What is Lymphoedema?
Lymphoedema, also written Lymphodema, is a swelling in any part of the body caused by an accumulation of protein rich fluid in the tissue which cannot be removed because the lymphatic system is damaged (secondary lymphoedema) or inefficient (primary lymphoedema).
People may be born with or develop a lymphatic system that does not function properly.
The most common, caused by injury to the lymphatic system. For example when lymphatic nodes and vessels are removed or damaged through an injury, surgery or treatment for cancer.
There is no cure for lymphoedema at present. It is a progressive condition that without therapeutic management gradually worsens. Lymphoedema can be managed with specialised massage, compression garments or compression systems, laser treatment, exercises and limb and skin care to minimise its development. Studies have shown that therapeutic management can help produce a reduced limb size, relieves pain and discomfort levels, and increases mobility. It also minimises the risk of infection or injury to the affected limb and increases the patient’s general good health and wellbeing.
People who are at risk of developing lymphoedema can put in place management practices to minimise or prevent the condition from developing or worsening.
Lymphoedema – The Condition
Oedema is the medical term for a swelling, so lymphoedema is the name given to describe a swelling which is due to some abnormality, malfunction or obstruction of the lymphatic system.
Lymphoedema – The Causes
Lymphoedema may be divided into two basic types – primary and secondary.
The cause of primary lymphoedema is unknown but it is thought to be due to impaired lymph vessel and/or lymph node development due to a birth defect when there is an absence, or a reduced number, of lymphatic vessels, or those that are present do not work properly.
Secondary lymphoedema follows trauma to the lymphatic system. In developed countries, the most common cause is surgical removal of lymph nodes in the treatment of cancer. For example, lymphoedema of an arm can develop following removal of armpit nodes in the treatment of breast cancer, or leg lymphoedema can develop following removal of groin or pelvic nodes in the treatment of cancer of the uterus, cervix or prostate gland. Secondary lymphoedema can also be caused by severe trauma such as deep penetrating wounds or compound fractures as seen in motor vehicle accidents. The oedema does not always appear immediately, whether the condition is primary or secondary. It can occur months or years later in life, being triggered by an incident which overloads the lymphatic system in the limb such as an insect bite which becomes infected, an injury or a plane flight.
Lymphoedema – The Symptoms
The usual symptoms of lymphoedema include any combination of aching, heaviness, tightness, itching, prickling, numbness, pins and needles, skin redness or pain. The affected limb can become grossly swollen, heavy, unsightly and incapacitating.
Lymphoedema – The Treatment
Lymphoedema in the very early stage does not require any physical treatment as such. It is obviously important for the patient to understand the nature of the condition and how it should be managed, but all that is usually required is the fitting of a compression garment on the limb and a self-management programme devised by the lymphoedema therapist.
For lymphoedema which requires further attention, the most effective and safest treatment to date in the long and short term is Complex Physical Therapy (CPT). The treatment is usually given daily for approximately one hour, six days a week for one to two weeks or sometimes longer, depending on the severity of the condition, the length of time it has been present and the progress made. CPT reduces the oedema, improves the lymphatic drainage, softens areas of hard oedema and increases the mobility of the limb, thereby relieving the aching, discomfort and incapacity. CPT is recommended by the International Society of Lymphology (ISL).
Low level laser therapy is also used to assist in softening hard oedema, reducing soft oedema, in scar management and to reduce cording.
At the completion of intensive treatment, patients are fitted with a suitable compression garment such as a sleeve, glove or stocking to maintain the improvement gained from the treatment and to keep the swelling under control. They are also given a home management programme consisting of self-massage and a suitable exercise routine.
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What is Lipoedema?
Lipoedema is an under diagnosed and poorly understood chronic and progressive disorder of subcutaneous fat metabolism and distribution.
Most commonly affecting the lower limbs, mainly the hips, inner thighs and ankles but spares the feet. It can also present in the arms and when linked with obesity it may present in a whole body type lipoedema. Lipoedema appears to mainly affect women and appears to be familial. It can occur in women of all sizes. Usually observable at puberty but it may also present and or worsen at times of hormonal disturbance, for example pregnancy, peri-menopause, menopause, post cancer treatments and trauma both surgical and emotional. Additionally, due to the hypertrophic adipose cells, the fragility of the vascular capillary walls and changes to the lymph capillaries a mixed picture of lipo-lymphoedema may occur. Clients may experience column like ‘heavy legs’, orthostatic swelling, pain and may bruise easily. The lipoedema adipose tissue cannot be lost by diet and exercise. Clients find it difficult to lose weight from their hips, thighs and lower legs. Osteoarthritis of the knees can be quite common.
Management consists of a healthy lifestyle that includes an alkalsing/anti-inflammatory type diet that is low in long-chain fatty acids to reduce the load on lymphatic transport, moderate/passive non weight bearing exercise, education, self help treatments, Manual Lymphatic Drainage, Combined Decongestive Therapy or compression therapies, scanning low level laser and lymph taping. Liposuction is in its infancy as a treatment here in Australia. European Doctors are having good results but only time will tell as to the long term outcome of this treatment option. Clients may also require psychosocial support to assist with the physical, emotional and cognitive challenges of lipoedema and to assist in making changes to their lifestyle.