What Is Lymphedema? How You Can Treat it with Proper Lymphedema Products
Lymphedema, or swelling in one limb or one particular area of the body, affects many patients every year. It’s estimated that one in 1,000 Americans and as many as 200 million people worldwide suffer from lymphedema. This disorder of the lymphatic system may arise spontaneously, or it can be caused by certain medical procedures, especially cancer treatment.
Below, we explain everything you need to know about lymphedema, starting with what the lymphatic system is and how it works. We then cover what symptoms of lymphedema to look out for and what diagnostic techniques your doctor might try. Finally, we offer tips for preventing the development of lymphedema and cover treatment options for those who already have symptoms.
The Lymphatic System
To understand the causes of lymphedema, you first need to understand the lymphatic system and how it works. Lymph (also called lymphatic fluid) is a clear substance that carries white blood cells to help fight infections and other diseases. The lymph vessels reach into all tissues of the body, drain them of fluid and transport the fluid to lymph nodes.
Lymph nodes are gland-like lumps of tissues that filter the fluid to destroy bacteria and other harmful substances. After the fluid is cleaned, larger lymph vessels carry it back to a major vein (called the super vena cava) so the clean lymph can re-enter the bloodstream.
The lymph system also includes three more critical parts: the bone marrow, which makes white blood cells (among other things); the thymus gland, which produces T lymphocytes, a specific type of white blood cell that destroys cells that have become cancerous or been taken over by viruses; and the spleen, which also makes lymphocytes.
Causes of Lymphedema
Lymphedema occurs when there is a blockage in the lymph system, causing excess fluid to collect and resulting in swelling (edema). Lymphedema often occurs in one arm or leg, causing the limb to swell while the other one remains normal. However, some people experience lymphedema in other parts of their body, including the head, genitals and chest, though this is much less common.
There are two kinds of lymphedema–primary and secondary. Primary lymphedema occurs when the swelling arises without a prior medical event. Physicians believe this kind of lymphedema might be caused by genetic mutations in genes that govern the lymphatic system’s development, which inhibit the system’s ability to drain properly.
Primary lymphedema may develop at three stages of life. Milroy’s disease (congenital lymphedema) causes lymph nodes to form abnormally in infancy. Meige’s disease (lymphedema praecox) usually causes lymphedema around puberty or during pregnancy, though it can occur up until age 35. Late-onset lymphedema (lymphedema tarda) usually begins after age 35 and is very rare.
Secondary lymphedema can be caused by a variety of medical events. If lymph nodes are removed to stop the spread of cancer, this removal can cause the lymph system to function differently, resulting in lymphedema. Other cancer patients experience lymphedema symptoms when radiation therapy destroys nearby lymphatic tissue in addition to targeting the cancer. Lymphedema caused by cancer treatment may manifest directly after surgery or treatment or it may not appear for months or years afterwards.
Other conditions besides cancer also increase your risk of experiencing lymphedema. Severe infections, such as cellulitis and certain parasites, can lead to damage and scarring in the tissue around the lymph nodes or vessels, which can in turn cause lymphedema. Other medical conditions that cause tissue to swell and become inflamed—including rheumatoid arthritis, dermatitis and eczema—can also permanently damage the lymphatic system. Some patients with cardiovascular diseases, such as deep vein thrombosis or varicose veins, are also at a greater risk of developing lymphedema.
Certain individuals, such as the elderly, the obese and those with rheumatoid or psoriatic arthritis, are more prone to developing lymphedema.
Symptoms of Lymphedema
Lymphedema can be so mild you hardly notice it, or so severe it restricts your use of your limb. There are many potential signs and symptoms to watch out for, including:
- Feeling heavy or tight in particular areas of your body
- Skin changing texture, feeling tight or hard or looking red
- New aching, tingling, numbness or other discomfort in the area
- Restricted movement in nearby joints or your eyelid(s), throat or lips
- Trouble fitting into clothes in one area (such as a sleeve or pant leg feeling tight)
- Collars, rings, watches and/or bracelets feeling tight even though you haven’t gained weight
- Aching or discomfort
- Recurring infections
Sometimes the swelling will go away on its own. However, if it persists, you should see a doctor about your symptoms. If you already have lymphedema and notice a sudden change in the size of the limb or affected area, you should also seek out your doctor’s advice.
Lymphedema may be described according to four grades (1-4) to capture its severity and to three stages (1-3) to capture the progression of your symptoms. If you have a clear potential cause of lymphedema—such as a recent cancer surgery or radiation therapy—your doctor might be able to diagnose you based on a physical examination of your symptoms. Your doctor might measure your limb and compare it to the other to get a sense of the severity of the problem.
