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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 300,000 new cases are diagnosed every year in the US.*

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.

What is the lymphedema treatment process?

The medi lymphedema therapy concept is a comprehensive approach in the treatment of lymphedema that provides the right products for each stage of treatment, from the decongestion phase, through the transition phase and finally with the maintenance phase. 

Decongestion Phase Lymphedema: An introduction to treatment plan and limb reduction

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 is applied after each treatment session and 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 throughout the treatment process. Only pH-neutral cleansing products and creams may be used. 

Compression products used during the decongestion phase include pneumatic compression devices or sequential compression pumps such as the medi PCS, compression bandaging and the use of compression wraps, such as the circaid® reduction kit™.


medi PCS is an offering of pneumatic compression devices that can be used in the treatment of lymphedema and venous-related disorders.  The medi PCS products have patient-friendly features like the self-learning, “fill-to-fit” technology and a multilingual touch screen display. Additionally, the pcs pumps deliver clinical results with use of overlapping chambers and customizable settings to meet each patient’s therapeutic need.

The circaid reduction kit uses Velcro® wrap enclosures to deliver MEASURABLE compression with inelastic Breath-O-Prene® material. The reduction kit is customizable to each patient and can be adjusted throughout the decongestion phase.

Transition Phase Lymphedema: The adjustment from clinic care to self-care

Once the affected limb volumes have plateaued, there is an important period when patients must transition from an in-clinic treatment program to a self-management program.  Education is a key component to an independent life with lymphedema by implementing a manual lymphatic drainage program. Skin care, nutrition and the development of good compression habits are essential to the progression to independence. 

Compression products used in the transition phase are pneumatic compression devices (pumps), bandaging and the introduction to a compression garment like the circaid® juxtafit®.

Maintenance Phase Lymphedema: Long-term independent management of lymphedema

The aim of phase three is to maintain the successes and results gained throughout the clinical treatment process. During the maintenance phase, manual lymphatic drainage should be given at least once a week in winter and twice a week in summer. The additional treatment measures such as special skin care and exercises must not be neglected either during this phase.
 At this phase, most patients will incorporate a flat knit compression garment into their collection of therapy products. Flat knit products are perfect for ambulatory patients and can be customized for both therapeutic and lifestyle needs. 
mediven 550 leg thigh length
mediven esprit flat-knit arm sleeve with glove

More information

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