Lymphoedema is swelling which results when a lymphatic system is unable to effectively drain fluid from the interstitial tissues. When the lymphatic system has been compromised by malformation, injury, malfunction or surgical interference, its ability to drain a normal load is diminished.
There are several known causes of lymphoedema, although in Western countries it is most commonly seen following surgery and/or radiotherapy for various cancers. Lymphoedema is termed "primary" and "secondary".
Primary Lymphoedema
This is due to genetic or congenital malformation of the lymphatic system. Although present at birth, swelling is usually not noticed until either puberty or mid-to-late thirties.
Secondary Lymphoedema
Secondary lymphoedema occurs following trauma, surgery or other events which affect the anatomy or function of the lymphatic system. Some causes are: cancer treatment (surgery/radiation therapy), vascular insufficiency, trauma, infection, obesity and filariasis. Filaritic lymphoedema is seen in tropical areas and is a result of mosquito bites.
Lymphoedema may only involve one limb or part of a limb if the damage is to the major node groups which drain this area. An example is breast cancer surgery, where nodes from under the arm are removed. Surgical procedures now identify and remove as few nodes as necessary. This minimises the likelihood of lymphoedema but there is no guarantee of prevention. Primary lymphoedema is often more widely spread and can affect head and trunk as well as limbs. A condition known as lipoedema may co-exist with lymphoedema.
Best practice treatment of lymphoedema has several components and is generally known as 'Complex Lymphoedema Therapy' or 'Complex Decongestive Therapy'. Lymphoedema is a chronic condition and will not be cured by treatment. The first, intensive, stage of treatment is to reduce the swelling as far as possible. The second is ongoing but less intensive and aims to maintain swelling at the minimal size obtained during the initial stage.
Treatments central to complex lymphoedema therapy are
- Compression — first by bandaging and then prescription of a compression garment
- Manual Lymphatic drainage
- Skin care — dressing of existing wounds and preventing infection through broken or cracked skin
- Free movement and graduated resisted exercise. Work and/or leisure activities will be taken into account by your therapist when recommending exercises
- Self-management. It would not be practical or affordable to receive daily treatment for the rest of your life. This is why it is important to learn and apply self-management techniques as part of your daily routine
The self-management of lymphoedema involves
- Wearing your bandages/garment every day and night or as prescribed by your therapist. Looking after your garment properly will ensure maximum effectiveness
- Maintaining a supple and intact skin — all wounds or breaks should be covered immediately. Avoid any infection at all costs and treat immediately if it occurs
- Performing regular self-massage and node clearance
- Regular exercise as recommended by your therapist
- Adjustment to the changes to your body and personal acceptance of the need for the time and effort involved in self-management. Get in touch with a Lymphoedema Support Group in your area or another similar source of peer support!
Those people who cope most effectively with lymphoedema are those who have accepted that they have an incurable but manageable chronic condition. In addition they have found a way to incorporate the necessary activities and precautions into their lives as far as possible.