What is Lymphoedema
Lymphoedema is a long-term (chronic) condition that causes swelling in the body's tissues. It can affect any part of the body, but usually develops in the arms or legs.
It develops when the lymphatic system does not work properly. The lymphatic system is a network of channels and glands throughout the body that helps fight infection and remove excess fluid.
It's important that lymphoedema is identified and treated as soon as possible. If it is not treated, it can get worse.
Symptoms of lymphoedema
The main symptom of lymphoedema is swelling in all or part of a limb or another part of the body. It can be difficult to fit into clothes, and jewellery and watches can feel tight.
At first, the swelling may come and go. It may get worse during the day and go down overnight. Without treatment, it will usually become more severe and persistent.
Other symptoms in an affected body part can include:
- an aching, heavy feeling
- difficulty with movement
- repeated skin infections
- hard, tight skin
- folds developing in the skin
- wart-like growths developing on the skin
- fluid leaking through the skin
Types of Lymphoedema
There are 2 types of lymphoedema – primary and secondary lymphoedema – which have different causes.
Primary lymphoedema
Primary lymphoedema is caused by alterations (mutations) in genes responsible for the development of the lymphatic system.
The faulty genes cause the parts of the lymphatic system responsible for draining fluid to not develop properly or not work as they should.
Primary lymphoedema often runs in families, although not every child born to someone with the condition will develop it themselves.
Secondary lymphoedema
Secondary lymphoedema develops in people who previously had a normal lymphatic system that then becomes damaged.
Causes of Lymphoedema
Surgery for cancer
- breast cancer
- skin cancer (melanoma)
- gynaecological cancers – such as cervical cancer and vulval cancer
- genitourinary cancers – such as prostate cancer or penile cancer
Radiotherapy
Radiotherapy uses controlled doses of high energy (radiation) to destroy cancerous tissue, but it can also damage healthy tissue.
Infections
An infection, such as cellulitis, can sometimes cause lymphoedema. Severe cellulitis can damage the tissue around the lymphatic system, causing it to become scarred.
Inflammation
Medical conditions that cause tissue to become red and swollen can also permanently damage the lymphatic system.
Venous diseases
Diseases that affect the flow of blood through the veins can cause lymphoedema in some people.
The abnormal or damaged veins can cause fluid to overflow from the veins into the tissue spaces.
This overwhelms and eventually exhausts the parts of the lymphatic system responsible for draining this fluid.
Obesity
Obesity is another possible cause of secondary lymphoedema.
People who are obese, particularly those who are severely obese, have an increased risk of developing swollen body parts.
It's not clear exactly why this is, but it's been suggested that the extra fatty tissue affects the lymphatic channels in some way, reducing the flow of fluid through them.
Trauma and injury
In a small number of cases, lymphoedema can be caused by an accidental injury to the lymphatic system.
For example, it can sometimes occur after a road traffic accident where there's extensive bruising or soft tissue loss.
Immobility
Movement and exercise help lymph drainage because muscle activity surrounding the lymphatic vessels massages fluid into and along them.
Reduced movement can therefore lead to lymphoedema because the fluid in the lymphatic system does not get moved along.
For example, people who have limited mobility for a long period of time as a result of an illness, nerve damage or arthritis may be at risk of lymphoedema.
Treatment of Lymphoedema
Decongestive lymphatic therapy (DLT)
There are 4 components to DLT:
- compression bandages – to complement exercise by moving fluid out of the affected limb and minimise further build-up
- skin care – to keep the skin in good condition and reduce the chances of infection
- exercises – to use muscles in the affected limb to improve lymph drainage
- specialised massage techniques – known as manual lymphatic drainage (MLD); this stimulates the flow of fluid in the lymphatic system and reduces swelling
DLT is an intensive phase of therapy, during which you may receive daily treatment for several weeks to help reduce the volume of the affected body part.
This is followed by a second phase called the maintenance phase. You'll be encouraged to take over your care using simple self massage techniques, wearing compression garments, and continuing to exercise.
This treatment phase aims to maintain the reduced size of the affected body part.
You'll have reviews every few months to check how your treatment is progressing.
Compression bandages and garments
Unlike blood circulation, the lymphatic system has no central pump, such as the heart, to move fluid to the lymph glands.
Instead, it uses the massaging effect of surrounding muscles to move the fluid. This is why exercise is important.
Compression bandages or garments, such as sleeves, gloves, stockings or tights, fitted over affected limbs act as a counter-force to muscles.
This stimulates more effective lymph drainage. The combination of exercise and compression encourages the fluid to move out of the affected limb.
Compression garments may also be applied after a massage session to prevent fluid accumulating in the limb again.
