Lymphedema is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system. This results in swelling in one or more limbs. However, lymphedema can also occur in other body parts, e.g. neck, genital region, inguinal region, face, etc. Approximately 1/3 to 1/4 of lymphedema cases have a primary (e.g. genetic) cause that led to a compromised lymph system. Women are six to 10 times more likely to develop primary lymphedema than men.
Secondary lymphedema occurs if a secondary reason is responsible for the damage that affected the lymphatic system (e.g. cancer, cancer treatment, surgery, infections, etc.)
Here’s what you should know about lymphedema, its treatment, and why compression therapy is essential.
The lymphatic system is a large network of lymphatic vessels and lymph nodes that plays an important role in transporting lymph fluid, immune function, fluid homeostasis, blood cleaning, and blood filtering.
The lymphatic system is our “waste disposal and recycling” unit. It transports waste products and toxins out of the body. Body waste products include proteins, metabolic breakdown products, inflammatory products, and fat from the abdominal cavity.
The lymphatic vessels, which are spread throughout the body like a net, carry a clear fluid called lymph towards the thoracic duct, which drains into the blood circulation at the venous-lymphatic junctions in the neck.
Lymph is formed from the fluid that filters out of the blood circulation into the interstitium and taken up by the blind-ended lymph-sinuses. The lymph consists of interstitial fluid, proteins (smaller than albumin), fibrinogen, and other coagulation factors, small molecules and ions of the serum and interstitium, leucocytes, immunoglobulins, fat in form of chylomicrons, cellular debris, waste products, and bacteria.
The lymphatic system is responsible for the majority of fluid uptake from the interstitial spaces. This collection of fluid is carried out by the initial lymph-sinuses, that are blind-ended epithelial lined vessels with fenestrated openings that allow fluids and particles as large as cells or proteins smaller than albumin to enter.
The fluids are then sucked and pressed into lymph pre-collectors. The lymph collectors and continually larger lymph vessels have a lymph valve system and lymphangiones (e.g. enlarged units with smooth muscle cells between two lymph vessels).
Through active contraction of the lymphangiones and restricted back flow of lymph due to the lymph vales, the lymph is transported in proximal direction through the lymph vessels and through lymph nodes.
Hundreds of lymph nodes are located within the human body (e.g. around the neck, intestinal tract or in the axilla or groin area) and are responsible for the removement of debris, regulation of the protein content of the lymph, the immune response, recirculation of lymphocytes, and re-absorption of water (approximately 5 to 8 liters per day).
Every day the lymphatic system takes up approximately 10 liters of interstitial fluid.
If the lymphatic drainage is intact, the initial lymph vessels, vessels with blind ends and windowed openings, transport the lymph fluid from the interstitial spaces.
Lymphedema can develop if the lymphatic drainage is interrupted, impaired, or if secretion of fluid into the interstitial tissue exceeds the uptake capacity of the lymph system.
Lymphedema is classified in two subtypes: primary lymphedema and secondary (or acquired) lymphedema.
The following factors can be causes of or lead to a progression or aggravation of existing lymphedema:
Depending on disease progression, lymphedema can be divided into three stages.
There are different possibilities to treat lymphedema. The “gold standard” and key treatment is the complex physical decongestive therapy (CPD).
Complex physical decongestive therapy (CPD) is based on two main pillars: manual lymphatic drainage (MLD) and medical compression. These two pillars are complemented by skin care, dietary changes, and exercises.
The treatment goal in the first phase of CPD is to reduce the volume as much as possible (reduction phase). Typically, medical compression in this phase consists of multi-layered bandage wrapping applied by a therapist or other medical professional that needs to to be replaced on a daily basis. The first phase of CPD lasts between 2 to 6 weeks, depending on the extent and stage of the lymphedema. Skin care is also very important.
In the second phase of CPD – called the maintenance phase – the goal is to conserve and optimize the volume reduction that was achieved in the first phase. Medical compression with flat-knit compression wear, skin care, exercise, and repeated MLD as needed, are the main elements of treatment.
There are several products that are used for lymphedema compression therapy.
If the lymph flow is chronically disturbed, the protein-rich liquid accumulates in the soft tissue and the swollen body parts become inflamed. Also, the function of the immune system is reduced since the lymph system is impaired. Even a small injury to your arm or leg can be an entry point for infection (such as cellulitis or erysipelas) or severe inflammation. Thus, it is important you maintain the integrity of your skin and carefully manage skin problems. This way, you minimize the risk of infections.
Skin care principles include:
Basic motions of the extremities (muscle pumping exercises), especially combined with external limb compression, performed on a daily basis (walking, yoga, bicycling, climbing stairs) are useful.
Persistent, asymmetric, and painless swelling in one or several of your limbs with a feeling of tightness could be a sign of a compromised lymphatic system. If other family members are also affected by swelling of the limbs or if you had a past cancer treatment or surgery where lymph nodes had to be extracted, it is recommended that you contact your doctor to clarify if you suffer from lymphedema.