Lymphoedema

Congestion in the tissue

Lymphoedema: Congestion in the tissue

What is a lymphoedema?

Lymphoedema mainly occurs in the arms or legs: if the lymphatic vessel system is damaged, lymph fluid accumulates in the limbs, causing them to swell. The swelling is chronic, but with the right, long-term treatment those affected can achieve very good therapeutic success.

Causes of lymphoedema – how does lymphatic congestion occur?

The lymphatic vessel system is part of our body’s immune system. Similar to hazardous waste collection, the lymphatic vessels filter and dispose of substances dissolved in liquid – the “lymphatic load” or “lymph” for short. These include, for example, blood proteins, fatty acids and metabolic or inflammatory products. If the lymph drainage is disturbed, the lymph accumulates in the tissue – usually in the legs or arms. As a result, fluid accumulates in the interstitial tissue.

Lymphedema may be congenital (primary lymphoedema) or may only form in the course of life (secondary lymphoedema).

Congenital: primary lymphoedema

This type of lymphoedema is congenital. In most cases, lymph channels or lymph nodes were not properly formed or were malformed. The symptoms of primary lymphoedema can appear immediately after birth, but usually appear at a later stage. Causes of primary lymphoedema:

  • complete absence of lymphatic vessels (aplasia, mostly only in individual body parts)
  • lymphatic vessels are too narrow or are missing (hypoplasia)
  • expanded vascular walls (hyperplasia)
  • hardening of the lymph nodes (lymph node fibrosis)
  • absence of lymph nodes (lymph node agenesis)

Primary lymphoedema may also be a component in syndromes such as Klippel-Trénaunay syndrome.

Resulting from external influences: secondary lymphoedema

This form of lymphoedema refers to oedema that only occurs in the course of life and is not congenital. Secondary lymphoedema results from external influences:

  • operations (lymph nodes completely or partially removed)
  • radiotherapy
  • malignant diseases, such as tumours
  • injuries
  • skin inflammation (e.g. erysipelas)

A special case: lymphoedema and breast cancer (mammary carcinoma)

In Germany, secondary lymphoedema often occurs as a result of cancer. The lymphatic vessel system can be damaged by the cancer. However, required surgical removal of lymph nodes or radiotherapy can also cause lymphostasis.
If breast cancer affects the axillary lymph nodes, which are important for transport, secondary lymphoedema can develop in the arms.

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Lymphoedema: Symptoms and signs

Take permanent swelling of your arms or legs seriously. The following signs may indicate lymphoedema:

  • unilateral (asymmetrical) swelling
  • natural skin folds become deeper
  • arches of the feet / back of the hand affected
  • skin colour mostly unchanged
  • generally pain-free
  • slow hardening of the skin
  • positive Stemmer’s test


Recognising lymphoedema with Stemmer’s test

The so-called “Stemmer's sign” is a reliable way of detecting lymphoedema. Try to lift a fold of skin, for example at the toe:

  • positive Stemmer’s sign: if this hard or impossible, this is a “positive Stemmer’s sign”. This is a sign of lymphoedema. Furthermore, deep natural skin folds on the joints and swellings on the back of the feet and hands as well as bulging skin indicate lymphoedema.
  • negative Stemmer’s sign: if it is easy to lift a skin fold, this is called a negative Stemmer's sign. This indicates that no lymphoedema is present, but it does not fundamentally rule out lymphoedema. A doctor should always be consulted at an early stage.

They will initiate appropriate therapies. The earlier lymph patients start their treatment, the more likely it is to keep the oedema under control in the long term.

Quick test: lymphoedema – yes or no?

Do you have a swelling on your body and suspect lymphoedema? Then take the following test. The result can give you an initial indication as to whether you have lymphoedema. Please note that this test does not replace a visit to the doctor or a professional diagnosis.

Lymphoedema risk factors

Risk factors are all influences that affect the lymph nodes and vessels. Factors such as age and gender can influence the development of lymphoedema.

In some cases, lymphoedema arises from a previous venous disease. During cancer therapy, patients' lymph nodes are often irradiated or removed. This affects the entire lymphatic system and may also lead to oedema.

