What is Lymphoedema

Lymphoedema is characterised by a congestion of protein rich fluid in the interstitial space (the cell network below the skin) caused by either a dysfunction or injury within the lymphatic vessel system.

Due to this dysfunction, the fluid can no longer flow along its intended pathway, causing it to slow down (pooling / swelling), increasing an entourage of chemical and inflammatory responses, which over time (in some cases may take years), the stagnant fluid thickens to a gel like state, (pitting present), making it almost impossible to move through a strained or damaged network of vessels.

In the later stages, and potentially after many years left untreated, its content will be very potent with disease carrying cell debris, waste products, pathogens, viruses and bacteria, evident in Stages 2-3 when the affected area begins to show skin changes & lymph fluid leakage through the skin (called Lymphorrea). See a more detailed description of Stages below.

Lymphoedema most commonly affects the arms or legs, but it can show up almost anywhere, as your lymphatics can be found mapped all over your body.

• What are the early signs of Lymphoedema?

  What are the early signs of Lymphoedema?

  Tightness ~ jewellery, shoes, clothing feeling too tight, particularly on one side, often without overall weight gain.

  Swelling ~ the area looks bigger than before or compared to the other side. This may not be something that others notice.

  Aching ~ the area feels achy and heavy especially at the end of the day.

  Cellulitis ~ people who have or are developing lymphoedema are at a higher risk of getting and infection called cellulitis. See the Wound Care page for ‘Risk of Cellulitis’

• Here’s what you need to know if you have Lymphoedema

  Here’s what you need to know if you have Lymphoedema

  I don’t have great news for you. Unfortunately, it doesn’t get better on it’s own. You need intervention, you need assistance now.

  Once the system is in overdrive or dysfunctional in any way, it’s a downward spiral from there. Fluid accumulates in the tissues, holding onto all the metabolic waste it’s designed to remove, thickens and becomes stagnant, accumulating and back filling until there’s no-where else to go except in the extreme later stages, out through the layers of skin.

  This is where your skin becomes a hardened, like elephantiasis skin, sores or blisters could appear, leading to cysts, leaking lymph fluid, or with known conditions such as (fibrosclerosis, pachydermia, hyperkeratosis, lymphatic vesticles, lymphatic fistulas, papillomatosis, cellulitis and myocosis)

  It can be very toxic, it can harbour a load of harmful bacteria and damaged cells, which need to be moved out of there promptly.

  Another thing to consider, is the damage it can do to your healthy lymphatic vessels in this process. Constantly overloading the lymph vessel network, causes premature wear and tear on the vessel walls, therefore decreasing it’s capability to move the fluid at first sign of trouble, greatly impacting the overall life span of your vessels.

  Left untreated Lymphoedema will cause painful swelling, immobility, and worse as explained throughout. It really is in your best interest to get this sorted as early as possible.

• What this means for our immune system

  What this means for our Immune System

  There is a number of defenses in the body that are designed to identify and attack any foreign invaders that are not supposed to be there. One of those defenses are our lymph nodes.

  The assigned lymph node filters the incoming fluid, sorts the diseased cells, and triggers the creation of killer cells to fight the infection and ultimately kill off the disease, whilst also producing antibodies to build up our immunity. But, if the bacteria, virus or foreign matter doesn’t make it to the lymph node due to stagnant thickened fluid in the tissues, there’s less chance for your immune system to fight that infection and build enough antibodies. Hence an influx of inflammatory autoimmune diseases and chronic illness to follow in the years to come.

• Types of Lymphoedema

  Types of Lymphoedema

  There are 2 types of Lymphoedema

  Primary Lymphoedema – You are born with a deficiency in your lymphatic system. Once the system becomes strained, it doesn’t recover as quickly as a system with an abundance of vessels. Usually starts from the lower leg & foot expanding to the upper leg over time.

  Secondary Lymphoedema – caused by a trauma, injury or damage to the lymphatic system. This will start in and around the area that has been damaged.

  Causes of secondary lymphoedema include:

  1. surgery in or near major lymphatic vessels causing accidental damage, e.g bowel, gynaecological, thyroid, cosmetic surgery (just to name a few)
  2. an accident or trauma causing damage to vessels under the skin
  3. lymph node dissection during cancer treatment
  4. radiation therapy – as it burns all in it’s path
  5. Infections, e.g. cellulitis,
  6. Prolonged untreated oedema

  As mentioned above at no. 6, untreated oedema – whether it be caused by an obstruction due to another condition such as Lipoedema (inflamed fibrotic fat cells – Lipoedema) or venous insufficiency (poor blood circulation) turned chronic oedema, (Phleboedema). These can also turn into a combination of issues with lymphoedema, due to the impact all of the above has on the lymphatic system.

  Those said combinations are diagnosed as Lipo-lymphoedema, Phlebo-lympheoedema or Lipo-phlebo-lymphoedema. Quite a mouthful I know.

• Stages of Lymphoedema

  Stages of Lymphoedema

  Stage 0 – Latent

  • Lymphatic transport capacity reduced
  • No visible/palpable oedema
  • Subjective complaints are possible such as a feeling of heaviness, skin tightness, aching or discomfort.

  Stage 1

  • Reversible lymphoedema (mild)
  • Accumulation of protein rich oedema fluid
  • Pitting oedema
  • Reduces with elevation (no fibrosis)
  • Upon waking in the morning the limb or affected area is almost a normal size.
  • The tissue is still in a “pitting stage” (when pressed by a finger the area indents and holds the indentation).

