Lymphedema

Causes of lymphedema

Anything that blocks the flow of lymph can cause lymphedema. In rare cases, the problem develops because of an inherited condition. But most often, it's the consequence of an injury or a side effect of cancer or cancer treatment.

Types of lymphedema

The two main types of lymphedema are primary and secondary.

• Primary lymphedema. This type is uncommon, caused by a handful of rare inherited conditions in which the lymphatic system doesn't develop properly. The symptoms can be present at birth or develop within the first two years of life, during puberty, during pregnancy or after age 35.
• Secondary lymphedema. The more common type of lymphedema, this may occur if the lymphatic system is damaged by a traumatic injury, surgery or radiation therapy. It most often happens as a result of cancer or cancer treatment, though it may not develop until months or even years after treatment. This type of lymphedema almost never affects children.

Risk factors for lymphedema

Certain factors and underlying conditions may increase someone's risk of developing lymphedema following damage to their lymphatic system. These include:

• Older age
• Excess weight or obesity
• Rheumatoid arthritis or psoriatic arthritis

Other common circumstances or events that can lead to lymphedema are:

• Removal of lymph nodes. This is sometimes done as part of surgery for cancer, especially breast and prostate cancer. The procedure may damage nearby lymph vessels.
• Radiation therapy. This may cause scarring that blocks the flow of lymph.
• Tumors. Tumors can block lymphatic drainage.
• Trauma. A blow or other traumatic injury can damage lymphatic vessels that lie just below the skin.
• Infection. An infection may damage the lymphatic system.
• Lack of activity. Movement and exercise help pump lymph through your system, whereas being sedentary can lead to swelling in your legs.
• Cardiovascular problems. If your heart or blood vessels aren’t working properly, it can affect the drainage of lymphatic fluid.
• Kidney disease. The kidneys remove waste products and extra fluid from your body. When they’re not functioning well, fluids can build up.

Symptoms of lymphedema

The most common symptom of lymphedema is swelling, most often in the arms and legs, but it can also occur in the head, neck, genitals and other body parts. The swelling can develop slowly or come on suddenly. Signs of swelling include:

• The veins or tendons in your hands and feet can't be seen or felt.
• The arms or legs appear to be slightly different sizes.
• Joints feel unusually tight or inflexible.
• The skin is red and puffy or feels tight.
• The affected part of the body feels heavy or full.
• Clothes or jewelry feel tighter.
• Burning or itching in the affected area.
• Numbness or tingling in the affected area.
• Difficulty breathing or swallowing.
• Changes in your voice.

Lymphedema and cellulitis

Skin swollen from lymphedema gets infected easily, and that can lead to cellulitis, a serious skin infection. Signs of cellulitis may include:

• Pain
• Redness
• Swelling
• Warm skin
• Fever
• Chills

If you have these signs, especially if they occur with a fever, call your doctor right away. You'll need antibiotics to treat the infection.

Diagnosis of lymphedema

Because other medical conditions cause swelling, your doctor may perform a variety of tests and procedures to make a diagnosis. These include:

• Volumetrics. These tests measure changes in limb size by comparing swollen and normal limbs.
• Lymphangiogram. This X-ray imaging technique uses an injectable dye to track how your lymphatic system is functioning.
• Lymphoscintigraphy. This imaging test uses a small amount of radioactive glucose (which is harmless) to trace the flow of lymphatic fluid and identify blockages.

Stages of lymphedema

Whether it’s primary or secondary lymphedema, the condition develops the same way, progressing through four stages over time:

• Stage 0. There may not be any symptoms, but the lymphatic fluid isn't flowing as it should.
• Stage 1. The affected area is swollen and heavy. Pressing on it leaves a dent in the skin. Elevating the limb can reduce the swelling.
• Stage 2. The affected area is even more swollen and may feel firmer than the surrounding area. Pressing on it doesn't dent the skin, and elevating the limb doesn't bring down the swelling.
• Stage 3. The affected area is extremely swollen. The skin there feels hard and thick, and may be dry and blistered. The swelling may limit mobility.

Treatment of lymphedema

Lymphedema is a chronic condition. While it can't be cured, a broad range of therapies can effectively manage the symptoms. If standard treatments fail, your doctor may recommend surgery.

Compression garments for lymphedema

Compression garments, made of nylon or spandex, are close-fitting sleeves or stockings that press on the affected limb. This supports the movement of lymphatic fluid and helps prevent it from accumulating. Low-stretch elastic bandages may also be used. Wrapped around an entire limb, they can help move the fluid into the trunk of the body.

Compression devices for lymphedema

A sleeve worn over the affected arm or leg connects to a pump that intermittently inflates the sleeve. This pumping action helps move the fluid through the limb, away from fingers or toes. The devices are most effective when used with compression garments. This treatment is typically monitored closely by a medical professional.

Lymphatic massage for lymphedema

Lymphatic massage is a gentle therapy used to help manage lymphedema. During this procedure, a trained massage therapist uses light pressure to stimulate the flow of lymphatic fluid. This promotes fluid drainage and reduces swelling in the affected area. A lymphatic massage can also improve circulation, ease discomfort and support other treatments.

Complete decongestive therapy (CDT) for lymphedema

Complete decongestive therapy (CDT) is a combination of lymphatic massage, bandaging, exercises and skin care. This treatment is given and monitored by a trained occupational or physical therapist. The therapist delivers several treatments in sessions over a short period to resolve most of the swelling in the affected limb. Following the therapist's treatments, the patient continues the regimen at home to keep the swelling down.

Exercise for lymphedema

Exercise can improve the flow of lymphatic fluid and support the function of the heart, helping to prevent or minimize the effects of lymphedema. The exercises will typically be gentle movements that promote lymphatic drainage and improve circulation without putting too much strain on the affected limb. Types of low-impact exercise that may be suggested to treat lymphedema include:

• Yoga, Pilates or tai chi
• Walking or swimming
• Resistance training or weight training
• Aerobics

Surgery for lymphedema

Surgery is an option for some patients. Depending on the lymphedema's grade and stage, surgery may be used to:

• Connect lymphatic vessels to a vein in order to create a new pathway for lymphatic fluid.
• Replace damaged lymph nodes with healthy ones from other areas of the body. This can support the growth of new lymphatic vessels, creating new pathways for lymph.
• Remove fat in order to alleviate pressure and improve lymph flow.

Laser therapy for lymphedema

Laser therapy uses light to stimulate the growth of new lymphatic vessels and improve the flow of lymph throughout the lymphatic system. This treatment can also be used to help repair skin damaged by lymphedema.

Prevention of lymphedema

While there’s no sure way to prevent lymphedema, you can do many things to lower your risk of developing it or to prevent it from getting worse. These measures include:

• Protecting your skin from damage and dryness
• Wearing certified compression garments
• Learning manual lymph drainage techniques that you can do at home
• Exercising regularly to keep lymphatic fluid flowing and maintain heart health
• Elevating the affected limb above heart level when sitting or lying down
• Maintaining a healthy weight
• Avoiding pressure on the affected area
• Protecting your skin against heat and sun
• Staying hydrated to support lymphatic fluid movement
• Limiting your salt intake