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Lymphedema

What causes lymphedema?

Our lymphatic system is connected to our cardiovascular system and fulfils functions for our body that are just as important as the cardiovascular system itself. It plays a decisive role in our immune system. If we are healthy, our lymphatic system runs smoothly. We only become aware of the lymphatic system when it is impaired – in the case of lymphedema, for example.

What exactly is Lymphedema? Lymphedema occurs when the lymph fluid cannot flow towards the heart properly and accumulates in the tissues. It’s often compared to a traffic jam. The arms and legs swell up and edema forms, and with that, chronic swelling.

With the right treatment, it is possible to lead a normal and enjoyable life with lymphedema.

The body's "hazardous waste disposal" service

The lymphatic system can be compared to a “hazardous waste disposal”, because it transports waste products out of the body. These include 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 liters of purified lymph back into the blood circulation. Lymphedema can develop if lymphatic drainage is interrupted or impaired. There are so many different treatment options available today that allow those living with lymphedema to lead almost perfectly normal lives.

Forms

There are two forms of lymphedema:

Primary lymphoedema:
Primary lymphoedema is congenital. It is usually caused by lymph channels or lymph nodes that have not been properly formed.

Secondary lymphoedema:
Secondary lymphoedema describes oedema that develops during a patient’s lifetime and is not congenital. The causes of this can be operations, infections or injuries, for example.

Signs and symptoms

The so-called Stemmer's sign is a reliable diagnostic sign to recognise lymphedema. Try to pinch the skin at the base of your toe. If this is difficult, or even impossible, we speak of a "positive Stemmer's sign".

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

Stages

The lymph vessels are already damaged, but there is not yet any visible swelling.
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.
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.
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.
In all cases, it is advisable to consult a doctor at an early stage (preferably at stage one). They can recommend suitable treatment and make sure that the edema does not develop further, is reduced or at least is sustained. This way, you can prevent edema from progressing to stage 3.

Lymphedema after breast cancer surgery

Breast cancer is the most common form of cancer in women. Over 70,000 new cases are diagnosed every year.*

On average, 20 to 30% of patients are affected by breast cancer-related lymphedema following removal of the axillary lymph nodes and adjuvant radiotherapy.**

Risk factors

Patients with cancer often go through radiotherapy of their lymph nodes or the nodes are removed altogether. Naturally, this influences the whole lymphatic system, so edema can develop. Other factors such as age or simply being female can favor the onset of lymphedema.

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

Prevention

Do you have lymphedema? The small things in everyday life make a difference in keeping your edema in check. For instance, wear comfortable, non-constrictive clothes. Take good care of your skin and only use pH-neutral substances. At home, protect against injuries to your nails and skin. Avoid stress and extreme cold, because both constrict the vessels. Activities that dilate the vessels such as sunbathing for a long time, visiting the sauna or taking a hot bath are not recommended either. While manual lymphatic drainage has a positive effect on the lymph system, you should avoid kneading massages which could over-stress the affected part of your body. And finally, wear compression garments whenever you exercise.

Living with Lymphedema – Education, Therapy, Quality of Life

Lymphedema changes lives. The chronic disease is a constant companion in all aspects of life. But what is the best way to deal with the disease symptoms? Which therapy is best suited for you? How can you live a normal life despite lymphedema? The film “Living with Lymphedema – Education, Therapy, Quality of Life“ from medi gives concrete answers as well as practical tips for everyday life.

How can lymphedema be treated?

Long-term treatment can achieve good results. Complex physical decongestive therapy (CPD) is particularly successful. The aim is to first decongest the affected limbs – as the name suggests.

Initially, the focus is on skincare and hygiene. You should clean and care for the affected areas. A 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 edema could return after about two hours. As part of the decongestion process, it is important to keep active – preferably directly after the manual lymphatic drainage and with the bandaging in place.

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

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 cleansing 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 are no longer reduced any further, we then move to the 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.
Lymphatic drainage - "Massage" for decongestion

Manual lymphatic drainage is a special form of massage given to increase the transport capacity of the lymphatic system. It is not only applied to the affected part of the body, but to the entire body.

The massage begins at the neck where the large lymph collector vessels open into the veins behind the collarbones. This stimulates the flow of lymph in the large lymph vessels to ease transport in the smaller vessels. Then the torso and limbs are treated.

Flat knit compression garments for maintenance

Flat knit compression garments exert constant pressure on the arm or leg during the maintenance phase. They do not crease into skin folds, which could lead to constriction. Compression hosiery is available on prescription from medical retailers (e.g., durable medical equipment stores) and is made-to-measure to suit the circumference of the arm or leg.

The measurements are taken by the DME retailer. It is important that you wear the garment regularly. Only then will the result remain constant and the edema will not spread. Medicines can be taken as add-ons to treat edema, but your doctor will decide whether these are needed.
In summary, it can be said that lymphedema is not entirely curable. However, successful results are achieved with CPD. Compression garments these days are available in fashionable colors and patterns, so patients are more inclined to wear them then ever before.
  • A wide range of colours
  • Innovative design elements
  • Highest wall stability
  • Strong for all-day support
  • Soft, comfortable finish
  • Most elastic of the flat-knit materials
mediven mondi esprit
  • Elegant with a subtle shimmer
  • All day comfort and control
  • Fashionable yet discreet

More information

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