Stages of lymphoedema

Stage 0 – latent lymphoedema

  • the lymph vessels are damaged, but no swellings are visible yet, normal lymph drainage
  • no oedema exists (yet)

Stage 1 – spontaneously reversible lymphoedema

Swellings occur during the course of the day, which are completely or partially reduced when the patient is elevated. When pressure is applied to the tissue, a dent is formed which remains for some time.

  • impaired lymph drainage
  • an oedema occurs during the course of the day
  • reduction of the oedema after lying with the legs elevated
  • visible dent after strongly pressing with the finger

Stage 2 – not spontaneously reversible lymphoedema

The swellings remain even during longer rest periods. The skin is hardened and raising the arms or legs does not bring any relief. Dents are difficult or impossible to push in.

  • hardened oedema
  • no reduction of the oedema after lying with the legs elevated
  • difficult or impossible to press the skin indentation inwards

Stage 3 – Elephantiasis

There is swelling with skin changes (e.g. small blisters from which lymph fluid leaks). In the past, this more pronounced form of such swellings was also called “elephantiasis”.

  • bulky swelling with extreme proportions (formation of beads)
  • hardened skin
  • creation of bubbles and fistulas from which lymph can trickle
  • complications: Erysipelas; deep wounds which do not easily heal

Mixed lipo-lymphoedema and phlebo-lymphoedema: Lymphoedema as a consequence of lipoedema or a venous disease

Lipo-lymphoedema

Lipo-lymphoedema is a consequence of lipoedema. This is a chronic fat distribution disorder of the subcutaneous fatty tissue on the legs and arms. If the subcutaneous fatty tissue exerts considerable pressure on the lymphatic channels, secondary lymphoedema may occur.

Phlebo-lymphoedema

Chronic venous diseases can also be the cause of secondary lymphoedema. This is known as phlebo-lymphoedema. With chronic venous insufficiency, there is increased fluid leakage into the tissue. Initially, the lymphatic vessel system removes this increased amount of fluid. If the lymphatic vessel system is permanently overloaded, it can lose its function resulting in protein-rich oedema.

Prevention of lymphoedema

You cannot prevent lymph congestion caused by primary lymphoedema because the malformation of the lymph vessels is congenital. You also do not have any influence on whether or not lymphoedema develops after a medical intervention or after radiation.

How to relieve your lymphatic vessel system

Fundamentally you should avoid all factors that can cause an increase in tissue fluid or make lymph drainage more difficult.

     

Factors that strain your lymphatic system – what you should avoid

  • sitting or standing for prolonged periods: raise your legs and arms as often as possible.
  • tight clothing: constrictive clothing makes lymph drainage even more difficult.
  • being overweight: puts additional strain on the lymph vessels.
  • too much salt in the diet: binds the water in the body. You can find information about diet for lymphoedema here.
  • long periods of sunbathing, sauna visits or hot tubs: heat dilates the vessels.
  • stress and extreme cold: both constrict the vessels.

Diagnosis and therapy: How can lymphoedema be treated?

Lymphoedema is a chronic disease and cannot be cured, but with the right, long-term therapy you can achieve very good success in terms of decongestion and maintaining the outcome. The most effective method of treatment for lymphoedema is complex decongestive therapy (CDT).

Complex decongestive therapy (CDT) as a basic therapy for lymphoedema

Complex decongestive therapy (CDT) consists of two phases and is built on five pillars:

Phase 1 – decongestive phase

The objective is to first unblock the affected limbs and reduce their circumference by daily manual lymph drainage and lymphatic compression bandages. In this phase, a therapist performs manual lymph drainage once or twice a day to promote the removal of fluid from the tissue.

The first phase of Complex Decongestive Therapy usually takes several weeks. The maintenance phase only begins when no further reduction in circumference is achieved in the affected body regions.

Phase 2 – maintenance phase

The maintenance phase of CDT aims to maintain the successes from the decongestion phase and further improve the tissue. Measures in the maintenance phase are usually continued for the rest of the patient’s life. In phase 2, the components of CDT are used more or less frequently – but regularly – depending on the diagnosis.

The compression bandage is also replaced with medical compression stockings: usually, flat knit medical compression stockings are used. Additional therapeutic measures, especially skin care and gymnastics, are also important success factors in this phase.

