About Lymphoedema Video by ComptonCare & BLS
Lymphoedema (pronounced Lim-fo-dee-ma) is a chronic inflammatory condition in which a part of the lymphatic drainage system fails to work effectively.
Lymphoedema affects all ages.
There are estimated to be almost 450,000 people in the UK with lymphoedema. It is more common than the combined number of people with Multiple Sclerosis, Motor Neurone Disease, HIV and Parkinson’s Disease.
It is sometimes referred to as chronic oedema, particularly in the lower limbs. However, chronic oedema (swelling that lasts more than 3 months), indicates that the lymphatic system is failing in its drainage function and should be considered and treated as lymphoedema.
What is the lymphatic system and what does it do?
The lymphatic system helps protect us from infection and disease. It is a crucial part of the body’s immune system. It keeps our body fluids in balance and absorbs and transports helpful vitamins and hormones. You can think of the lymphatic system - made up of a vast network of vessels and nodes (glands) - as a kind of waste disposal system. The vessels collect fluid containing waste products and potentially harmful bacteria and toxins away from the tissues around your skin, fat, muscle and bone. The term for this fluid and cells is lymph. The glands, or lymph nodes, filter the lymph and the waste moves on through the body where it is passed in urine.
What happens when the lymphatic system fails?
When the lymphatic system fails, fluid and some harmful substances collect in the affected areas. We see swelling which most commonly affects one or more limbs but it may also affect the head and neck, body, breasts or genital area.
In addition to swelling, there may be changes in the skin and the tissue under the skin. The skin may become very dry, cracked and less stretchy. The skin may feel thickened as the tissues under the skin become firmer.
Early symptoms of lymphoedema include:
- Feelings of tightness, tension or discomfort, possibly tingling
- Feeling clothes, shoes or jewellery tight or seeing marks or indentations on the skin where clothing digs in.
- A cellulitis attack (a bacterial infection of the skin) may be the first indication that there is a problem with the lymphatic system (see Cellulitis Consensus Guidance for information on recognising cellulitis).
If swelling is ignored and goes untreated what happens?
Over time, the condition may worsen, increasing the risk of further complications such as:
- Cellulitis – a bacterial infection of the skin which may progress very quickly and be serious, possibly developing into sepsis. Some people experience regular cellulitis attacks. Each attack may cause more damage to the smaller lymphatic vessels.
- Swelling may extend beyond the limb and onto the body, making it more difficult to treat.
- Development of lymph blisters, becoming fibrosed over time, giving a ‘warty’ appearance.
- The soft tissues under the skin change, becoming fattier and firmer. This is distributed unevenly, changing the shape of the limb. Deep folds may be seen at the toes/fingers, ankles/wrists, knees/elbows. Sometimes, fungal infections can develop in deep folds.
- If swelling occurs quickly, the skin may be overstretched, becoming thin and easily damaged. Areas of lymph leakage or lymphorrhoea (lim-fo-ree-a) may occur through cracks in the skin.
- Skin tears, wounds or ulceration which may be very difficult or take longer to heal.
- Increased discomfort or pain may occur in the affected area but also in the spine or neck due to a heavy limb dragging on muscles and joints and changing the way a person walks and moves.
Importance of early diagnosis and treatment
Treatment is always easier, with better and faster results if it is recognised early and treated promptly. Lymphoedema is a life-long condition but ‘nipping it in the bud’ makes it much more likely that individuals will be able to manage their own condition with minimal intervention or dependence on health care professionals.
What causes lymphoedema?
Lymphoedema may be Primary. This means there is an abnormality of the lymphatic system that has been present from birth. In some people, it will be evident at birth but in others, it may be identified later in life, possibly triggered by an event that has caused further damage to the system.
Secondary lymphoedema arises as a result of damage to a normally functioning lymphatic system. There are many causes of secondary lymphoedema including:
- Cellulitis
- Lifestyle factors including obesity and inactivity
- Inflammatory conditions that may impair the small lymphatic vessels, such as chronic skin conditions, wounds, particularly if healing is prolonged, untreated fungal infections, inflammation following insect bites or stings.
