What is Lymphedema?

Lymphedema, also known as Lymphoedema is a condition of fluid retention which is a symptom of a damaged lymphatic system.

There are a number of ways this condition occures. It may be inherited, caused by trauma but is most commonly caused by cancer treatments such as surgery, where lymph nodes are removed.

Lymphedema can also be associated with accidents or certain diseases or problems that may inhibit the lymphatic system from functioning properly. In tropical areas of the world, a common cause of secondary lymphedema is filariasis, a parasitic infection.

It generally occurs due to poorly-developed or missing lymph nodes or channels in the body. Lymphoedema may be present at birth, develope at the onset of puberty (praecox), or not become apparent for many years into adulthood (tarda).

Lymphedema affects both men and women. In women, it is most prevalent in the upper limbs after breast cancer surgery and lymph node dissection, occurring in the arm on the side of the body in which the surgery is performed. It may also occur in the lower limbs or groin after surgery for colon, ovarian or uterine cancer in which removal of lymph nodes is required.

In men, lower-limb primary lymphoedema is most common, occurring in one or both legs. Surgery or treatment for prostate, colon and testicular cancers may result in secondary lymphedema, particularly where lymph nodes have been removed or damaged. Swellings can become extremely pronounced and often cause a limb to double it's normal size.

Infections are a common problem with this condition and must be guarded against.

When the lymphatic impairment becomes so great that the lymph fluid exceeds the lymphatic system's ability to transport it, an abnormal amount of protein-rich fluid collects in the tissues of the affected area. Left untreated, this stagnant, protein-rich fluid causes tissue channels to increase in size and number, reducing the availability of oxygen.

This interferes with wound healing and provides a rich culture medium for bacterial growth that can result in infections: cellulitis, lymphangitis, lymphadenitis, and in severe cases, skin ulcers.

Usually the affected areas are the legs or arms. As the limb swells the skin can become dry and irritable. If not managed correctly the skin may become infected leading to further complications.

This condition requires constant maintenance to counteract swelling and possible onset of infection. Exercise is important to maintain good circulation and keep the flow of fluids constant throughout the body and avoiding stagnation of the lymphatic system.

Compression garments are commonly used on the affected area to squeeze the excess fluids out from the area and back into circulation. These garments are very effective and anyone suffering from this condition should own a set.

Compression bandaging, also called wrapping, is the application of several layers of padding and short-stretch bandages to the affected areas.

Short-stretch bandages are preferred over long-stretch bandages as the long-stretch bandages cannot produce the higher tension necessary to safely reduce Lymphedema and may in fact end up producing a tourniquet effect.

During activity, whether exercise or daily activities, the short-stretch bandages enhance the pumping action of the lymph vessels by providing increased resistance for them to push against. This encourages lymphatic flow and helps to soften swollen areas.

Sequential Gradient Pump Therapy is another method which utilizes a multi-chambered pneumatic sleeve with overlapping cells, to gently move lymph fluid out from the affected area and back into circulation.

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Patients may often receive treatment on a pump for 10-15 minutes before an MLD (Manual Lymphatic Drainage) session to help break up fibrotic (hard) tissue.

By softening or breaking up the fibrosis, the MLD Therapist may be more effective with the given treatment. Many patients may benefit from a pump without ever going to MLD sessions, as they are very beneficial, but not a requirement.

However, after completion of the appropriate number of MLD sessions, many patients will benefit from a home use of a sequential pump.

A recent Stanford University medical studyshowed that patients receiving the combined modalities of MLD/CDT and pneumatic pumping had a greater overall reduction in swelling than patients receiving only manual lymphatic drainage.

Manual manipulation of the lymphatic system is very beneficial in treating lymphedema. It consists of gentle, rhythmic massaging of the skin to stimulate the flow of lymph and its return to the blood circulation system.

In the blood’s passage through the kidneys, the excess fluid is filtered out and eliminated from the body through urination. The treatment is very gentle and a typical session will involve drainage of the neck, trunk, and involved extremity, lasting approximately 40 to 60 minutes.

The onset of secondary lymphedema in patients who have had cancer surgery has also been linked to aircraft flight (likely due to decreased cabin pressure). For breast cancer survivors, wearing a prescribed and properly-fitted low-compression sleeve and gauntlet may help decrease swelling during flight.

Currently there is no cure for this ailment but there are certain steps which can be taken to manage the symptoms and maintain good health. It's highly recommended that anyone suffering from lymphedema should educate themselves upon it and understand what steps can be taken to manage and control swelling. Action everyday is recommended to maintain good health & circulation.

If no action is taken, then more often than not, the problem worsens and over time will have a negative affect on general health.

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