Lymphoedema

What causes lymphoedema?

Our lymphatic system is connected to our cardiovascular system and fulfils functions for our organism that are just as important as the cardiovascular system itself. It plays a decisive role as part of our immune system. As long as we are healthy, there are hardly any reasons for thinking about the lymphatic system. We only become aware of it when it is impaired – in the case of lymphoedema, for example.

What, exactly, is it? Lymphoedema occurs when the lymph fluid cannot flow towards the heart properly and accumulates in the tissues. You can compare this with a sort of traffic jam. The arms and legs swell up and oedema forms, i.e. chronic swelling.

However, with the right treatment and a positive attitude, it is possible to lead an everyday life that is as normal as possible. Because one thing is for sure: there are ways of keeping lymphoedema constant and enjoying life all the same.

The body's "hazardous waste disposal" service

The lymphatic system can be compared with “hazardous waste disposal”, because it transports waste products out of the body. These include, for example, proteins, metabolic breakdown products, inflammatory products or fat from the abdominal cavity. The lymphatic system runs alongside the blood vessels and covers our entire body like a net.

Every day it transports up to four litres of purified lymph back into the blood circulation. Lymphoedema can develop if lymphatic drainage is interrupted or impaired. There are so many different treatment options available today that you can lead an almost perfectly normal life, even with lymphoedema.

Forms

There are two forms of lymphoedema: primary and secondary lymphoedema:

Signs and symptoms

The so-called Stemmer's sign is a reliable diagnostic sign to recognise lymphoedema. Try to pull a fold of skin upwards (for example, over your toe). If this is difficult, or even impossible, we speak of a "positive Stemmer's sign".

This is a sign of lymphoedema. Furthermore, deeper natural skin folds over the joints, swelling over the backs of the hand and feet and taut skin indicate lymphoedema.

Stages

• Stage 0: The lymph vessels are already damaged, but there is not yet any visible swelling.
• Stage 1: Swelling develops over the course of the day, but it disappears partially or completely when you elevate the limb. If you push down on the tissues with your finger, a pit forms that persists for some time.
• Stage 2: The swelling persists, even if you take longer rests. The skin is hard and elevating the limb no longer helps. It is difficult or even impossible to make pits in the skin.
• Stage 3: This is marked by swelling and skin changes (for example, in the form of small blisters that leak lymph fluid). Another form of this swelling is called elephantiasis

But in all cases, it is advisable to consult a doctor at an early stage (already at stage one). He can recommend suitable treatment and make sure that the oedema does not develop further, but is reduced or at least stays constant. This way you can prevent oedema progressing to stage 3

Lymphoedema after surgery for breast cancer

Risk factors

Patients with cancer often have to have radiotherapy of their lymph nodes or the nodes are removed altogether. Naturally, this influences the whole lymphatic system, so oedema can develop. Other factors such as age or simply the fact that one is a woman can favour the onset of lymphoedema.

In many cases, lymphoedema also develops from a previous venous disorder combined with too little physical exercise. There are many causes, but the good news at this point is: there are efficient treatment options available to give lymph patients their quality of life back.

Prevention

You have lymphoedema yourself? Pay attention to the small things in everyday life. These will all make a contribution to keeping your oedema in check. For instance, wear comfortable clothes that do not constrict you. Clean and care for your skin carefully and only use pH neutral substances. You have a pound or two more than you should? Try to lose weight. For example, ask your doctor or your health insurer about gymnastic and exercise programmes that decongest the limbs. At home, protect yourself against injuries to your nails and skin. Avoid stress and extreme cold, because both of these constrict the vessels. Activities that dilate the vessels such as sunbathing for a long time, visiting the sauna or having a hot bath are not recommended either. Also important: while manual lymphatic drainage has a positive effect on the lymph system, you should avoid kneading massages. These could overstress the affected part of your body. And last but not least: wear compression garments whenever you exercise (for example, during sporting activities).

Living with Lymphoedema – Education, Therapy, Quality of Life

How can lymphoedema be treated?

Lymphoedema is a chronic disease. However, correct and, above all, long-term treatment does achieve very good results. Complex physical decongestion therapy (CPD) has proved particularly successful. The aim is to first decongest the affected limbs – as the name suggests.

Initially the focus is on skincare and hygiene. Clean and care for the affected areas carefully. The therapist then performs manual lymphatic drainage before applying a compression bandage immediately afterwards. This encourages the return flow of lymph fluid during this phase. Without the bandages, the oedema would return after about two hours. Important as part of the decongestion process: move around – preferably directly after the manual lymphatic drainage and with the bandaging in place.

Once the decongestion phase is complete, the second phase is started: the maintenance phase. The four components are the same as in decongestion: hygiene, lymphatic drainage, compression and physical activity. But now the compression dressing is replaced with a compression garment. Flat knit compression stockings garments are usually used for this. These are seamed garments that are made of less elastic, stiffer material than round knit garments. Round knit hosiery is used more for venous diseases such as varicose veins.

Phase 1 – Decongestion phase

The aim is to reduce the circumference of the affected limbs. So in the first phase of complex physical decongestion therapy (CPD), manual whole-body lymphatic drainage is performed once or twice a day to promote the return transport of the fluid away from the tissues. A compression dressing is applied after each treatment session. The decongestion therapy is also supported by special exercises. When beginning treatment, skin conditions such as fissures or athlete's foot are treated intensively, because an inflammation can cause additional damage. Consistent skin hygiene and care are also important later on. Only pH-neutral cleaning products and creams may be used.

The first phase of complex physical decongestion therapy lasts about three to six weeks. The individual duration depends on how successful decongestion is. Once the circumference of the affected regions of the body can no longer be reduced any further, we then go on to the maintenance phase.

Phase 2 – Maintenance phase

The aim of phase 2 of complex physical decongestion therapy (CPD) is to maintain the successes and results gained in phase 1. During this treatment phase, manual lymphatic drainage should be given at least once a week in winter and twice a week in summer. Compression therapy is still supported by compression garments/sleeves/hand parts and toecaps. The additional treatment measures such as special skin care and exercises must not be neglected either during this phase.

Flat knit compression garments for maintenance

¹ www.krebsdaten.de
² Deutsche Krebsgesellschaft e.V. (2008): Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms, Germering, München: W. Zuckschwerdt Verlag.