Lymphoedema
The Lymphatic System
The lymphatic system is composed of lymph channels and glands found throughout the body. It exists to transport excess fluid from tissues back into the central veins of the body. This fluid accumulates in tissues for a variety of reasons but only on a very small level. Lymph glands are the sites from which immune responses are mounted against organisms that invade the body and infections. Under normal conditions, we are blissfully unaware of the transport function of the lymph channels and their importance. Even when things go wrong, because only small amounts of fluid are left to accumulate it may take many months or years before any symptoms occur.
What is Lymphoedema?
Lymphoedema occurs when the lymphatic system is damaged and unable to cope with the carriage of excess fluid from tissues, resulting in swelling of limbs or other parts of the body (Figure 1). This damage can occur after surgery or injury. There are two types of lymphoedema, Primary and Secondary.
Figure 1: Moderate Lymphoedema of the right leg
Primary
Primary lymphoedema occurs in people who were born with an impaired lymphatic system. It can develop at any stage of life for no apparent reason.
There are 3 main types:
- Congenital Lymphoedema: For example, Milroy’s disease is present at birth.
- Lymphoedema Praecox: Most commonly develops between the ages of adolescence and 35yrs of age, and is usually present in one leg.
- Lymphoedema Tarda: This is a later onset of lymphoedema over the age of 35, and can affect one or both legs. This can suddenly present itself after a small insect bite or scratch; resulting in an infection to the limb. (Milroy’s Disease, late onset due to infection)
Secondary
Secondary lymphoedema can occur after surgery, or following infections such as cellulitis. Some treatments for cancer such as radiotherapy will also result in lymphoedema of the affected part. Immobility/paralysis (following a stroke or plaster cast) can also cause mild lymphoedema. Obesity and some circulatory conditions e.g. varicose veins and chronic venous insufficiency are also causes.
Treatment
Unfortunately, lymphoedema can seldom be completely cured. If caught early enough however, with the appropriate treatment many sufferers can lead a virtually normal life with an easily manageable limb. The treatment of this condition is highly specialised and we recommend that you only visit qualified practitioners for therapy. De-bulking surgery is rarely performed and only used for very advanced cases where there is a danger of limb loss or severe impairment of social activity. Treatments for lymphoedema provided at The Vein Clinic consist of the following:
1. Medical Lymphatic Drainage (MLD): This is a treatment that should only be undertaken by a qualified practitioner. It involves massaging the affected area using specialised techniques to stimulate the flow of lymph away form the swollen leg/arm. It is a gentle and relaxing treatment.
2. Multi-layer Lymphoedema Bandaging (MLLB): This provides a firm support for the muscles which helps them pump lymph fluid away during activity reducing the shape and size of the affected limb. This treatment is more successful when combined with a course of MLD (de-congestive Treatment), producing an excellent reduction in limb size.
3. Compression Garments: These are specialised knitted garments, which are available for the arm or leg. Specialised garments can also be designed for the torso, and genital area.
4. Kinesio Taping®: This is a new and effective treatment for lymphoedema. An elastic, latex free tape is used to cover the skin. This helps lift the top layer of the skin relieving pressure during movement and helps disperse the accumulation of lymph fluid.
5. Instruction on self maintenance. The successful treatment of lymphoedema involves the patient in management of their own condition. The “four corner stones of care” involve the basic steps of:
- Skin care: The skin should be well hydrated to prevent infection.
- Self Lymphatic Drainage (SLD): A simpler version of MLD that the patient learns to help move the build up of lymph fluid on a daily basis.
- Compression Garments: Wearing an elastic form of compression regularly to maintain shape of limb and reduce swelling.
- Exercise and Movement: It is important that you regularly perform the special exercises you are taught to move muscles and in turn aid the movement of lymph fluid. Always wear your compression garment when exercising. Breathing exercises can help stimulate deeper lymphatic vessels in the chest and abdomen to help drain away lymph fluid.
Remember that although there is no cure for lymphoedema it can be successfully kept at bay if recognised early enough and treated appropriately. Any treatment can only be as successful as your motivation and desire to be part of your therapy.
5. Surgery: De bulking surgery that is only done where severe cases are apparent, and should only be done by a surgeon who specialises in treating lymphoedema.
It is important to realise that lymphoedema is an under diagnosed condition and in many cases patients may not even notice the mild swelling affecting the limb for some time. When recognised, treatment is relatively straight-forward. Good results can only be achieved in conjunction with patient-education and the self-motivation to persevere with the treatments necessary.