The five pillars of CDT

1. Manual lymph drainage (MLD):

Manual lymph drainage is a massage technique performed by specialised therapists: a lymph therapist stimulates lymphatic drainage with certain movements. Mild mechanical stimuli stimulate the lymphatic vessels to work harder, i.e. to better remove lymph fluid from the tissue. 

2. Compression therapy

In the decongestive phase, a lymphological compression bandage is applied after each MLD. This is adjusted to the daily changing circumferences of the affected limbs. Without compression, the affected extremity would quickly swell again.
In the maintenance phase, flat knit medical compression stockings are used to prevent the recurrence of oedema. These are prescribed by a doctor and are available from specialist medical retailers.

3. Hygiene and skin care

Daily thorough skin care with special care products is essential for lymphatic diseases: the skin is particularly sensitive and has a tendency to become dry and itchy. Infections, inflammations and wound healing disorders arise quickly, because the upper skin layer often is not supplied with sufficient moisture: the skin can no longer perform its natural barrier function. The medi care series may only be used on undamaged skin and is tailored to the needs of compression stocking wearers.

Tip: With lymphoedema therapy, even minor skin irritations should be taken seriously and, if necessary, shown to a dermatologist.

5. Learning and self-management

In order to get the best therapy results, the motivation of the patient is also decisive. They need to get involved in the treatment as independently and actively as possible under the guidance of a therapist. This personal commitment requires the patient to be informed and trained to understand the necessity of the therapy components.

Infographic nutrition for lipoedema and lymphoedema
Discover how the right nutrition can contribute to greater wellbeing.

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Positive factors: prophylaxis for lymphoedema patients in everyday life

Even small changes in behaviour can improve wellbeing:

  • Take care of your skin and avoid injuries: Lymphoedema patients are more prone to infections.
  • Relieve your legs through regular exercise.
  • Practice suitable exercises (water aerobics / swimming) and sports with low risk of injury.
  • Disinfect even the smallest injuries immediately.
  • In case of redness, swelling or fever, consult a doctor immediately.
  • And last but not least: Wear medical compression stockings​​​​​​​​​​​​​​ every day, especially when you exercise (e.g. when doing sports).

Tip: Share information with other affected people, for example in an online forum or in a local self-help group. Lymph patients come together in these places to exchange information and support each other: they share experiences and news about treatment and around everyday life with their disease. In addition, collaborative projects are undertaken and expert lectures are organised.

Which doctor treats lymphoedema?

Depending on the situation, it may be general practitioners, oncologists or specialists and clinics specialising in lymphoedema. When searching for a suitable specialist, be sure to look for “Phlebologist” or “Lymphologist”. Your doctor will prescribe potential therapies (for example lymph drainage or compression stockings) if necessary.

The doctor will prescribe a lymphological compression treatment if the diagnosis is correct. Your legs are precisely measured for the stockings in specialist medical stores.

Lymph network groups combine therapy knowledge and practice

Lymph network groups exist in many regions. A lymphatic network is a multidisciplinary, interdisciplinary association of all those involved in the therapy: it includes (specialist) doctors, lymph therapists and representatives of the medical specialised trade with a lymphological focus.

Competent support for patients on their way to successful therapy

Lymph networks maintain a constant exchange of experience, they continue to learn from each other and hold educational events for those affected. The purpose of such collaborations is to guarantee a high level of diagnostic and therapeutic reliability through close cooperation – with the aim of achieving optimal treatment results and an improved quality of life for patients.

Research a lymph network in your area online.

Products by medi: Lymphological treatment is as individual as the patients

Every person is different. Lymphoedema patients in particular have different requirements for their compression care depending on their physique, clinical picture and life situation. medi offers individual products that not only meet medical requirements, but also satisfy users' fashion demands: customised, flat knit compression fittings.

Lymphoedema and fashion: individuality and self-confidence in lymphoedema therapy with colours and patterns

medi increases the confidence of lipoedema and lymphoedema patients so they can wear their compression stockings with pride. Colours, patterns and design details create individuality.
Experience our full range of colours, patterns, accessories, design and fashion elements.

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Health personnel will make the diagnosis and can prescribe compression stockings, e.g. from medi if necessary.

Your medical retailer will fit them individually for you.