What is Lymphedema

Lymphedema is swelling that is caused by the abnormal collection of lymph in the tissues under the skin. Lymph is fluid from the tissues in your body that is removed through the lymphatic system.

This system is part of your body’s defense system (immune system) and includes lymph nodes and lymph vessels. The lymph vessels collect and carry the excess fluid, fats, proteins, and wastes from the tissues of the body to the bloodstream. This system also works to clean and remove bacteria and waste products from the body.

Lymphedema occurs when the lymphatic system is blocked. When the lymph vessels or lymph nodes are blocked or damaged, lymph does not drain properly. This causes an abnormal buildup of lymph, which leads to swelling in the affected area. This may include the trunk area, or an arm or leg. Lymphedema cannot be cured by medicines, but various methods can be used to help reduce the swelling.

There are two types of lymphedema: primary lymphedema and secondary lymphedema.

What are the causes?

The cause of this condition depends on the type of lymphedema that you have.

• Primary lymphedema is caused by the absence of lymph vessels or having abnormal lymph vessels at birth.
• Secondary lymphedema occurs when lymph vessels are blocked or damaged. Secondary lymphedema is more common. Common causes of lymph vessel blockage include:
  • Skin infection, such as cellulitis.
  • Infection by parasites (filariasis).
  • Injury.
  • Radiation therapy.
  • Cancer.
  • Formation of scar tissue.
  • Surgery.

What are the signs or symptoms?

Symptoms of this condition include:

• Swelling of the arm or leg.
• A heavy or tight feeling in the arm or leg.
• Swelling of the feet, toes, or fingers. Shoes or rings may fit more tightly than before.
• Redness of the skin over the affected area.
• Limited movement of the affected limb.
• Sensitivity to touch or discomfort in the affected limb.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and medical history.
• A physical exam.
• Bioimpedance spectroscopy. In this test, painless electrical currents are used to measure fluid levels in your body.
• Imaging tests, such as:
  • Lymphoscintigraphy. In this test, a low dose of a radioactive substance is injected to trace the flow of lymph through the lymph vessels.
  • MRI.
  • CT scan.
  • Duplex ultrasound. This test uses sound waves to produce images of the vessels and the blood flow on a screen.
  • Lymphangiography. In this test, a contrast dye is injected into the lymph vessel to help show blockages.

How is this treated?

Treatment for this condition may depend on the cause of your lymphedema. Treatment may include:

• Complete decongestive therapy (CDT). This is done by a certified lymphedema therapist to reduce fluid congestion. This therapy includes:
  • Manual lymph drainage. This is a special massage technique that promotes lymph drainage out of a limb.
  • Skin care.
  • Compression wrapping of the affected area.
  • Specific exercises. Certain exercises can help fluid move out of the affected limb.
• Compression. Various methods may be used to apply pressure to the affected limb to reduce the swelling. They include:
  • Wearing compression stockings or sleeves on the affected limb.
  • Wrapping the affected limb with special bandages.
• Surgery. This is usually done for severe cases only. For example, surgery may be done if you have trouble moving the limb or if the swelling does not get better with other treatments.

If an underlying condition is causing the lymphedema, treatment for that condition will be done. For example, antibiotic medicines may be used to treat an infection.

Follow these instructions at home:

Self-care

• The affected area is more likely to become injured or infected. Take these steps to help prevent infection:
  • Keep the affected area clean and dry.
  • Use approved creams or lotions to keep the skin moisturized.
  • Protect your skin from cuts:
    • Use gloves while cooking or gardening.
    • Do not walk barefoot.
    • If you shave the affected area, use an electric razor.
• Do not wear tight clothes, shoes, or jewelry.
• Eat a healthy diet that includes a lot of fruits and vegetables.

Activity

• Exercise regularly as directed by your health care provider.
• Do not sit with your legs crossed.
• When possible, keep the affected limb raised (elevated) above the level of your heart.
• Avoid carrying things with an arm that is affected by lymphedema.

General instructions

• Wear compression stockings or sleeves as told by your health care provider.
• Note any changes in size of the affected limb. You may be instructed to take regular measurements and keep track of them.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take or apply it as told by your health care provider. Do not stop using the antibiotic even if you start to feel better.
• Do not use heating pads or ice packs over the affected area.
• Avoid having blood draws, IV insertions, or blood pressure checked on the affected limb.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you:

• Continue to have swelling in your limb.
• Have a cut that does not heal.
• Have redness or pain in the affected area.

Get help right away if you:

• Have new swelling in your limb that comes on suddenly.
• Develop purplish spots, rash or sores (lesions) on your affected limb.
• Have shortness of breath.
• Have a fever or chills.

Summary

• Lymphedema is swelling that is caused by the abnormal collection of lymph in the tissues under the skin.
• Lymph is fluid from the tissues in your body that is removed through the lymphatic system. This system collects and carries excess fluid, fats, proteins, and wastes from the tissues of the body to the bloodstream.
• Lymphedema causes swelling, pain, and redness in the affected area. This may include the trunk area, or an arm or leg.
• Treatment for this condition may depend on the cause of your lymphedema. Treatment may include complete decongestive therapy (CDT), compression methods, surgery, or treating the underlying cause.