Lymphoedema

Home / Lymphoedema

What is Lymphoedema?

Lymphoedema occurs when the lymphatic system is unable to drain fluid effectively. This causes a build-up of protein-rich fluid in the tissues, most commonly in the arms or legs, and occasionally in other parts of the body.

Over time, this trapped fluid can lead to thickening and hardening of the tissues (fibrosis) if left untreated.

Common Signs of Lymphoedema

Gradual swelling of one limb (rarely more than one)
A feeling of heaviness or tightness in the affected area
Skin that feels firm or tight and may be difficult to pinch (positive Stemmer’s sign)
Skin that leaves an indentation when pressed in early stages
Deepened skin folds around joints
Hardening of the tissues in later stages

How Lymphoedema is Diagnosed

Lymphoedema is usually diagnosed by a doctor experienced in lymphatic conditions through medical history and physical examination. In some cases, imaging tests such as ultrasound, lymphatic scans, or MRI may be used to confirm the diagnosis or rule out other conditions.

Why does lymphedema develop?

There are basically two types of lymphoedema:

1. Primary lymphoedema is congenital:

In this case, some areas of the lymphatic system show defective development. Although damage is present, there is often little or no sign of primary lymphoedema before puberty. Hormonal changes lead to a more pronounced tendency for oedema and an increase in the lymph-obligatory load. The limited capacity of the lymphatic system to transport it away is no longer adequate – oedema develops and eventually becomes evident.

2. Secondary lymphoedema results from various conditions:

• The removal of lymph nodes in the course of cancer surgery

• Damage to the lymphatic system as a result of surgical interventions

• Radiotherapy

• Infections with bacteria, fungi or tropical nematodes (filariasis)

• Injuries

• Burns

• Lipoedema

• Complicated bone fractures

The course of the disease is divided into various phases:

Stage 0 – subclinical stage

Damage to the lymph vessels, no visible or palpable oedema.

Stage 1 – reversible stage

The soft oedema appears over the course of the day and is reduced or disappears entirely when the limbs are elevated. The tissue pits when pressed and the area holds the indentation for a short time.

Stage 2 – spontaneously irreversible stage

The oedema persists even after prolonged periods of rest. The skin is often already fibrotic (hardened) and not even elevation reduces the swelling. There is little or no pitting when the skin is pressed.

Stage 3 – lymphostatic elephantiasis

Complicated swelling characterised by gross skin changes and fibrotic tissue, which may be wart-like or take the form of small blisters or fistulas which leak lymph, sometimes resulting in huge swellings.

Treatment

The fact is that consistent treatment compliance is the only way to prevent

lymphoedema from worsening.

Complex decongestion therapy (CDT*1) is the tried and tested first-line therapy in the

treatment of lymphoedema. By increasing drainage this removes the lymph congestion

to reduce the swelling and stimulates the activity of the body’s lymphatic system.

It may also serve to eliminate pre-existing connective tissue fibrosis

CDT phase 1 – Decongestion phase

Depending on the stage of the disease, this is performed either in an outpatient setting or in hospital.

1. Manual lymphatic drainage (MLD*3) – daily, several times if needed

2. Skin care / hygiene

3. Subsequent compression bandaging with short-stretch bandages

4. Exercise

5. Healthy diet and, if necessary, weight reduction

6. Psychological care / self-motivation

7. Reduction Kit – Contact us for more information

In addition, the use of intermittent mechanical compression (IMC*2) can have a positive effect on lymphoedema and its sequelae. Magnetic-field, ultrasound, ozone and CO2 therapy are also used in some cases. A slimming diet is also frequently necessary, as obesity leads to a worsening of the oedema.

CDT phase 2 – Maintenance phase

1. MLD*3 – one to three times a week (depending on the stage) and compression bandaging with short-stretch bandages

2. Skin care / hygiene

3. Subsequently wearing flat knit compression garments – Contact us for more information

4. Exercise

5. Healthy diet

6. Self-motivation