What is Lymphedema?
Lymphedema is a blockage or damage of the lymph vessels resulting in an accumulation of lymph fluid, which leads to chronic swelling primarily of the arms, legs but can also affect other body parts.
The lymphatic system is responsible for removing lymph fluid, consisting of fat, protein, water and cell waste, from the tissue spaces. When lymph vessels become blocked or damaged, excess lymph fluids begin to accumulate. Lymphedema can affect infants, children, women and men of all ages. If left untreated, lymphedema will progress and increase in severity.
Symptoms of Lymphedema
The symptoms of lymphedema vary with each individual; however, some common symptoms include:
- Swelling of the arm(s), leg(s), or other parts of the body
- A feeling of heaviness or discomfort in the affected body part, which may result in a loss of mobility
- Recurrent infections in the affected area
- Hardening or thickening of the skin in the affected area
- Lymph fluid leaking through the skin
Types of Lymphedema
Patients experiencing lymphedema have either primary or secondary lymphedema.
Primary Lymphedema is a result of congenital malformation of the lymphatic system. Primary lymphedema may be present at birth, occur later in life, depending on the type and degree of malformation present.
Secondary Lymphedema is a result of damage to the lymphatic system caused by infection, blood clots, and removal of lymph nodes, radiation, surgery or other trauma.
*NOTE: It is important for a patient’s physician to rule out other medical conditions that may be contraindicated for lymphedema treatments including: blood clots, CHF, active cancer, renal failure, etc.
Treatment of Lymphedema
The recommended treatment for lymphedema is Complete Decongestive Therapy (CDT) and it is performed in two phases. Phase 1: "Intense Phase" the goal being to decrease swelling. Phase 2: "Home Phase" the goal being to teach the patient and family the skills to manage this chronic condition at home.
Four Components of Compete Decongestive Therapy
Manual Lymph Drainage (MLD)
This is a gentle manual treatment performed directly on the skin to improve the activity of the lymphatic system. Manual treatment stimulates the lymph vessels in the trunk that carry lymph fluid to the other lymph nodes. Next, the lymph fluid in the congested limb is gently directed toward the healthy nodes. From there, the lymph is transported back into the blood system.
After each MLD session, the affected limb or body part is wrapped with bandages to prevent re-accumulation of lymph fluid in the affected area. These bandages are short-stretch bandages, which apply a graded pressure to the limb.
Patients are taught this wrapping technique and instructed to wear the bandages until the next treatment session during phase one.
Gentle exercise is incorporated into treatment to improve the lymph vessel activity and improve the lymph circulation. These exercises are performed while the bandages are in place. This provides a semi-rigid barrier for the muscles to pump against, which in turn improves lymph circulation.
Skin & Nail Care Education
Diligent skin and nail care are important in the management of lymphedema. As the affected limb swells, the body’s ability to fight infection in that area is decreased, resulting in frequent infections. These infections occur as cellulites, lymphangitis or fungal infections of the nails.
Patients are taught skin care precautions, including the use of low pH, lanolin based lotion. This keeps the affected region well hydrated and decreases the chance of skin cracks through which infection can enter.