HEALTH
Lymphedema is a very common condition that affects at least three million Americans. You can get lymphedema in your arms, legs, head, neck, trunk, and even genitalia. Lymphedema can begin suddenly or gradually. Lymphedema can be painful and uncomfortable. Most often, lymphedema presents after surgical or radiation treatments for breast cancer. Unfortunately, there is no cure for lymphedema, but self-management can control its progression and improve the quality of the patient’s life. (2)
Understanding Lymphedema:
Lymphedema is a chronic disease caused by an abnormal accumulation of protein-rich fluid in the affected area of the body. This causes localized swelling and can also lead to skin changes. (1) As previously stated, swelling from lymphedema can occur anywhere in the body. (2) Lymphedema is not the same as edema. Edema is a symptom caused by an accumulation of water in the body’s tissues. For example, when you sprain your ankle, it gets swollen, due to a dynamic insufficiency or high-volume insufficiency of the lymphatic system. In other words, the lymph volume exceeds the transport capacity that a healthy lymphatic system can relocate. (3) In contrast, lymphedema is a disease caused by a mechanical insufficiency of the lymphatic system. In other words, the lymphatic system is damaged and is unable to function properly. (3) There are also different stages of lymphedema. These stages are determined by the changes in the skin, not the amount of swelling of the affected body part. Staging will be discussed later.
What is the Lymphatic System
The lymphatic system is part of the circulatory system and also has a network of vessels. The main function of the lymphatic system is to collect and transport fluid from the intercellular spaces of tissue in the body, and return it back to the venous system. (3) It drains those substances that cannot be drained or reabsorbed by the vascular system. It also absorbs and transports fatty acids from the digestive system and plays a crucial role in the body’s immune response. Lymph travels along the vessels and through glands, called lymph nodes, which filter the impurities from the lymph fluid. There are two layers of vessels in the lymphatic system: a superficial layer and a deep layer. (3) These layers are separated by fascia. The superficial vessels are responsible for the drainage of skin and subcutaneous tissue. The deep vessels drain lymph from muscles, tendons, joints, and internal organs. (3)
What Causes Lymphedema
There are 2 types of lymphedemas: primary and secondary.
- Primary lymphedema is a developmental abnormally of the lymphatic system. Although it is a congenital malformation of the lymphatic system it isn’t always present at birth, it can present later in life. Often, lymphedema occurs during puberty or pregnancy. This type of lymphedema typically effects the legs, but can also affect the arms. (3)
- Secondary lymphedema is caused by an injury to the lymphatic system. These injuries can be the result of surgery, radiation, infection, cancer or trauma. For example, treatment for breast cancer frequently includes a mastectomy or lumpectomy with removal of local lymph nodes and can result in lymphedema. Severe venous insufficiencies can also contribute to the onset of lymphedema. (3)
Stages of Lymphedema:
There are 4 stages for lymphedema. These stages are based on the skin changes that occur and the type of edema that is present, not the amount of swelling. (2)
- Stage 0, Pre-stage or latency: This stage is spoken about least often because there is no visible swelling. However, any person who undergoes surgery for trauma to the lymph system or involving the lymph system is considered to be in this stage. It is also known as hidden lymphedema. (1,2,3)
- Stage 1: Lymphedema at this stage is reversible. There is a high chance that the swelling will improve significantly. The edema is soft and pitting and there are no skin changes. Also, elevating the area will reduce swelling. (1,2,3)
- Stage 2: At this stage, the lymphedema is irreversible. The skin hardens and pitting is difficult. They may also experience frequent infections due to the amount of fluid under the skin. (1,2,3)
- Stage 3: This is the most severe stage. Skin breakdown occurs, and the person develops frequent infections. Also, the natural folds in the skin get deeper. (1,2,3)
How Can a Lymphedema Therapist Help?
A certified lymphedema therapist is equipped with the knowledge and skills to improve the swelling an individual experiences due to the disease, regardless of the location of that swelling (arms, leg, trunk, face or genitalia). The gold standard for treating lymphedema is complete decongestive therapy. This therapy includes manual lymphatic drainage, compression, skin care, and exercise. Manual lymph drainage (MLD) improves the activity of the lymph vessels as it mobilizes the lymphatic fluid and re-routes lymph fluid around blocked/damaged areas. (3) Compression increases reabsorption of the lymph fluid but also provides support for skin that has lost elasticity due to the amount of fluid underneath the skin. As previously stated, the increased fluid beneath the skin, increases the diffusion distance from the blood capillaries and the skin cells. When swelling is present, the local immune response is compromised due to the increased distance the nutritional supplies to the cells suffer, putting the person with lymph edema at a higher risk of infection. Also, dry skin can lead to cracking which can also lead to infection. (3) Based on the amount of swelling, there can be increased folds in the skin which can also increase bacterial or fungal growth. For all these reasons, good skin care is essential for a person with lymphedema. Finally, exercise is very important. This may seem unimportant or extremely difficult to the person who is having difficulty feeling and moving the affected area. However, exercise improves lymph transportation, improves and increases venous return, and optimizes joint and muscle pumping which all helps lymphatic flow. These exercises are not strenuous; they include diaphragmatic or belly breathing, and basic mobility exercises. Ideally, exercises should be performed with a compression garment. (3)
Self-Management of Lymphedema
Learning about the causes and risk factors for lymphedema is the first step toward managing this condition. Compression therapy during the day, with compression sleeves, gloves, or stockings, helps reduce swelling and improve lymphatic flow. Individuals with lymphedema should maintain low impact activities and motion exercises. (2,3) Vigilant skin care to prevent infections, cuts, burns, and insect bites is essential. Self-manual lymph drainage, though not as effective as that done by a trained therapist, is helpful to stimulate the lymphatic system. Diet and weight management are also important management techniques because maintaining a healthy weight can alleviate stress on the lymphatic system. Staying hydrated and reducing salt intake can also help manage fluid buildup. Psychological support can also be very helpful since this disease can be mentally/emotionally challenging and frustrating. (2,3)
Conclusion:
Living with lymphedema can be very challenging, however there are self-management strategies and professional therapies that can improve overall quality of life and prevent the condition from worsening.
References:
1. Kayıran O, De La Cruz C, Tane K, Soran A. Lymphedema: From diagnosis to treatment. Turk J Surg. 2017;33(2):51-57. Published 2017 Jun 1. doi:10.5152/turkjsurg.2017.3870
2. Sleigh BC, Manna B. Lymphedema. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. [Updated 2023 Apr 19]. Available from https://www.ncbi.nlm.nih.gov/books/NBK537239/.
3. Zuther, J. E., & Norton, S. (2018). Lymphedema management: The Comprehensive Guide for Practitioners. Thieme.
