What is lymphoedema?
We all have a small amount of fluid (lymph) in our body tissues. This fluid leaves our blood system to provide water and nourishment to the tissues. Most of this fluid is collected by a system of drainage tubes, similar to blood vessels, called the lymphatic system. Lymphoedema is swelling which is due to a build up of lymph in the limbs if the fluid is not draining out properly.
First of all, the swelling is often noticeable at the end of the day and decreases at night. However, if the swelling is not treated properly, the fluid will remain permanently set in the leg.
What causes lymphedema?
The most common cause of lymphedema is that you were born without enough lymph vessels. If there are very few lymph vessels, the swelling may start in your teenage years or even earlier. This type of lymphedema is called Milroy’s disease. One leg is often worse than the other and sometimes only one leg is affected.
In less severe cases, the lymph vessels may be able to cope with it initially and only begin to fail as you get older. This type is sometimes called Tarda lymphedema.
Are there other causes?
Lymphedema can also be caused when the lymph vessels of the arm and leg are damaged by surgery or radiation therapy to treat cancer. Sometimes this is inevitable if the cancer is to be cured. There are also some rare tropical parasites (filariasis) that invade and block the lymphatic vessels. These parasites do not live in the UK.
What are the effects of lymphedema?
Aside from the uncomfortable and unsightly swelling, lymphedema can cause problems, especially if not kept under control. There is an increased risk of infection under the skin (cellulitis) and repeated attacks of cellulitis lead to more lymph damage. This vicious cycle can, in extreme cases, lead to serious infections, ulcers and even amputations.
What is the treatment?
Lymphedema cannot be cured, but it can usually be controlled so that there are no complications later. The main pillars of treatment are compression bandages or stockings, limb elevation, and external pneumatic compression.
Elevation of the extremity
Whenever the leg is raised, fluid can drain from the leg. Put your legs up whenever you can and as high as you can – a sofa armrest is good. Raise the end of your bed (6 inches or so) so your feet are slightly higher than your head. You can use some old books for this.
Compression bandages or stockings
Compression is required to force fluid out of your legs while standing. It may first be necessary to use bandages to remove the worst of the swelling before stockings can be used. These stockings have to be specially adjusted and are much stronger than ordinary “support tights”. If the swelling only affects the lower leg, you can wear a self-supporting stocking under the knee, like a pop sock. The usual thickness of the stocking used is a Class II, but sometimes a stronger Class III is required. If you have trouble putting on your stockings, you can purchase a special stocking applicator.
External pneumatic compression (EPC)
Despite compression stockings, many people find that some swelling builds up at the end of the day. The EPC device is a pneumatic shoe that inflates and deflates to force fluid out of the leg. EPC is usually used in the evening to remove fluids that have built up despite compression stockings. If your doctor thinks you need EPC therapy, they will usually have a test of the device done so that you can decide whether it’s worth buying one.
What about an operation?
Many surgeries have been tried to cure lymphedema, but none have been successful. An operation to reduce the size of the lower leg (Homan’s Reduction) may be recommended if your leg remains very swollen despite compression therapy.
How can I help myself?
Wear your compression stockings every day from morning to evening.
Raise your legs whenever possible.
Get plenty of exercise and don’t gain weight.
Keep the skin in good condition by using plenty of moisturizer to prevent dryness.