Lymphoedema is a swelling which is the result of a damaged or weakened lymphatic system. This may be due to the lymphatic system not developing properly or from injury or damage following trauma or surgery (where the lymphatic system has been affected).
Lymphoedema most commonly affects the arms and legs but it can affect other parts of the body.
Recent research estimates that approximately 100,000 people in the UK may be suffering from this condition.
What is the lymphatic system and what does it do?
Blood flows through the body to nourish the tissues and any excess fluid is removed by the lymphatic system to be returned to the blood circulation.
There are many lymphatic channels and some, especially near the skin, are very small and delicate. As the channels go deeper into the body, the lymphatics become larger and drain through groups of lymph nodes (sometimes called glands).
The lymphatic system has an important role in fighting infection.
Lymphoedema develops for many reasons, some of which are as yet not fully understood.
Primary lymphoedema can develop at any age and is due to an 'inbuilt' problem with the lymphatic system, that may occur at birth or develop later in life. The most common problems are absent or obstructed lymphatics or scarring of the lymph nodes.
Secondary lymphoedema can occur when part of the lymphatic system gets damaged and may result from cancer treatment, injury or infection. Sometimes people with vein problems and ulcers get lymphoedema. Other conditions such as heart and kidney problems or limb paralysis can also lead to swelling.
These are some possible signs of lymphoedema but they can be due to other conditions so you need to get advice from an appropriately trained practitioner if you think you may have lymphoedema.
Your lymphoedema practitioner, nurse or physiotherapist will talk to you individually about what treatments are suitable for you but these are usually based on four main areas:
In the long term you will need to decide how you can adapt your lifestyle and get into a routine with doing the various self-treatments including daily skin care, wearing of lymphoedema garments, regular exercising and use of self-massage where necessary. It will be important to try to keep your body weight within normal limits. Making these self-treatments a natural part of your daily life is the key to successful control of your lymphoedema.
Some people require an Intensive Treatment programme combining bandaging and manual lymphatic drainage massage to reduce the swelling. This Intensive Treatment course is usually given over 2 or more weeks.
What can I do to help prevent problems?
What is cellulitis and how can I prevent it?
Some people with lymphoedema get an infection called cellulitis. This can reoccur in some people making the lymphoedema worse. It is vital that cellulitis is properly treated and you should see your doctors immediately if you get any of these signs of infection:
If you get cellulitis you should:
Once the early symptoms are controlled, it may be possible to recommence lymphoedema treatment. Limb swelling will probably have increased due to the infection and compression therapy will be important in managing any changes.
Lymphoedema develops for many reasons, some of which are as yet not fully understood. By definition, 'lymphoedema' is due to insufficiency in the lymphatic system. However, several factors can contribute to swelling in an individual and therefore the term 'chronic oedema' reflects the broader aetiology of this condition.
Primary lymphoedema is due to an intrinsic abnormality in the lymphatic system including an absence of lymphatics (aplasia), obliteration of lymphatics or lymph node fibrosis. It can develop at any age and genetic studies have shown that it may be congenital and inherited (Milroy's disease). Meige's disease is used to describe inherited lymphoedema that develops between the ages of 2-35.
Secondary lymphoedema may occur following surgery, radiotherapy, injury or infection that damages or obstructs lymph drainage. Lymphoedema of the arm develops in 1 of 4 women following breast cancer treatment and can be a particular problem in recurrent and advanced cancer. Filarial infection is the most common lymphoedema worldwide but is predominately seen in underdeveloped countries. However, cellulitis or lymphangitis, particularly if they are recurrent, will damage lymphatics and can predispose to lymphoedema.
In some individuals, the amount of fluid accumulating in the tissue is increased due to alterations in capillary filtration. This can be due to venous hypertension, cardiac failure, chronic ulceration and infection, reduced mobility and limb dependency. Hypoproteinaemia, often associated with liver problems, raises the net capillary filtration rate, producing a generalised oedema. In all these situations, if the lymphatic system is unable to compensate for the excess fluid, swelling will ensue.
If someone has swelling of > 3 months duration that does not significantly reduce on elevation, several others signs may be present to indicate that this is lymphoedema. Some examples of there are:
In the early stages of lymphoedema, the swelling may be mild and can reduce overnight when in bed. This 'pitting' oedema is indented by finger pressure but the chronic accumulation of fluid, proteins, fats and various waste products can eventually result in fibrotic, 'non-pitting' tissues.
Other skin and tissue problems in lymphoedema include hyperkeratosis (thickened scaly areas), dermatitis, folliculitis and fungal infections, particularly in skin folds and between fingers and toes.
Lymphoscintigraphy, the injection of a radio-labelled protein into the interstitial tissues, provides images of lymphatics and lymph nodes and quantifies lymph flow. It is mainly used in primary lymphoedema or in children but may not provide any additional information to change the treatment plan. Investigations such as CAT scans, ultrasound and Magnetic Resonance Imaging may help to distinguish lymphoedema from other causes of swelling such as lipoedema and may be useful in patients with cancer. None of these investigations are routinely used although a full blood count, urea and electrolytes and ECG may be indicated in patients with a non-specific limb swelling of unknown origin.
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This information is not intended as a substitute for the advice of a health care professional. Consumers should rely on the judgement of a health care professional for specific conditions.
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