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The body can experience lymphedema, a condition in which lymph, a clear and thick fluid, accumulates in the tissues. Lymph flows through a network of small vessels that lead to round formations known as lymph nodes throughout the body. This system is comparable to a parallel track to the bloodstream, and it’s necessary for cleansing cells and tissues by collecting proteins, water, salts, and toxins, filtering them in the liver and kidneys, and excreting them in the urine.
Unlike blood, lymph flows in one direction, from the limbs and head to the chest area. The flow of lymph is facilitated by muscle contractions throughout the body, and the presence of special valves in the lymphatic vessels prevents backward flow.
To treat lymphedema, different techniques are available, including compression therapy, manual lymphatic drainage, exercise, and skin care. Similar methods can also manage chronic swelling, and it’s essential to identify any underlying conditions that could be contributing to the swelling, such as heart or kidney disease.
The lymphatic system produces up to two liters of lymph every day. However, when there is a problem with the lymphatic system, lymph can start to accumulate in the area between organs, resulting in swelling. This condition is known as lymphostasis or lymphedema.
Lymphostasis: its classification and underlying causes
Lymphostasis typically results from harm to the lymphatic vessels, with around 90% of cases affecting the legs, 10% involving the arms, and occasional incidences affecting the face, torso, or genital area.
Two primary types of lymphedema exist, namely primary and secondary.
Primary lymphedema is a congenital disease caused by anomalies of the lymphatic vessels, which is diagnosed in children, or hereditary changes in the lymphatic system of the limb affected by lymphedema. In the latter case, the signs of lymphedema usually appear during puberty.
Secondary lymphedema can occur for various reasons:
- Infectious diseases;
- Injuries such as bruises, fractures, and penetrating wounds;
- Obesity;
- Breast cancer and the consequences of its treatment.
Infectious diseases
Lymphedema can be triggered by infectious diseases such as erysipelas and phlegmon. Erysipelas, also known as erysipeloid inflammation, is a skin condition caused by streptococcus, which has well-defined borders on the skin and often results in damage to the lymphatic system. On the other hand, phlegmon is a condition characterized by acute purulent inflammation, caused by staphylococcus, E. coli, or anaerobic bacteria, such as clostridia.
Lymphedema after mastectomy
Secondary lymphedema can be caused by lymphedema after mastectomy, a severe swelling that occurs in the arm of about 25% of women who have undergone breast removal. Mastectomy usually involves the removal of some of the lymph nodes, and this can impair the functioning of the lymphatic system, leading to lymphedema. Additionally, lymphedema can occur even before surgery if the tumor inside the breast puts pressure on the lymph nodes.
Symptoms of lymphedema at different stages
The primary symptom of lymphedema is the swelling of limbs. Initially, the swelling may not be very noticeable and is almost painless, but the skin leaves a depression when pressed. As the condition worsens, it can become painful and affect various areas of the body, including the neck, abdomen, and back.
In some cases, the limbs can swell to such an extent that a person can no longer use them for work or even move around the house easily. The pain associated with the swollen limb can interfere with daily activities and disrupt sleep. It is not recommended to treat the swelling with hot or cold compresses, so it is essential to seek medical advice.
Another concerning symptom is the appearance of red spots, which can be accompanied by pain, itching, and burning. These symptoms indicate skin damage as lymph accumulates in the intercellular space, leading to frequent inflammations, dryness, and thickening of the skin. It’s especially dangerous as it can cause ulcers in people with lymphedema in their legs that may be challenging to treat.
Furthermore, the absence of a pattern of subcutaneous veins may also be a symptom of lymphedema, although it is not a reliable indicator as the veins may not always be visible on the skin of healthy individuals’ extremities.
Mechanism underlying the development of lymphostasis
When there is a disturbance in the lymphatic system’s function, it upsets the balance between the production of lymph and the pumping function of the lymphatic vessels. This can result in tissue edema and a disruption of metabolic processes in the body. Lymph then accumulates in the interstitial space between organs, which initiates the onset of lymphedema.
During the initial stage of lymphedema development, changes in the appearance and functioning of the affected limb may be imperceptible or barely noticeable. Although edema appears, it may subside after a period of rest or when the limb is elevated.
During the second stage, the edema persists and the affected limb feels soft while painful sensations arise, accompanied by a deterioration in mobility.
During the third stage, the edema hardens and expands in size, potentially leading to the skin developing a brownish-gray hue. Without seeking medical attention, these changes can become irreversible. Ideally, seeking medical help during the first stage is recommended.
The dangers of lymphedema
Failure to treat lymphedema can result in disability. During the third stage of the disease, lymph may seep out of the body through breaks in the skin, making it impossible to restore the healthy appearance and mobility of the limbs.
Inflammation and trophic ulcers that go untreated can result in complete immobility of the affected limbs due to severe, persistent edema, and may even lead to death as a result of infectious complications.
Diagnosis of lymphedema
To obtain an accurate diagnosis, it is recommended to seek advice from a phlebologist. The doctor conducts a physical examination and reviews the medical history of the patient. Blood tests such as general, biochemical, and coagulogram may also be prescribed if deemed necessary.
Furthermore, instrumental studies are commonly recommended. One such study is Dopplerography of the lower extremities, which is a non-invasive ultrasound examination that evaluates the condition of the leg veins. This test is harmless, and it helps distinguish lymphedema from varicose veins while identifying any associated vein-related issues.
Another method is lymphography, which is an X-ray technique that evaluates the lymphatic pathways’ patency. In this procedure, a contrast medium is gradually introduced into the lymphatic vessel, and one or more X-rays are taken. Lymphography is a safe diagnostic test, and the received dose of X-ray radiation usually does not harm the body. It is needed to locate the inflammation site and determine the lymph nodes’ damage nature and extent.