Velcro wraps may be used instead of bandages or compression garments. These are easier to apply yourself.
You'll be taught how to correctly apply compression garments or Velcro wraps so you can continue using them during the maintenance period.
Skin care
It's important to take good care of your skin to reduce your risk of developing an infection, such as cellulitis.
See preventing lymphoedema for more skin care advice.
Movement and exercises
Your lymphoedema care team will help devise an exercise and movement plan designed to strengthen and stimulate the muscles involved in lymph drainage.
They'll also help you lose weight if you're overweight. Your exercise plan will be tailored to your requirements and ability.
Your plan may involve specific limb exercises, as well as gentle activities that involve the whole body, such as swimming, cycling and walking.
Massage
To begin with, you may receive specialised massages called manual lymphatic drainage (MLD) – usually carried out by a specialist therapist – to move fluid from the swollen areas into working lymph nodes, where it can be drained.
Your lymphoedema therapist will also teach you a range of simpler massage techniques that you or your carer can use during the maintenance phase of treatment to help keep the swelling down. These self massage techniques are known as simple lymphatic drainage (SLD).
Prevention and Management of Lymphoedema *(drop down)
It's not possible to completely prevent lymphoedema, but the following advice may help reduce your chances of developing it.
If you already have lymphoedema, this advice may stop it getting worse.
Skin care
The part of your body affected by lymphoedema is more vulnerable to infection of the build-up of fluid within the tissues.
Any cuts in your skin can allow bacteria to enter your body and may quickly develop into an infection.
Skin infections can also damage your lymphatic system and cause lymphoedema to develop.
You can reduce your chances of developing skin infections by:
- not having injections or blood pressure readings in the affected area whenever possible
- treating cuts and scratches immediately with an antiseptic cream
- using insect repellents to prevent insect bites
- moisturising the skin daily to keep it supple – a GP can prescribe a suitable cream
- avoiding very hot baths and showers – the heat from saunas, steam rooms and sun beds may increase the swelling
- using sunscreen with a high sun protection factor (SPF) to prevent sunburn
- wearing gloves for gardening and household tasks to avoid cuts if your upper limbs are affected
- using anti-fungal powder to prevent fungal infections in your skin or feet if your lower limbs are affected
- cutting your nails with nail clippers
- seeing a chiropodist for foot and nail care – make sure you tell them you have lymphoedema
- wearing shoes that fit correctly and provide support on the top of your feet if your lower limbs are affected
- using an electric razor if you need to shave to reduce the risk of cutting yourself
- not wearing tight fitting clothes or jewellery
Contact a GP as soon as possible if you develop symptoms of a possible skin infection. These symptoms may include redness or a feeling of heat in the skin.
Healthy lifestyle
Adopting a healthy lifestyle may help reduce your risk of developing lymphoedema, and may also help control the condition if you already have it.
This includes:
- eating a healthy, balanced diet
- maintaining a healthy weight – use the healthy weight calculator to work out whether you're a healthy weight for your height
- exercising regularly
Preventing Infection and Injury
Protecting the arm on the side of the surgery is very important after breast surgery. Poor drainage of the lymphatic system can cause that arm to be more at risk of infection and less sensitive to extreme temperature. Be aware of activities that put too much pressure on the affected arm. To protect your arm from injury and infection, make sure to do the following:
- Ask for injections and blood draws to be done on the unaffected arm.
- Ask for all blood pressure tests to be done on the unaffected arm.
- Don't wear nightgowns or clothing with elastic cuffs or tight bands.
- Carry your handbag or heavy packages with the unaffected arm.
- Be very careful and use a clean razor when shaving underarms.
- Prevent sunburns and other burns to the affected arm.
- Wear gloves when gardening and when using strong household cleaners.
- Clean the skin of the affected arm daily, gently dry well, and apply lotion.
- Do approved exercises regularly to improve drainage.
- Eat a healthy, low-sodium diet.
- Avoid extreme hot or cold temperatures on the affected arm, such as hot tubs, saunas, and heating pads or ice packs.
- Take good care of your fingernails and don’t cut or bite your cuticles.
- Clean all cuts with soap and water, and then apply antibacterial ointment and a sterile dressing.
- Protect your fingers from needle pricks and sharp objects. Use a thimble when sewing.
- Avoid vigorous, repetitive movements against resistance, such as scrubbing, pulling, or pushing with the affected arm.
- Tell your doctor right away if you have any signs of infection, such as redness, pain, heat, increased swelling, or fever.
Further reading and Information
Pocket Medic - Lymphoedema Education
What Is Lymphedema?
Self Lymphatic Massage for the Upper Extremity
