What is lymphedema?
The lymphatic system is designed to return protein-rich fluid from tissues to the central circulation. When lymphatic vessels are blocked or not working well, lymph fluid accumulates in extracellular spaces and results in swelling in the limbs known as lymphedema. Lymphedema is a chronic condition and happens when the lymphatic load exceeds the transport capacity.
What causes lymphedema?
Lymphedema can be categorised into primary or secondary. The cause of primary lymphedema is unknown and presents prior to adulthood. It is rare and affects 1 in 100,000 children. Secondary lymphedema is caused by damage to the lymphatic system such as cancer, radiotherapy, surgery, infection or trauma. It is much more prevalent and affects 1 in 1000. In developed countries, the most common cause of lymphedema is radiation for cancer treatment or lymphadenectomy i.e. surgical removal of lymph nodes.
What are the signs and symptoms of lymphedema?
In secondary lymphedema, signs of swelling may happen 9-24 months after damage to the lymphatics. It usually affects the arms and legs before moving towards the groin or armpit area. If the hands or feet are not affected, it is unlikely to be lymphedema. In the earliest stage, there may be no clinical signs but patients may report feeling heaviness in the limb. As the condition progresses, the affected limbs will appear to be enlarged and skin infections are more common. Lymphedema is usually painless.
What are some conservative management of lymphedema?
Lymphedema is considered incurable due to the permanent damage to various lymphatic components. However, early detection and management is essential to prevent long term physical, functional and psychological impacts secondary to chronic swelling. Management varies according to the severity of the condition.
Conservative management strategies include:
- Elevation during the early stages
- Aquatic therapy/water-based exercise programs
- Muscle pumping exercises e.g cycling, walking, yoga, climbing stairs
- Manual lymph drainage
- External compression therapy
- Compression bandaging
- Compression garments
- Thermal therapy
- Skin and nail care