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What is Lymphoedema?

Lymphoedema is diagnosed where there is tissue swelling caused by an accumulation of lymph fluid over time, usually a period of three months or longer.

Lymphatic fluid, or lymph, is much like blood plasma and tends to be watery and transparent with a slight yellow tinge. It is made up of lymphocytes, bacteria, cellular debris (dead tissue cells), plasma proteins, and other cells. The lymphatic system is part of your Immune System.

Blood vessels 'leak' fluid (lymph) through its walls into the interstitial tissue carrying nutrients and proteins and is then usually collected and drained out through the body's lymphatic system, carrying with it dead cells, bacteria and any excess fluid. This 'waste' is then returned to the blood stream for disposal through the body's own waste disposal unit - the liver and kidneys as urine and stool. If the lymphatic system is not 'emptying or draining' the lymph fluid as it should, swelling occurs. It most commonly affects legs, but can also affect the arms, chest wall, abdomen, neck and genitals.

Symptoms of Lymphoedema

Lymphoedema can present with the following symptoms:

Swelling of part or all of the arm or leg, including fingers or toes

Heavy, achy limbs with tightness or a feeling of being 'stretched' in the skin

Restricted mobility, or limb movement

Recurring skin infections (cellulitis)

Hardened or thickened skin with a 'waxy' feel

Thickened folds or creases developing in the skin

Wart-like growths on the skin

Fluid leaking through the skin, or 'wet legs' (lymphorrhoea)

If you are unsure if this treatment is for you, please get in touch and I would be more than happy to answer any questions you may have. Contact Me

Types of Lymphoedema

Primary lymphoedema occurs when there is a gene mutation in the development of the lymphatic system as a foetus. This can sometimes be congenital – but can also sometimes be hereditary. The lymphoedema may not develop for some time and can be triggered by trauma near the area of mutation (infection or injury). In some cases, the lymphoedema is present at birth.

Secondary lymphoedema develops from a normal and fully functional lymphatic system that has been damaged through causes such as:

Surgery: Any major surgery can affect the lymphatic system, but it is most commonly found with any cancer related surgery, particularly when lymph nodes are removed.

Radiotherapy: This involves high but controlled doses of radiation to destroy cancerous tissue – this also damages healthy tissue, including the lymphatic vessels and nodes. There is always a risk that the damage can be permanent.

Cellulitis is more common amongst the elderly or less active, mobility impaired people. This infection is usually found on the lower legs and is often referred to as a ‘skin infection’ and if severe or severely recurrent, can cause scarring in the tissue around the lymphatic vessels, leading to lymphoedema.

Lymphatic filariasis (also known as elephantitis) is a parasitic disease which causes blockage in the lymphatic system, not usually found in the United Kingdom. (i.e.mosquito bites common in tropical or sub-tropical countries)

Inflammation caused by conditions like psoriasis or eczema can cause permanent damage to the lymphatic system

Venous disorders can lead to an overflow of fluid from the blood vessels into the tissue, causing the lymphatic system to be overwhelmed and unable to cope with the drainage of excess fluid. (compression garments are sometimes contraindicated for venous disorders)

Obesity can cause the development of lymphoedema in some people. If severe enough, the excess adipose tissue (fat) can have an impact on the lymphatic system, causing blockages and restriction in the natural flow of the lymphatic veins, vessels or capillaries. The lymphatic system does not have a pump (such as the heart which pumps blood around the circulatory system) and so if a person does not move - the lymphatic system will not function effectively.

The lymphatic system requires body movement as the muscles contracting and expanding help to 'pump' lymphatic fluid therefore if a person is not physically active - their lymphatic system will also remain inactive, potentially causing a build up of lymphatic fluid and swelling, particularly in the feet and lower legs (gravitation).

Exercise or reasonable regular physical activity plays a vital role in prevention, or worsening, of lymphoedema.

Trauma / Injury can sometimes cause damage to the lymphatic system, leading to lymphoedema

Treatment and management

There is no cure for lymphoedema, unfortunately. This condition requires teamwork between the patient and their trained Lymphoedema Therapist or Specialist Lymphoedema Nurse in reducing the swelling as much as possible for a ‘normal’ size and shape, with regular maintenance to manage the condition. There is a large element of self-responsibility needed by the patient to secure their best possible outcome, which includes for many a change in their lifestyle habits.

