Lymphedema occurs when the lymphatic fluid can't be adequately drained from the limb region because of the damage caused due to surgery, infection or radiation treatment for cancer. It can be characterized by mild to severe swelling in the limbs. Treatment aims at reducing the swelling and easing the pain by using various techniques like wrapping the limb, massage, pneumatic compression, complete decongestive therapy or exercising regularly.
Symptoms may range from mild, hardly noticeable swelling to severe form that affects movement. Symptoms include:
- Swelling of a part of or the entire arm, including fingers
- Swelling of a part of or the entire leg, including toes
- Feeling of heaviness or tightness in arms and legs
- Reduced ability to move the hands and legs
- Aching or discomfort in the affected limbs
- Increased frequency of infections
- Hardening and thickening of the skin (fibrosis)
Primary lymphedema may be the result of:
- Milroy's disease/congenital lymphedema: Abnormally formed lymph nodes
- Meige's disease/lymphedema praecox: Causes lymphedema during puberty or pregnancy
- Late- onset lymphedema/lymphedema tarda: Affects people older than 35 years
Secondary lymphedema is caused by the blockage of lymphatic system, due to:
- Cancer or tumor, either growing in or near the lymph nodes
- Infection of the lymph nodes
- Cancer treatment, including radiation treatment
- Removal of lymph nodes as in case of cancer biopsies
- Damage to lymph nodes, for example, surgery of blood vessels
- Older age
- Obesity or over weight
- Rheumatoid or psoriatic arthritis
There's no cure for lymphedema. Treatment focuses on reducing the swelling and controlling the pain. Lymphedema treatments include:
Exercises - Light exercises in which you move your affected limb may encourage lymph fluid drainage and help prepare you for everyday tasks, such as carrying groceries. Exercises shouldn't be strenuous or tire you but should focus on gentle contraction of the muscles in your arm or leg. A certified lymphedema therapist can teach you exercises that may help.
Wrapping your arm or leg - Bandaging your entire limb encourages lymph fluid to flow back toward the trunk of your body. The bandage should be tightest around your fingers or toes and loosen as it moves up your arm or leg. A lymphedema therapist can show you how to wrap your limb.
Massage - A special massage technique called manual lymph drainage may encourage the flow of lymph fluid out of your arm or leg. And various massage treatments may benefit people with active cancer. Be sure to work with someone specially trained in these techniques.
Massage isn't for everyone. Avoid massage if you have a skin infection, blood clots or active disease in the involved lymph drainage areas.
Pneumatic compression - A sleeve worn over your affected arm or leg connects to a pump that intermittently inflates the sleeve, putting pressure on your limb and moving lymph fluid away from your fingers or toes.
Compression garments - Long sleeves or stockings made to compress your arm or leg encourage the flow of the lymph fluid out of your affected limb. Wear a compression garment when exercising the affected limb.
Obtain a correct fit for your compression garment by getting professional help. Ask your doctor where you can buy compression garments in your community. Some people will require custom-made compression garments.
If you have difficulties putting on or taking off the compression garment, there are special techniques and aids to help with this; your lymphedema therapist can review options with you. In addition, if compression garments or compression wraps or both are not an option, sometimes a compression device with fabric fasteners can work for you.
Complete decongestive therapy (CDT) - This approach involves combining therapies with lifestyle changes. Generally, CDT isn't recommended for people who have high blood pressure, diabetes, paralysis, heart failure, blood clots or acute infections.
In cases of severe lymphedema, your doctor may consider surgery to remove excess tissue in your arm or leg to reduce swelling. There are also newer techniques for surgery that might be appropriate, such as lymphatic to venous anastomosis or lymph node transplants.