However, if you develop primary lymphedema, or if the cause isn’t immediately clear, your doctor might need to run some tests in order to take a look at your lymph system. Possible imaging tests are:
- MRI scan, which uses a magnetic field and radio waves to create 3D, high-resolution images
- CT scan, a special X-ray technique that produces cross-sectional images of your body's structures
- Doppler ultrasound, a variation of the conventional ultrasound that bounces high-frequency sound waves to determine blood flow and pressure to see if there are any obstructions
- Lymphoscintigraphy, which uses a radioactive dye to map the movement of fluid through your lymph vessels, highlighting blockages; you’ll be injected with the dye and then a machine will scan you
How to Prevent Lymphedema
There are certain steps you can take to lower your odds of developing lymphedema, especially if you’ve recently had surgery. These strategies include:
Protecting your arms and legs from injury.
Keep the affected area safe from injury, as cuts, scrapes and burns can all result in infection. Be especially aware of common sharp objects, such as razors, scissors and knives and use alternative products or wear gloves when you can. If you need to get any medical procedures done using a needle, such as blood draws or vaccinations, try to get them done on your healthy limbs.
Resting while recovering.
After any significant disease treatment, injury or surgery, your doctor may recommend stretching or exercise to help you recover and get your mobility back. However, it’s important to be extremely careful and not strain yourself (especially the affected limb) until you’re fully recovered.
Elevating your limbs as needed.
Elevating the affected limb above the level of your heart can help encourage lymph flow and reduce swelling. If you have trouble getting into position, try a leg rest pillow to elevate your legs at the proper angle.
Avoiding extreme temperatures.
Don’t apply very hot or cold products (such as ice or heat packs) to the affected area, as the extreme temperatures can cause tissue damage.
Avoiding tight clothing.
Avoid tight-fitting clothing (other than lymphedema compression stockings and other specific lymphedema products) as they can limit the flow of lymph and blood, causing swelling. If one of your arms is affected and you need to get your blood pressure taken, be sure to do it on your healthy arm.
Keeping the area clean.
Take good care of yourself and keep the affected site clean, as well as your skin and nails. Don’t go barefoot, as this exposes your feet to dirt, germs and injury. Inspect the skin around the affected site daily, looking for any cuts, breaks or other changes that could lead to infection.
How to Treat Lymphedema
If you already have lymphedema, there are steps you can take to reduce both the swelling and pain, and your doctor might recommend a combination of any of the following strategies.
Lymphedema Compression Products
There are many compression sleeves available for lymphedema. These long sleeves and stockings compress your arms and legs to encourage the healthy flow of lymph. At the very least, you should wear compression sleeves and stockings for lymphedema while you’re exercising, and you can also wear them while you go about your daily activities.
Be sure to take your measurements so you can choose the right size sleeve or stocking, as it’s critical that compression garments have just the right fit. If you have trouble getting the compression garments on or off, donning devices can help you out.
If the compression garments are still too difficult to take on and off with the help of donning devices, you can also look into lymphedema wraps, which are strips of compression fabric you wind around your limb rather than a single continuous sleeve. Because of their wrap design, these products can be adjusted to a wider range of sizes so you can achieve the perfect fit each time.
Pneumatic Compression Therapy
The inflatable sleeves cover your arms and/or legs and connect to a pump that automatically and intermittently inflates the sleeves (pneumatic means operated by air under pressure). The inflated sleeves put pressure on your limbs and push the lymph away from your extremities.
Gentle exercises can encourage lymph flow in the affected limb and help you regain some of your former mobility. These exercises should focus on enhancing flexibility, practicing stretching, building strength and otherwise gently contracting the affected limb. Don’t overexert yourself or strain your muscles, as this might make the problem worse. A certified lymphedema therapist can help you figure out a safe exercise routine to combat your lymphedema.
Massages don’t just help you relax and de-stress. Physically kneading the muscles can encourage lymph flow and drainage. In particular, a massage technique called manual lymph drainage can help the lymph drain out of your arm or leg. Look for a masseuse trained in this particular technique. However, you should avoid massage if you have a skin infection, blood clots or an active disease in the affected lymph drainage areas.
Complete Decongestive Therapy
Complete decongestive therapy (CDT) combines lifestyle changes with many of the above techniques—including manual lymphatic drainage, compression, exercises and skin care—to comprehensively fight lymphedema symptoms. However, CDT might not be appropriate for all patients, including those with high blood pressure, diabetes, paralysis, heart failure, blood clots or acute infections.
In very severe cases of lymphedema, your doctor might recommend a surgical option to get your symptoms under control. Possible procedures include liposuction, lymphaticovenous anastomosis (also called lymphovenous bypass), vascularized lymph node transfer surgery (a lymphovenous transplant) and the Charles procedure (skin grafts).
While there is no cure for lymphedema, there are practical steps you can take to keep yourself from developing symptoms—and if you already have it, there are many treatment options available. Close communication with your doctor is key for both preventing and treating lymphedema, so if you’ve got a surgery or other medical procedure coming up that could lead to lymphedema, discuss a strategic plan of approach with your doctor.