  • Healthy lifestyle, including regular adequate exercise and a healthy diet
  • Good skincare routine (prevent skin infections and maintain skin suppleness)
  • Specialised Manual/Medical Lymphatic Drainage (reduces swelling/moves the lymph fluid)
  • Multi-component bandaging applied in graduated compression (if necessary)
  • Compression garments (usually - to be worn daily)
  • Simple Lymphatic Drainage techniques taught to you to enable you do to this yourself daily at home (SLD)
  • Regular maintenance sessions would be required until you reach a standard of self-care and maintenance that allows you to manage on your own, returning for a checkup and remeasurement when necessary (usually every six months).

Compression garments

Compression garments will need to become a part of your daily life if you have lymphoedema – you will need to start wearing compression garments every day to help control the swelling and prevent tissue/skin deterioration. I can help you with measurements (either bespoke made to measure or sized/off the shelf) and can order these garments in for you via NHS on prescription (you will still be liable for a prescription charge unless exempt) or if you wish to buy them yourself the compression company will take payment from you directly once I send them your measurements and contact details.

A phase of Decongestive Lymphatic Therapy (DLT) would be intensive to quickly reduce swelling and/or to return a more normal shape to a limb before moving into (or returning to) resized compression garments. This treatment is also beneficial in stopping lymphorrhoea, a condition whereby lymph fluid ‘leaks’ out onto the skin, and also helps reduce and promote the healing of leg ulcers. This involves a period of daily visits to my clinic for at least 5 days clinic for rebandaging. This treatment needs pre-planning, as my clinic is non-NHS and I would need to liaise with your GP Surgery for the supply of necessary bandages, or I could advise what is needed and you may purchase these supplies yourself.

Surgery is an option in a small number of lymphoedema cases, where:
(a) liposuction is used to remove some adipose tissue (fat) on an affected limb or body part. This will help reduce the size, but compression garments will still need to be worn daily, for the rest of your life.
(b) lymphaticovenular anastomosis to help restore the normal flow of lymphatic fluid in an affected area. This option again helps to reduce the size.

These surgical options would require referral to a Lymphatic Specialist and would be considered an option when ongoing conventional management and treatment has been unsuccessful.

Why is MLD recommended? - Dr Dennis Wolf

TIPS to help prevent, or manage Lymphoedema:

  • Skin trauma such as cuts, grazes, scratches or burns can easily become infected and lead to a damaged lymphatic system, potentially triggering lymphoedema.
  • Avoid injections or blood pressure readings in the affected area whenever possible, if you already have lymphoedema.
  • Treat cuts and scratches immediately with an antiseptic cream.
  • Use insect repellents to prevent insect bites (feet/ankles/hands/arms).
  • Regular bathing or showering, keeping your skin clean and dry.
  • Moisturise your skin daily to maintain hydration and good skin viability – a thicker, plain moisturizing cream is best, such as E45, or Aveeno.
  • Avoid very hot baths and showers if you have lymphoedema. The extreme heat can trigger further swelling.
  • Use a high sun protection factor (SPF) sunscreen cream to prevent sunburn.
  • Wear gloves for gardening and household chores to avoid cuts if your upper limbs are affected, and protective boots or shoes if your lower limbs are affected.
  • Use anti-fungal powder to prevent any fungal infections in your skin or feet if your lower limbs are affected.
  • Keep your toenails and fingernails well filed and well maintained, see a chiropodist for foot and nail care if you can’t manage this yourself. If you have lymphoedema, make sure they know this.
  • Wear correct fittingshoes that provide support on the top of your feet and avoid being barefoot if your lower legs and feet are affected.
  • Use an electric razor if you need to shave to reduce the risk of cutting yourself.
  • Don’t wear tight fitting clothes or jewellery over a lymphoedema affected area.
  • Maintain good mouth and dental hygiene if you have lymphoedema in your head and neck.