- Conditions that cause more fluid to leak into the tissues of the body, such as varicose veins, deep venous thrombosis, heart failure.
- Surgery or treatment that removes or damages areas where there are a lot of lymph nodes, such as cancer of the breast, pelvic area (gynaecological or genito-urinary cancers in men), melanoma, head and neck cancer. Orthopaedic surgery also carries risks.
- Conditions that inhibit mobility and activity, such as stroke, multiple sclerosis and frailty.
- Some medications, such as calcium channel blockers used to treat hypertension, especially amlodipine. Others include corticosteroids, non-steroidal anti-inflammatory drugs and sex hormones.
Further information: Who has a predisposition to lymphoedema
Can lymphoedema be prevented?
There are things that can be done to keep the lymphatic system healthy and stimulate lymphatic drainage. It is important that anyone with conditions and lifestyles that increase their risk of developing lymphoedema is made aware of what they can do to help prevent it. The same strategies will also help those who have lymphoedema keep it under control and prevent complications.
How can the risk of lymphoedema or its complications be reduced?
Activity and movement: The lymphatic system depends on movement of the muscles and tissues around the vessels to enable them to collect fluid from the tissue spaces and move it through the vessels and nodes. Without movement, lymphatic vessels collapse. Movement, activity, stretching and deep breathing are vital to keep it working effectively and help to reduce swelling. It doesn’t need to be vigorous. Regular, short periods of activity really make a difference to lymphatic drainage. There is more information and tips on this in the resources section, including activities that may be done while sitting.
Maintaining a healthy diet and weight: Being overweight puts an extra burden on the lymphatic system by pressing down on the vessels in the pelvic area and restricting the flow of lymph from the legs and feet. It makes it harder to be active and reduces the positive impact of movement on the lymphatic vessels.
Looking after skin: The skin is a barrier to infection which may trigger lymphoedema. Protecting the area at risk from injury and infection is really important. Here are some tips -
- Keep skin clean – wash daily with a mild, non-perfumed soap or soap substitute
- Keep skin supple and well-moisturised with a daily application of a bland, non-perfumed moisturising cream or ointment
- Protect from sunburn with high factor cream or lotion
- Use insect repellent in areas of risk and consider antihistamine creams or tablets if there is a reaction to the bite. Consult your doctor if it doesn’t resolve.
- Avoid walking barefoot or wearing shoes that cause blisters
- Check between toes or skin folds regularly and treat any fungal infection
- Clean any cuts or scratches with antiseptic and consult your doctor if it becomes inflamed
- If there are signs of cellulitis, medical help should be sought as quickly as possible. See Consensus document on Cellulitis for more information.
Treatment
There are four main pillars of lymphoedema treatment, some of which can be self-managed by the patient.
Movement – Remaining active in a safe way will assist the lymphatic system in collecting, transporting and safely removing lymph (fluid and cells). Movement does not need to mean exercise; simple activities like walking, stretching to hang out the washing on the line and heel-raises will aid the lymphatic system.
Skin care – keeping the skin moisturised and clean to prevent Cellulitis. Avoiding sunburn and insect stings and injury, e.g. wearing protective clothing when doing activities like gardening.
Compression – is a key part of treatment to reduce swelling and keep it under control. Its effect is enhanced by movement and activity as together they encourage movement of lymph through the vessels. Treatment may involve the use of compression garments (socks/stockings/tights or sleeves and gloves), bandages or Velcro wraps to compress the affected areas. This helps drain fluid and reduce swelling. There are many options and it is important to determine what will work best for the individual.
Lymphatic Drainage – the use of massage techniques to move fluid through the lymphatic system. This may be done by a specialist practitioner or a simplified version may be taught to enable self-care or undertaken by a family member or carer.
These treatments can support each other, and the more the patient understands and looks after their lymphatic system, the better the outcomes of the other treatments will be.
For further details, see Lymph Facts What is Lymphoedema? and the 'About Lymphoedema' Video by ComptonCare & BLS
