider when going on holiday especially overseas.

PocketMedic

Resources

 

Healthy eating and weight management

Healthy eating

Healthy eating can help to control body weight and improve general health. Guidance and support can be offered from GP, dietician and local support groups/ weight management services.

 

Weight management

  • Obesity is often a contributing factor in the development of lymphoedema, especially in the lower limbs. Some patients may require referrals to weight management for support and guidance.
  • A healthy BMI for an adult is between 18-25.
NHS
Resources

 

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