  Stage 2

  • Spontaneously Irreversible Lymphoedema (moderate)
  • Accumulation of protein rich edema fluid
  • Pitting becomes progressively more difficult
  • Connective tissue proliferation (fibrosis)

  Stage 3

  • Lymphostatic Elephantiasis (severe)
  • Accumulation of protein rich edema fluid
  • Non pitting oedema
  • Fibrosis and sclerosis (severe induration)
  • Skin changes (papillomas, hyperkeratosis)
  • The tissue at this stage is hard (fibrotic) and will only be slightly responsive to the touch.
  • The limb is very large and swollen and the swelling is almost irreversible.
  • Infections are possible at any stage of lymphoedema but occurrence becomes greater as the stages progress. A swollen limb left untreated becomes hard and full of lymph fluid which is high in protein and a perfect medium for bacteria and infections.
  • While complications can arise in all stages of lymphoedema, it is Stage 3 that presents with the most significant and severe complications which is another very important reason for early diagnosis and immediate treatment.

• Lymphoedema Wounds & Skin Changes

  Chronic inflammation that accompanies lymphoedema can cause changes in the thickness, texture and shape of the skin, which leads to an overgrowth of the surface layer, wounds.

  Such changes are:

  Fibrosclerosis – inflammation and fibrous lesions

  Hyperkeratosis – thickening of the skin, due to excess keratin production

  Pachydermia – thick, heavy, hard (elephantitis) skin

  Lymphangiectasia – small, raised skin lesions that contain clear lymphatic fluid and appear as tiny blisters over lymphatic malformations. They can look like blood blisters and may turn dark purple or black if blood leaks into them

  Papillomatosis – Small cysts, dry, wart-like spots on the ankles, feet, and toes. The skin may also thicken and develop folds and bulges

  Lymphorrhea – Wet legs, lymph fluid leaking through the skin excessively,  a big risk of developing a leg ulcer due to lymphorrea and maceration of the skin

  Complications

  Cellulitis – is a bacterial infection within the skin and underlying tissues. This is quite a dangerous infection that requires immediate medical attention and antibiotics.

  Myocosis – contagious fungal infection

  Malignant, secondary Tumors

  Safe to say, all of the complications listed above, require medical attention first before any lymphatic treatment can go ahead.

• Treatment for Lymphoedema

  Treatment for Lymphoedema

  Ultimately, treatment for Lymphoedema requires a detailed study of what may be occurring beneath in your tissues, reasons why it has occurred and treating the cause not just the symptoms. An MLD massage here and there weeks apart, will likely not have an affect.

  If lymphoedema is left untreated , it can cause very painful swelling, that can lead to life altering infections (such as cellulitis), a greater toxicity within the body which in turn can result with many other health concerns.

  In the later stages, you will notice skin changes, first through heavy, thick and pitting skin, progressively breaking through and painful to touch, cysts, sores, red and inflamed elephant-like skin, and eventually causing debilitating immobility and pain.

  How to do the Pitting Test – Hold your thumb down into the middle of your swelling for 10 seconds, if a divot/pit remains, lymphoedema is threatening, get yourself to a lymphoedema therapist asap.

  Treatments Phases

  Decongestive Phase

  The swelling and stagnant lymph will need to be addressed straight away, or in the case of later stages, wound management will be the priority first.  

  Keeping your appointment times close together will be important at this stage. Once Lymphoedema has taken hold, your lymphatic system will need accumulative encouragement to get moving again, therefore multiple treatments close together is highly recommended.

  Once your swelling is under control, and has plateaued to the same or similar measurements, we then get you fitted for your garment/s and work towards the maintenance phase.

  You can see recommendations for garments that are specific to a condition on the Compression bandaging and garments page {link}

  For a more detailed look at examples of decongestive treatments see the Decongestive Therapy page {link}

  Maintenance Phase

  The maintenance phase is a combined effort by you and your therapist. Your therapist’s responsibility is to teach you how you can manage the condition at home, and your responsibility will be to adopt a new routine for self-care and your new lymphoedema way of life.

  Of course, we all understand that life and commitments can get in the way of keeping up with your routines. So, you may prefer to leave the management up to your therapist with continued regular treatments, compression and pumping. How much you choose to adopt is up to you.  But please keep in mind, without proper management it will likely come back.

  Here are your self-treatment options @ home

  • compression garments (a MUST)
  • pneumatic compression pump
  • exercises and self-drainage techniques
  • a full detailed list of great options is available on the Conservative treatments @ home page under the conditions tab

  Treatment options available in clinic with Sal

  • (MLD) Manual hands-on lymphatic Drainage
  • Combined (MLD) & Pneumatic Compression Pump
  • Pneumatic Compression Pump only sessions (45mins)
  • Decongestive Therapy – Bandaging & Garment prescription
  • Wound Management
  • Scar & fibrosis management
  • Low Level Laser Therapy
  • Muscle treatments (see myotherapy page for details)

Other references/support networks 

ALA– Australian Lymphology Association 

Sal is proudly a part of the ALA Accredited Lymphoedema Practitioner Program keeping up with the latest treatments, research and information (Dedication / Professionalism / Expertise)

Look up an accredited lymphoedema practitioner close to you via the above ALA website.

https://www.lymphoedema.org.au/

LAA – Lymphoedema Association Australia

This amazing association is bringing patients and therapists together, with loads of information, network days and so much more…

https://www.lymphaustralia.org.au/