Understanding What Lymphedema Is
Lymphedema is an increased amount of lymphatic fluid in the tissues of the skin. It occurs when the lymphatic system is overwhelmed and cannot process fluid fast enough. There are two types of lymphedema:
- Primary lymphedema: due to lymphatic system malformations that can occur at birth or later in life, genetic or hereditary causes
- Secondary lymphedema: due to damage to lymphatic system that originally was working normally; causes can include cancer treatments (surgery, radiation), traumatic injury, parasitic infection
The lymphatic system is present all throughout your body like your arteries and veins are. Its job is to absorb and transport immune cells and lymphatic fluid. This fluid contains proteins, water, and waste products from your tissues. As this fluid goes through your lymph nodes, the fluid is filtered. Your nodes are located in your armpits, where your hips meet your torso, neck, and abdomen. There are tiny lymphatic vessels all over your body that are located in your skin. The tonsils, thymus, spleen, bone marrow, and small intestine are also part of your lymphatic system.
Early Signs and Symptoms
Sometimes the first symptoms people notice are how they feel but no visible swelling. These symptoms can be heaviness, numbness, tightness of clothes/jewelry, and aching. Lymphedema is typically not painful, however the side effects such as tight skin and decreased movement of the affected body parts can cause pain as the disease progresses. If you do notice swelling, it will reduce with elevation/sleeping and there will be what is called pitting edema. This is when you press your finger into the skin and it leaves an indentation after you remove your finger. There are no skin changes. If and as the disease progresses, the swelling may fluctuate but is always present, even with elevation. You will start to notice non-pitting edema where your finger no longer leaves an indentation, as well as skin changes and hardening/thickening.
The Importance of Treatment for Lymphedema
Lymphedema is a progressive disease with no cure. Without treatment and consistent management, your symptoms will become more severe. Possible side effects of delayed treatment or inconsistent management can be:
- Increased infection risk
- Skin thickening/hardening (called fibrosis), as well as other skin changes
- Increased discomfort due to tight skin
- Decreased ease of movement
However, you can be very successful in decreasing your symptoms and swelling with lymphedema therapy!
Complete Decongestive Therapy
The gold standard for lymphedema treatment is called Complete Decongestive Therapy or “CDT” for short. There are four components to CDT: compression, exercise, Manual Lymphatic Drainage (MLD), and skin care/patient education. There are two phases of CDT in which ease of these components is implemented:
Phase 1: Decongestion: goal is to reduce swelling
- Compression
- Exercise
- MLD
- Patient education w/ an emphasis on skin care
Phase 2: Maintenance: goal is to maintain decongestion
- Compression
- Exercise
- Pneumatic Compression Pump (if needed)
- Patient education with an emphasis on long term care of lymphedema
Other Diagnoses that Lymphedema Therapists Treat
Lipedema is bilateral and symmetrical build up of adipose tissue, typically in women, most commonly seen in the legs (ankles to hips, feet are not involved) but can occur into the arms and trunk as well. Symptoms can be intermittent or constant and include pain to the touch, bruising easily, swelling, and no significant changes with diet/exercise. MLD and garments can decrease pain and sensitivity.
Chronic Venous Insufficiency (CVI) is swelling in lower legs caused by damaged veins in your legs, resulting in decreased blood flow from your legs back to your heart. Symptoms can include non-pitting edema from ankles to knees, dark brown/purple color, varicose veins, skin that is shiny / thin, bruising easily skin, possible ulceration, and pain with standing / walking for longer durations.
