Lymphoedema

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What is Lymphoedema?

Lymphoedema is a build-up of lymph fluid in one or more areas of the body. Lymph fluid usually gets filtered back into the bloodstream; however, when the lymphatic system is compromised it prevents healthy fluid drainage which can cause a build-up. A lymphatic fluid accumulation, also known as Lymphodoema, is often presented as swelling under the skin. Lymphoedema is most common in the face, arms, and legs but can be anywhere in the body.

What are the signs & symptoms of Lymphoedema?

Lymphoedema can present through numerous signs and symptoms such as:

  • Swelling
  • Pitting
  • Heaviness
  • Achiness
  • Skin tightness
  • Feeling hot
  • Reddening of the affected area

Swelling in the limbs (legs and arms) is the most common sign of Lymphoedema, which can develop gradually or appear suddenly. When Lymphoedema is present, the texture of the skin can change, becoming more soft and spongy.
One way to identify a swollen area is to apply pressure on the skin and release it. If there is Lymphoedema, once the pressure is removed, the indentation on the skin may remain in the skin for a prolonged amount of time as opposed to disappearing immediately. This is known as pitting. Lymphoedema doesn’t always involve the symptom of pitting; however, this is a typical sign of first stage Lymphoedema.

Some cases of Lymphoedema can cause a person to feel excessively heavy or achy in a particular area, often in the arms or legs. This symptom often is long-lasting and doesn’t go away with exercise.

If the area is swollen then the skin may become tight as though it is stretching. When this occurs, the texture of the skin hardens, becoming more firm to the touch.

For many, the affected area with Lymphoedema increases in temperature, often feeling hotter in conjunction with a reddening of the skin.

What are the common causes of Lymphoedema?

The lymphatic system is composed of multiple vessels, glands and lymph nodes whose main aim is to remove any excess fluid in the bloodstream such as proteins and to produce white blood cells which fight foreign viruses or bacteria, maintaining a healthy balance throughout the body.

There are two categories of causes of Lymphoedema: primary and secondary.

Primary Lymphoedema refers to those who have a genetic disposition to the disorder inherited from previous family members.
Secondary Lymphoedema is when someone experiences the condition as a result of the body’s natural response to another factor such as infection, illness or surgery.

The lymphatic system can interact with hormones throughout the body, and functions to help maintain a healthy balance of these hormones. When our hormone levels change, often due to menstrual cycles, menopause, or changes in medication; the lymphatic system can become overwhelmed and a buildup of fluid can occur.

Alternatively, another cause of Lymphoedema may be the removal of lymph nodes through surgery. Those who have undergone surgery as part of their cancer treatment are at higher risk of developing Lymphoedema if the removal of lymph nodes is needed. Lymph nodes are all over the body and are used to filter and drain lymphatic fluid. When lymph nodes are removed, the lymph fluid cannot be filtered or drained as effectively in turn leading to fluid build-up and the development of swelling. Redirecting lymph fluid can increase lymphatic flow and reduce further risk of Lymphoedema in the body.

Lymphoedema may not appear immediately after surgery; it can be several months before symptoms start to present. Nevertheless, swelling is a normal reaction to an operation, and it usually subsides within a few weeks.

How is Lymphoedema diagnosed?

When Lymphoedema is a suspected diagnosis, your GP or doctor will ask for your full medical history, and carry out a physical exam. Your physical exam will likely involve checking lymph nodes throughout the body but in particular those in the neck, underarm, and groin. This examination is to help discover any swollen or tender lymph nodes as this indicates poor drainage capabilities in the lymphatic system.

After the physical assessment, other tests such as blood tests or medical imaging may be required to further confirm any condition(s).

Imaging scans are an accurate method to detect and trace the lymphatic flow, which can determine impairments or blockages. Examples of these scans include:

  • Magnetic resonance imaging (MRI)
  • Ultrasound
  • Computerised tomography scan (CT scan)

Lymphoscintigraphy is a type of scan that is designed to specifically screen the lymphatic system. Lymphoscintigraphy uses a special dye which follows the lymph fluid through the body allowing the flow of the fluid to be tracked and blockages to be detected.

