What is lymphedema?

The term lymphedema refers to swelling due to the abnormal accumulation of protein-rich lymphatic fluid. The lymphatic system is an important part of the body’s immune system. Lymphedema occurs when the lymphatic system is deficient or damaged, altering the transport of the lymph fluid. Lymphedema usually affects the arms or legs, but it can also affect the head and neck, genital and trunk regions.

If it is not treated, lymphedema can cause enlargement of the tissue channels that transport the lymph fluid, limit the oxygen in the transport system, interfere with wound healing, and provide a culture medium for bacteria that can result in lymphangitis (infection).

Lymphedema should not be confused with the swelling resulting from venous insufficiency, which is a pooling of blood in the veins of the legs.



There are two types of lymphedema, Primary and Secondary, which both occur when normal drainage is impaired or disrupted.

Primary lymphedema is due to a defect in the lymphatic system, either from hereditary or sporadic causes. The majority of primary lymphedemas appear before the age of 35. A primary lymphedema may develop at any point in life and occurs most often in the lower extremity.

Secondary lymphedema, the most common form, can develop as a result of surgery, radiation, infection or trauma. Lymphedema can occur immediately post-operatively, or develop within months or even years. The swelling can range from mild to severe.


WHAT ARE THE symptoms?

Persistent swelling;
Arm or leg feels full or heavy;
Skin feels tight;
Decreased flexibility in hand, wrist or ankle;
Difficulty fitting into clothing in a specific area of the body; and
Ring/watch/bracelet/anklet tightness
Early diagnosis and treatment is important in the management of lymphedema as it will help both the prognosis and the condition.

If you have or are at risk of getting lymphedema, it is important to practice good skin care techniques. Look after your skin by preventing anything from piercing the skin layer, which could enable bacteria to enter the body (i.e. cuts, scratches, pinpricks as well as needle pokes, insect bites, and burns). If your skin is injured, clean and protect the skin from further injury. Consult your physician if you suspect an infection (i.e. if you experience redness, swelling, pain or increased warmth in that area).

Avoid hot environments. Use saunas, steam baths and hot tubs with caution; Travel with care. If you have a compression garment, you should wear it when traveling, especially during long flights;
Exercise the affected body part (arms or legs). A good exercise program of stretching and strengthening may help to control your lymphedema. Some experts recommend that you wear a compression garment during exercise; and maintain an ideal body weight.


how physiotherapy can help

Although there is no cure for lymphedema, there is treatment available to help prevent or limit the severity of the condition.Physiotherapists with training in the management of lymphedema will prescribe an individualized treatment program that will involve:

Patient evaluation in consultation with the physician to determine the best treatment plan; A home exercise program to improve lymphatic drainage, increase or maintain range of motion and strength of the affected area, and improve cardiovascular fitness; Education in effective skin care; Manual lymphatic drainage that will reduce and/or control the swelling. A comprehensive program will include compression pumps, bandaging techniques, and massage, or a combination of therapies; Treatment to reduce pain; and
Assistance in obtaining and fitting a compression garment with instruction on frequency and use.

After treatment, the physiotherapist will also encourage normal exercise and activity with certain precautions. For example, the best type of exercise for people with lymphedema is swimming and other water exercises, where the body weight is supported. However, for other exercises, such as walking, running, biking or weight lifting, it is advisable to wear either bandages or the compression garment.

The physician, the physiotherapist, and the patient work as a team to achieve success in managing lymphedema.



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