Lymphoscintigraphy, or scintigraphy of lymph nodes, is another diagnostic method that involves subcutaneously or intracutaneously injecting radioactive isotopes into the body. The isotopes then spread through the lymphatic vessels and release gamma rays, which are detected using a gamma camera. This technique generates scintigrams that help identify impaired lymphatic vessel patency. Lymphoscintigraphy is a safe test because radioactive isotopes are usually excreted from the body within one to two days.
How to treat lymphedema
A complete cure for this condition is unlikely due to its chronic nature, and therapy typically focuses on alleviating symptoms. Lymphedema is difficult to cure as the lymphatic vessels are delicate and restoring their patency is often challenging after damage has occurred. Consequently, lymph may occasionally accumulate under the skin, and the objective of treatment is to prevent stagnation of lymph in the tissue for an extended duration.
What is included in the treatment of lymphedema
Comprehensive anti-edema therapy is currently the only effective way to manage lymphedema. This treatment approach includes manual lymphatic drainage massage, compression bandaging, skin care, and therapeutic exercises. Venotonic drugs and physiotherapy have proven to be ineffective in treating this condition.
Manual lymphatic drainage massage is a gentle, rhythmic technique that uses stroking movements to promote lymphatic flow towards the body’s core. The duration of each session is approximately an hour, and the discomfort experienced by patients during massage depends on the severity of their lymphedema.
Pneumatic compression massage is similar to manual lymphatic drainage massage, but it involves the use of cuffs that rhythmically pump air. Research has shown that machine-assisted massage is an effective and more cost-effective alternative to manual massage.
Bandaging, typically with elastic bandages or compression knitwear, is used to support the effect of massage. A healthcare specialist selects the most suitable type of bandage based on the severity of the disease and the patient’s individual health characteristics. Bandaging prevents the recurrence of swelling by preventing lymph accumulation in areas with damaged vessels.
Therapeutic exercise is another essential part of anti-edema therapy. The specialist prescribes the exercise program based on the patient’s degree of the disease and individual health characteristics. The exercises aim to strengthen the vessels and maintain the effects of massage and bandaging.
Surgical treatment is not always effective in treating lymphedema and is usually only recommended when conservative treatment is unsuccessful. Even with a successful surgical intervention, patients may still require regular massage or compression garments. Therefore, the suitability of surgery should be discussed with the treating doctor.
Skin care for lymphedema
Lymphedema patients are advised to regularly moisturize their skin to prevent the appearance of cracks and subsequent infections. It is important to quickly treat any cuts or scratches, avoid insect bites, and carefully shave to prevent cuts. If a wound infection is suspected, it is recommended to seek medical attention.
Keeping the affected limb clean is essential and for the arm, it is advised to avoid wearing jewelry and to use gloves when cleaning. For the leg, tight shoes and bracelets should be avoided as they can compress the skin.
Do exercises help with lymphedema?
Regular exercise is important for managing lymphedema, in addition to massage and bandaging. Lymphatic drainage exercises are helpful at any stage of the disease, but they do not replace massage and bandaging. A specialist trained in lymphedema management will choose exercises based on a patient’s condition and physical characteristics.
For leg lymphedema, it is recommended to exercise in compression stockings and repeat each exercise 5-10 times. Good exercises to try while lying down include extending the legs forward, sliding the heels on the floor, raising and lowering the legs, and doing the “bicycle” and “scissors” exercises.
Prevention of lymphedema
To reduce the risk of recurrent edema, it is important to be careful with the affected lymphedematous limb.
Avoid injuries
Skin infections can arise from cuts, scratches, or burns, which is why it’s crucial to avoid them. Make sure your shoes fit comfortably and do not cause any rubbing, and refrain from walking barefoot where sharp objects could be present. When working in the garden or sewing, consider wearing gloves or using a thimble if you have lymphedema in your arms.
Keep your limbs elevated
In case of arm swelling, it’s advisable to frequently move them during the day, lifting them above your head. If you have leg swelling, avoid standing in one place for extended periods of time and do not carry heavy loads. When sitting, use a footstool to aid in lymphatic drainage.
Maintain good hygiene
Taking care of your skin and nails is not only important for appearance but also for your health. Check the skin of the affected limb daily to identify any changes, ulcers, or thickening of the skin. Be cautious while trimming your nails; don’t cut them too short to avoid ingrown nails or inflammation, but don’t leave them too long to prevent accidental scratching of the skin.
Do not use compresses
Using ice or a heating pad on the affected limb may not alleviate the swelling, and could potentially cause harm. It’s important to avoid overheating or excessively cooling the affected hands or feet, so dress appropriately for the weather and check with your doctor before going to saunas or swimming pools.
Avoid tight clothing
Consider going through your wardrobe and discarding any clothes and jewelry that may constrict your arms and legs, as they could potentially contribute to the development of swelling. Additionally, if one arm is swollen, it may be best to measure blood pressure using a tonometer on the other arm, and make sure to inform your doctor about this.
Remember:
- Lymphedema is a chronic disease of the lymphatic system that causes swelling of the arms and legs, along with potential pain and skin changes.
- If experiencing unexplained limb swelling, it is important to see a therapist or phlebologist to rule out urgent treatable conditions.
- There is no known cure for lymphedema, but it can be managed through regular massage, bandaging, and therapeutic exercise to reduce swelling.
- Ointments and tablets for lymphedema treatment are typically ineffective and should be discussed with a specialist before use.
- Adjusting one’s lifestyle, avoiding injuries, and limiting excessive physical activity can help reduce the frequency of swelling episodes.
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