What are the treatment options for Lymphoedema?

In many cases, compression garments are recommended in order to help aid the drainage process. Compression garments work by controlling the amount of fluid passing through one area of the body at a time preventing any build-ups or swelling. In turn, by taking the pressure off the lymphatic system, it allows the body to function at a more optimal rate. There are different types of specialist compression garments for different areas of the body such as the stomach, arms and legs, this ensures there is an appropriate level of compression for each specific area.

Gentle exercise is vital for increasing the heart rate. During exercise the muscles contract creating a pumping motion, which helps to push the lymph fluid more efficiently around the body, directing it away from the site of build-up. Exercise also promotes movement which can help prevent restriction in the muscles.

  • Examples of exercises that are good for the lymphatic system would be:
  • Walking
  • Yoga
  • Swimming

Stretching can also increase the heart rate and improve lymph flow without being too strenuous.

With symptoms of Lymphoedema such as restriction in movement due to excessive swelling or tightening of the skin, manual therapy is typically recommended to help improve a patient’s range of motion and release tension in the muscles through specifically tailored exercises.

Can Lymphoedema be prevented?

Whilst Lymphoedema does not yet have a direct preventative treatment, there are steps that can be taken to decrease the risk of the condition.
Making sure you are regularly drinking water can help with multiple aspects of the lymphatic system. The majority of lymph fluid is made up of water, therefore the more hydrated the body is, the easier it is for the lymph to flow through the body and prevent the chances of blockages.

Regular exercise is vital for overall health and has profound benefits for the lymphatic system. When you exercise, the muscles contract creating a pump-like system which pushes the fluid around the body more efficiently, preventing blockages in the flow.

Avoiding hot baths/showers and saunas will help prevent swelling. When the body is hot, the blood vessels expand allowing for more fluid to flow through. This can create a build-up of fluid and blockages in the lymphatic system. This is why it is important to have warm baths and showers instead of hot ones.

Maintaining regular movements throughout the day, to avoid being in the same position for prolonged hours at a time helps prevent a backlog of fluid in the body.

Does Lymphoedema hurt?

Due to the nature of the condition, Lymphoedema can be painful and cause skin and mobility issues. If the body is injured or has an impairment, the lymphatic system creates and directs white blood cells together with oxygen to the affected area to help the healing process. If the lymphatic system is compromised or has any blockages, the fluid isn’t able to deliver those cells as efficiently, therefore, hindering the healing process and preventing pain relief. In acute cases, the swelling can become so tight around the limb that it can restrict movement and cause pain in the affected area.

Do I need to go to the GP or visit my local hospital?

If you have a pre-existing condition where swelling or Lymphoedema is a known side effect then be sure to make your regular doctor aware as a precaution. If you have no underlying health conditions and notice any swelling or dramatic change in the texture of your skin then we would recommend you get in touch with your GP for a full check-up.

FAQ’s

Someone may develop Lymphoedema because of a pre-existing condition. Alternatively, lymphoedema can occur after surgery, either medical or cosmetic. This would be because of a build-up of excess fluid that
Lymphoedema is not cancer however can be a result of cancer surgery when lymph nodes are removed.
Manual therapy can be a great way to increase lymph flow throughout the body. Compression garments can also help with controlling the flow, preventing any build-up of fluid in one area of the body.
The main symptoms of Lymphoedema are swelling, often found in the arms, legs and neck, tightening of the skin, pitting of the skin, and limbs feeling heavy or achy.
Lymphedema can go away. In some cases it goes away on its own, others find manual therapy helpful in assisting the symptoms.
Yes! When dehydrated, the body tends to hold onto the excess fluid in order to keep a healthy balance of fluid throughout the body. The more water intake into the body, the healthier the flow of lymph fluid, therefore preventing further fluid build-ups.
Lymphoedema can appear differently for people but the common signs are; Swelling of the skin, pitting in a particular area on the skin, the feeling of heaviness or aching in the limbs, and skin tightness.