Lymphedema

What is Lymphedema?
Lymphedema is a blockage of the lymph vessels resulting in an accumulation of lymph fluid, which leads to chronic swelling of the arms, legs or other body parts.

The lymphatic system is responsible for removing lymph fluid, consisting of fat, protein, water and cell waste, from the tissue spaces. When lymph vessels become blocked or damaged, excess lymph fluids begin to accumulate. Lymphedema can affect infants, children, women and men of all ages. If left untreated, lymphedema will progress and increase in severity.

Symptoms of Lymphedema
The symptoms of lymphedema vary with each individual; however, some common symptoms include:

• Swelling of the arm(s), leg(s), or other parts of the body
• A feeling of heaviness or discomfort in the affected body part, which may result in a loss of mobility
• Recurrent infections in the affected area
• Hardening or thickening of the skin in the affected area
• Lymph fluid leaking through the skin

Types of Lymphedema
Patients experiencing lymphedema have either primary or secondary lymphedema.

Primary Lymphedema is a result of congenital malformation of the lymphatic system. Primary lymphedema may be present at birth, occur later in life, depending on the type and degree of malformation present. This is usually hereditary and affects females more often than males.

Secondary Lymphedema is a result of damage to the lymphatic system caused by infection, radiation, surgery or other trauma. Common causes are treatment for breast cancer and chronic circulatory problems of the lower extremities.

Treatment of Lymphedema
The recommended treatment for lymphedema is Complete Decongestive Therapy (CDT) comprised of four components. It is performed in two phases. Treatment at St. Rita’s Lymphedema Program is proved on an outpatient basis by an experienced therapy staff certified in CDT.

Four Components of Complete Decongestive Therapy

Manual Lymph Drainage (MLD)
This is a gentle manual treatment performed directly on the skin to improve the activity of the lymphatic system. Manual treatment stimulates the lymph vessels in the trunk that carry lymph fluid to the other lymph nodes. Next, the lymph fluid in the congested limb is gently directed toward the healthy nodes. From there, the lymph is transported back into the blood system.

Compression Bandaging
After each MLD session, the affected limb or body part is wrapped with bandages to prevent re-accumulation of lymph fluid in the affected area. These bandages are short-stretch bandages, which apply a graded pressure to the limb.

Patients are taught this wrapping technique and instructed to wear the bandages until the next treatment session during phase one.

Exercise
Gentle exercise is incorporated into treatment to improve the lymph vessel activity and improve the lymph circulation. These exercises are performed while the bandages are in place. This provides a semi-rigid barrier for the muscles to pump against, which in turn improves lymph circulation.

Skin & Nail Care Education
Diligent skin and nail care are important in the management of lymphedema. As the affected limb swells, the body’s ability to fight infection in that area is decreased, resulting in frequent infections. These infections occur as cellulites, lymphangitis or fungal infections of the nails.

Patients are taught skin care precautions, including the use of low pH, lanolin based lotion. This keeps the affected region well hydrated and decreases the chance of skin cracks through which infection can enter.

Phases of Complete Decongestive Therapy

Phase I
Phase I involves daily therapy (5 days a week) with a goal of maximum decongestion of the involved area. Patients in this phase wear short stretch compression bandages at all times except during manual lymph drainage. Once the amount of lymphedema decreases and begins to stabilize, patients are fit for a compression garment and progress into Phase II.

Phase II
In Phase II, treatment focuses on progressing patients to independent home management of their lymphedema. The frequency of visits is gradually decreased until the patient is independent. Patients in this phase wear compression garments during the day and bandages at night. This self-maintenance will last a lifetime.

Results of Treatment

There is no cure for lymphedema; therefore it is essential to treat and manage the condition effectively. Complete decongestive therapy can help to decrease swelling of the affected area, decrease the incidence of infections and improve function of the affected arm and leg.