Lymphoedema Management

Lymphoedema Management. Effective Strategies for Managing Swelling and Improving Lymphatic Function

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What is Lymphoedema

Lymphoedema is a chronic condition characterized by fluid accumulation from the lymphatic system in the body’s tissues, resulting in swelling, mainly in the limbs and other body parts. The lymphatic system is made of a network of vessels, ducts, and nodes that help remove excess fluid from the body’s tissues and transport it back to the bloodstream. When the lymphatic system is damaged or does not function properly, this can lead to a build-up of lymphatic fluid in the affected area, resulting in swelling and other symptoms. Lymphoedema can occur due to various factors, including surgery, radiation therapy, certain types of cancer, and certain genetic conditions.

What causes Lymphoedema?

The causes of Lymphoedema can be divided into two categories: primary and secondary Lymphoedema.

Primary Lymphoedema is caused by a genetic defect in the development of the lymphatic system; it is a rare condition not caused by an external condition that can be present at birth or develop later in life.

Secondary Lymphoedema is caused by an external factor that damages or impairs the function of the lymphatic system. The most common causes are:

• Surgery: Lymph nodes or vessels may be removed or damaged during surgery, leading to Lymphoedema. This is particularly common in breast, prostate, or gynaecological cancer surgeries.
• Radiotherapy: Radiation therapy can damage or destroy lymph vessels and nodes, leading to Lymphoedema.
• Cancer: Certain types of cancer, such as breast or melanoma, can invade and damage the lymphatic system, leading to Lymphoedema.
• Infections: Chronic infections such as filariasis can damage the lymphatic system, leading to Lymphoedema.
• Trauma: Trauma to the lymphatic system, such as injury, burns, or fractures, can lead to Lymphoedema.
• Obesity: Obesity can put extra pressure on the lymphatic system, making it harder for the body to drain fluids and increasing the risk of Lymphoedema.
• Age: as people age, their lymphatic system may not function as well, increasing the risk of Lymphoedema.
• Gender: women are more likely to develop Lymphoedema than men.

Not all people with one or more of these risk factors will develop Lymphoedema.

What are the symptoms of Lymphoedema?

• Swelling in the affected limb or area
• A feeling of heaviness or tightness
• Reduced range of motion
• Hardening or thickening of the skin
• Recurrent infections

How is Lymphoedema diagnosed?

Lymphoedema is typically diagnosed through a physical examination, medical history, and imaging studies.

1. Physical examination: The doctor will examine the affected area for swelling, skin changes, and other symptoms of Lymphoedema. They may also measure the circumference of the affected limb to assess the degree of swelling.
2. Medical history: The doctor will ask about previous surgeries, radiation therapy, or other medical conditions that may have damaged the lymphatic system. They may also ask about symptoms such as swelling, heaviness or tightness, and recurrent infections.
3. Imaging studies: Ultrasound, MRI, or CT scan to examine the lymphatic vessels and nodes and assess the extent of the swelling.
4. Lymphoscintigraphy: This is a particular type of imaging test that consists in radioactive material that flows through the lymph ducts to visualize the lymphatic vessels and assess the function of the lymphatic system.
5. Pitting oedema test: it’s a simple test that consists of pressing the swollen area with a finger and checking if the skin dimples.

It’s important to note that Lymphoedema can be difficult to diagnose. Its symptoms may be similar to other conditions, such as venous insufficiency, which may not be evident in imaging studies. The diagnosis may also be delayed if the patient’s primary concern is the cosmetic aspect of the swelling rather than the functional aspect of it.

What are the different options for Lymphoedema Management?

Lymphoedema is a chronic condition that requires ongoing management. 

Treatment options for Lymphoedema include:

1. Manual lymphatic drainage (MLD) massage (Fill & Flush Technique): This gentle massage technique uses light, rhythmic strokes to help move lymphatic fluid out of the affected area.
2. Compression therapy: Compression garments such as stockings, sleeves, or gloves can help reduce swelling and improve lymphatic flow.
3. Exercise and movement: Gentle exercises such as walking, swimming, or yoga can help to improve lymphatic flow and reduce swelling.
4. Skincare and self-management: Proper skin care, such as keeping the skin clean and moisturized to reduce the risk of infection while improving the appearance of the affected area.
5. Medications: Medications such as diuretics or non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to help reduce swelling.
6. Surgery: In severe cases of Lymphoedema, surgery may be an option to remove excess fluid and reduce the size of the affected limb.
7. Complex Decongestive Therapy (CDT): it’s a combination of MLD, compression therapy, skincare, and exercise that is used to manage Lymphoedema.

It’s important to note that the treatment plan will vary depending on the individual’s needs, the severity of the condition, and the underlying cause of the Lymphoedema.

Therefore, a multidisciplinary approach is often needed for optimal management, including the participation of a lymphoedema therapist, a physician, and a physiotherapist.