What is Lymphedema?

Lymphedema is a swelling of a body part, most often an extremity, resulting from an accumulation of fluids, in such proportions to be palpable and visible.

Lymphedema occurs when the lymph vascular system is not able to fill its functions of reabsorption and transport of the protein and lymph load.

Lymphedema occurs whenever lymphatic vessels are absent, underdeveloped, obstructed or damaged.

The condition most often causes a feeling of embarrassment and causes decreased mobility, discomfort and often repeated episodes of infection, cellulitis and lymphangitis. This can lead to general worsening of the patient’s life and health.

Fungal infections can be very frequent and these place a greater load on the lymphatics. Severe cases are associated with thickening of the skin, hardening of the limb (fibrosis), leakage of lymph and massive swelling (elephantiasis).

How Does Lymphedema Occur?

A stagnation of protein develops in the tissue. This raises the colloid osmotic pressure and a protein rich edema arises. There are more protein rich fluids in the tissue than can be transported and the proteins attract water by osmosis. The affected area becomes swollen, enlarged and uncomfortable. This swelling decreases oxygenation of the tissues, interferes with their normal functioning and makes them heal more slowly than normal. The excess protein also serves as a stimulus for chronic infection and can result in formation of excess fibrous tissue.

Lymphedema is a chronic and if left untreated, progressive condition. It can however, be brought under control by appropriate treatment and care.

Lymphedema may be due to primary (congenital) cause or of a secondary cause ( caused by unknown condition), including removal of the lymph nodes or trauma.

What is the Treatment of Lymphedema?

Lymphedema is a serious condition, indicating that the lymph system is unable to handle the lymph load. Treatment should begin as soon as lymphedema is diagnosed.

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The goal of treatment is to reduce the swelling and facilitate the flow of lymph fluid to the venous circulation of the affected area.

The most effective approach used by therapists in many European countries is a method called COMBINED OR COMPLEX DECONGESTIVE THERAPY; a four step process. The individual elements are Manual Lymph Drainage, compression therapy, remedial exercises, breathing techniques and excellent skin hygiene.

Dr. Vodder’s Combined Decongestive Therapy

  1. Lymphatic Therapy- patients receive manual lymph drainage (MLD) to remove excess fluid and protein. The MLD is performed to open lymphatics in the unaffected regions so these can help to drain the affected area. MLD stimulates lymphangions to increase their activity, which results in a decompression and emptying of obstructed lymphatic channels.
  2. Compression Therapy- Bandaging of the affected limb should follow each MLD session. This is a precise and accurate procedure using specific bandages and interfacing materials.
  3. Remedial Exercises and Breathing-Further promote venous and lymphatic flow by activating the muscle and joint pumps.
  4. Skin Care and Hygiene – Excellent skin cleansing with antibacterial washes and neutral balanced PH lotions will help to eliminate bacterial and fungal growth and so minimize the possibility of repeated attacks of cellulitis and/or lymphangitis.

Treatment Problems

Lymphedema patients are constantly frustrated as they clearly face a major problem, yet cannot find answers to reduce a swollen limb. The most frequently given advice is to elevate the limb, wear compression garments (an elastic sleeve or stocking), avoid salt and take diuretics. Sequential pumps are sometimes recommended and while they may give some relief, the benefits are short lived. Surgery has never solved the problems of lymphedema even though dozens of different operations have been recommended and thousands of patients have been operated on. Dr. Vodder’s Combined Decongestive Therapy offers a practical and long lasting solution to the millions of lymphedema sufferers throughout the country.

Factors That Contribute To Lymphedema

  • combined surgery and radiation therapy
  • combined surgery and post operative infection
  • obesity
  • cellulitis
  • infections (insect bites, athletes foot)
  • sedentary life-style
  • constrictive clothing or jewellery
  • heavy breast prosthesis
  • trauma to remaining lymphatics (sunburn, surgery)
  • recurrent tumor

Impact of Lymphedema On The Patient

  • swollen body part of limb
  • condition generally worsens over time-heaviness and limitation of motion
  • repeated episodes of infection
  • skin thickening, lymph leakage through skin
  • cosmetic problem, difficulty finding clothes or shoes
  • multiple hospitalizations
  • altered life-styles-no sun or heat, limited activities
  • constant medical care and expense
  • general depression and worsening of the patient’s life and health can occur

Source: Dr. Vodder’s brochure—more info vodderschool.com or navalt.org  

Additional Information

Lots of information on lymphedema. Shows pictures and explains different stages of lymphedema.

Consult the Canadian Lymphedema Framework:

Would you like an information package? Please contact the LAS at contact@sasklymph.ca