What is Lymphedema

Learn more about the different types of lymphedema and their effects on the body.

Lymphedema is the accumulation of protein rich fluid in the tissue which causes swelling. This fluid accumulates in the extracellular space outside your blood stream and around the cells of your body.

Lymphedema is estimated to impact ~ 3 million people in the United States.

Source: BSN medical research

 

Lymphedema Types

There are two types of lymphedema - primary lymphedema and secondary lymphedema. Both types relate to lymph vessels or lymph nodes that are missing, damaged, removed or otherwise impaired.

Primary Lymphedema

Primary lymphedema occurs when the lymph system is damaged due to a developmental defect. Primary lymphedema can be classified according to age of onset.

  • Congenital: The lymphedema is noticeable at birth
  • Praecox: Lymphedema occurs after birth, but before age 35
  • Tardum: Lymphedema presents after age 35

Primary lymphedema can present as a variety of abnormalities:

  • Lymphatic Aplasia: Rare condition where portions of the lymph system never develop and are missing
  • Lymphatic Hypoplasia: This is the most common malformation, and refers to incomplete development of lymph vessels and/or nodes.  The number of lymph vessels and / or nodes is reduced, or they can be smaller than normal.
  • Lymphatic Hyperplasia: Structural malformation of lymph vessels and/or nodes with enlarged dilated lymph vessels which can cause malfunction of lymph valves and compromise lymphatic flow.

Secondary Lymphedema

Secondary lymphedema occurs due to an outside factor damaging or impairing the lymph system. Causes of secondary lymphedema include:

  • Cancer surgery/radiation: Removal of lymph nodes from cancer surgery disrupts lymph flow. Radiation treatment can damage the fragile lymphatic vessels and cause lymphedema.
  • Tumors: Tumors can grow and press on the lymph vessels, blocking flow and causing lymphedema. Tumors often cause lymphedema which differs in that it starts in the upper part of the limb. Other causes of lymphedema usually result in swelling that starts in the lower parts of the limb first.
  • Trauma: Injury to the body can damage the fragile lymphatics and lead to development of lymphedema.
  • Infection: Infections can cause inflammation and permanent damage  to the fragile lymphatic vessels.
  • Chronic Venous Insufficiency: Severe chronic venous insufficiency can overwhelm the lymphatics, leading to development of phlebolymphedema (venous disease with secondary lymphedema). Often the CVI is exacerbated by other medical conditions. Phlebolymphedema can develop in patients with normal lymphatics, or in patients with damaged lymphatics. Contributing factors include heart failure, renal failure, liver disease, untreated sleep apnea, obesity, paralysis/paresis, pulmonary hypertension, certain medications.
  • Obesity: Obesity is an independent risk factor for lymphedema, particularly in cancer survivors. Morbidly obese patients with a BMI > 59 are high risk for spontaneous development of lower limb lymphedema.
  • Filariasis: A parasitic disease that is found mostly in third-word countries and impairs the lymphatic system. It is the most common cause of lymphedema worldwide.

Lymphedema Symptoms

  • Swelling in the arm or leg or affected body part. Limb swelling can include the fingers or toes.
  • Heavy sensation or feeling of tightness to the skin of the affected area
  • Pain or discomfort in the limb
  • Skin dimpling like an orange peel
  • Recurring infections in the affected limb or body area
  • Hardening and thickening (fibrosis) of the skin
  • Decreased range of motion of the affected limb

Lymphedema Management

Complete Decongestive Therapy (CDT) is an intensive program with multiple components. CDT is divided into two phases:

  • Phase I – Decongestion
    • Manual Lymphatic Drainage (MLD):  a light, skin stretching massage aimed to increase flow of lymph fluid in a desired direction.
    • Pneumatic Pumps: select patients benefit from use of a lymphedema pump to help maintain limb reductions
    • Compression Therapy: short-stretch compression bandages or short-stretch garments are utilized to decrease limb volume.
    • Decongestive Exercises:  the muscle pumping action that occurs with exercise helps promote lymphatic flow.
    • Skin and Nail Care: lymphedema patients are highly susceptible to infection and must be meticulous about their skin and nail hygiene.  
  • Phase II – Maintenance
    • Manual Lymphatic Drainage (MLD):  MLD is highly beneficial in the maintenance phase to preserve decreased edema and to reduce edema when an increase occurs.
    • Compression Therapy:  compression garments, such as JOBST® Elvarex® or JOBST® FarrowWrap® are worn after full decongestion is achieved to maintain limb volume.
    • Decongestive Exercises:  continued exercise promotes lymphatic flow.
    • Skin and Nail Care:  lifelong management of healthy skin and nails will help prevent infections.

Using JOBST® compression garments is essential in effectively managing lymphedema. To browse the compression garments we have available, check out our online catalog to find the right garment for your lifestyle.