Overview and Facts
Lymphedema means swelling of the lymph passages. Lymphedema, also called Lymphatic obstruction, is a chronic disease involving blockage of the lymph nodes. Lymph nodes vessels drain fluid from tissues throughout the body and allow immune cells to travel where they are needed.
Lymphedema is characterized by persistent and often chronic swelling, usually of a person’s arm or leg.
Lymphedema is a chronic disease that usually requires lifelong management. In some cases, lymphedema improves with time. However, some swelling is usually permanent.
Symptoms and Types
There are many causes for this condition. Some of the most common include infections with parasites such as filariasis, injury or trauma to the area, past radiation therapy and surgeries, tumors and cellulitis. One of the most common causes of lymphedema is removal of the breast (mastectomy) and underarm lymph tissue for breast cancer. In a few cases the condition is present from birth (congenital).
In addition to swelling, the most common complications include chronic wounds and ulcers and skin breakdown. Patients with lymphedema must be vigilant about skin care and hygiene.
Your physician can offer different treatment options for lymphedema including:
- Compression devices prescribed by a doctor usually with multi-layered bandages
- Manual lymph drainage (MLD) or light message to drain fluid
- Range-of-motion exercises done with the help of a physical therapist
- Surgery may be necessary in some cases
Contact your doctor if you have swelling of your arms, legs, or lymph nodes that does not go away.
Diagnosis
Your doctor may try to rule out other causes of swelling in order to arrive at a diagnosis of lymphedema. Swelling can have many causes, including a blood clot or an infection that doesn’t involve your lymph nodes.
If you’re at risk of lymphedema — for instance, if you’ve recently had cancer surgery involving your lymph nodes — your doctor may assume you have lymphedema based on your signs and symptoms.
If the cause of your lymphedema isn’t as obvious, your doctor may order imaging tests to determine what’s causing your signs and symptoms. To get a look at your lymphatic system, your doctor may use an imaging technique, such as:
- Radionuclide imaging of your lymphatic system (lymphoscintigraphy). During this test you’re injected with a radioactive dye and then scanned by a machine. The resulting images show the dye moving through your lymph vessels, highlighting areas where the lymph fluid is blocked.
- Magnetic resonance imaging (MRI). This scan gives your doctor a better look at the tissues in your arm or leg. He or she might be able to use an MRI to see characteristics of lymphedema.
- Computerized tomography (CT). A CT scan produces images of your arm or leg in cross sections.
- Doppler ultrasound. This variation of the conventional ultrasound assesses blood flow and pressure by bouncing high-frequency sound waves (ultrasound) off red blood cells.
Treatment and Care
Lymphedema can’t be cured. Treatment focuses on minimizing the swelling and controlling the pain. Lymphedema treatments include:
- Exercises. Light exercises that require you to move your affected arm or leg may encourage movement of the lymph fluid out of your limb. These exercises shouldn’t be strenuous or make you tired. Instead, they should focus on gentle contraction of the muscles in your arm or leg. Exercises help pump the lymph fluid out of your affected limb. Your doctor or a physical therapist can teach you exercises that may help.
- Wrapping your arm or leg. Bandages wrapped around your entire limb encourage lymph fluid to flow back out of your affected limb and toward the trunk of your body. When bandaging your arm or leg, start by making the bandage tightest around your fingers and toes. Wrap the bandage more loosely as you move up your arm or leg. A lymphedema therapist can show you how to wrap your limb.
- Massage. A special massage technique called manual lymph drainage may encourage the flow of lymph fluid out of your arm or leg. Manual lymph drainage involves special hand strokes on your affected limb to gently move lymph fluid to healthy lymph nodes, where it can drain. Massage isn’t for everyone. Avoid massage if you have a skin infection, active cancer, blood clots or congestive heart failure. Also avoid massage on areas of your body that have received radiation therapy.
- Pneumatic compression. If you receive pneumatic compression, you’ll wear a sleeve over your affected arm or leg. The sleeve is connected to a pump that intermittently inflates the sleeve, putting pressure on your limb. The inflated sleeve gently moves lymph fluid away from your fingers or toes, reducing the swelling in your arm or leg.
- Compression garments. Compression garments include long sleeves or stockings made to compress your arm or leg to encourage the flow of the lymph fluid out of your affected limb. Once you’ve reduced swelling in your arm or leg through other measures, your doctor may suggest you wear compression garments to prevent your limb from swelling in the future. Obtain a correct fit for your compression garment by getting professional help — ask your doctor where you can buy compression garments in your community. Some people will require custom-made compression garments.
In cases of severe lymphedema, your doctor may consider surgery to remove excess tissue in your arm or leg. While this reduces severe swelling, surgery can’t cure lymphedema.
Living Your Life
Copyright by the Society for Vascular Surgery and NorthPoint Domain.
If you are at risk for developing lymphedema, you can act to prevent it. Initially, if you have mild lymphedema, you can act to keep the condition from worsening. You can take the following precautions to prevent or minimize symptoms:
- Clean your affected limb regularly. Remember to dry it thoroughly and apply lotion
- Wear gloves while gardening and cooking
- If you shave the affected area, use an electric razor
- Don’t go barefoot
- Do not cross your legs when you sit
- Do not carry a handbag with your affected arm.
In addition, if you are at risk for lymphedema, avoid having injections and blood pressure readings performed on your affected limb. You can also wear a special bracelet or necklace to notify medical personnel of your risk for lymphedema and the risk for complications, such as infection.
Physicians have not agreed about how to best treat chronic lymphedema. Some people have benefited from manual lymphatic drainage. This treatment uses massage to stimulate your weakened lymphatic system. Other treatment methods include special exercises that you can do while wearing compression stockings or bandages, and the use of external pumps to aid the movement of fluid through your body. A treatment that combines these treatments with lifestyle changes is called complex decongestive therapy.
Medication cannot cure lymphedema. However, your physician may prescribe medications to treat associated conditions. For example, antibiotics play an important role in combating infections that can worsen lymphedema.
Your physician may recommend surgery to remove excess tissue if your limb becomes so large and heavy that it interferes with your ability to move it.
Treating your lymphedema requires your participation. Because lymphedema can be very painful, you may benefit from individual counseling. You can also join support groups that provide practical advice as well as social and emotional support.
Assistance and Comfort
It can be frustrating to know that no cure exists for lymphedema. But if you find yourself getting down about the daily bandaging or constant need to protect your affected limb, know that you can control some aspects of lymphedema. To help you cope, try to:
- Find out all you can about lymphedema. Knowing what lymphedema is and what causes it helps you better understand the signs and symptoms you experience. The more you know, the better you can communicate with your doctor or physical therapist.
- Take care of your affected limb. Do your best to prevent complications in your arm or leg. Clean your skin daily, looking over every inch of your affected limb for signs of trouble, such as cracks and cuts. Apply lotion to prevent dry skin.
- Take care of your whole body. Eat a diet full of fruits and vegetables. Exercise daily, if you can. Reduce the stress in your life that you can control. Try to get enough sleep so that you wake up refreshed each morning. Taking care of your body gives you more energy, encourages healing and helps you control your lymphedema.
- Get support from others with lymphedema. Whether you attend support group meetings in your community or participate in online message boards and chat rooms, it helps to talk to people who understand what you’re going through. Contact the National Lymphedema Network to find support groups in your area. They can also put you in touch with other people with lymphedema with whom you can connect via e-mail or letter.
If you feel frustrated or overwhelmed by lymphedema, talk to your doctor or other health care provider about how you feel. He or she may be able to address your concerns.
