Lymphedema, caused by a disorder of the lymphatic system, usually occurs on the extremities (hands, feet, legs). However, it can also affect other parts of the body. Treatment depends on the form and progression of the disease.
What is Lymphedema?
According to Wholevehicles, lymphedema is visible and palpable swelling of a part of the body and is caused by a build-up of lymph fluid. The lymphatic fluid is responsible for the transport of lymphatic plasma and lymphocytes via the lymphatic system and the lymph nodes, the filtering and cleaning stations of the lymph.
If this transport is disrupted, the fluid accumulates in front of a lymph node and lymphedema develops. This is proteinaceous water retention that makes the affected body part swollen and bulging.
The most commonly affected parts of the body are the arms and legs. The head, neck, torso, and genitals can also be affected.
Lymphedema can be described as rather rare, with women being affected nine times more often than men.
Depending on the age of onset, a distinction is made between early lymphedema, which occurs between the ages of 15 and 20, and late lymphedema in people over 35 years of age. Late lymphedema is very rare.
Causes
Basically, lymphedema is caused by blocked lymph channels that generate such high pressure that the lymph fluid escapes into the surrounding body tissue.
In order to be able to pinpoint the causes more precisely, medicine distinguishes between primary and secondary forms of lymphedema:
- Primary lymphedema occurs without objective causes and is usually localized to one extremity or is inherited and can be present from birth or develop over the course of life. The cause of hereditary lymphedema is a developmental disorder of the lymphatic system, which can occur without any other symptoms or be accompanied by short stature, intellectual disability and obesity.
- In the case of secondary lymphedema, a cause can be identified, although the triggers are varied. In principle, injuries and the consequences of operations can be identified as causes. Cancer, blood congestion, inflammation of the lymphatic system and parasites are also conceivable causes.
Typical Symptoms & Signs
Symptoms of lymphedema can vary depending on which part of the body is affected, but there are symptoms common to all lymphedema. The area of the body in which the lymph congestion occurs is bulging with fluid and is very swollen, and the skin may be pulled in. In the beginning there is usually no pain.
Other symptoms can provide information as to whether the lymphedema is hereditary (primary lymphedema) or whether it was caused by an illness, injury or the like (secondary lymphedema). Primary lymphedema spreads from the bottom up from the toes over the foot and lower leg on both sides towards the thigh. In summer and in women during the day, the swelling is more severe.
The toes appear square (box toes) and the skin does not lift (Stemmer’s sign). As the disease progresses, the lymphedema can lead to deformity of the legs ( elephantiasis ) and the skin can be prone to warts and infections. Secondary lymphedema can have a similar course, but it causes different symptoms and travels top-down from armpit to hand or groin to foot. In secondary lymphedema, the front foot and toes are unaffected by lymphedema.
Diagnosis & History
Lymphedema is easy to diagnose based on the symptoms present, but the doctor must differentiate between primary and secondary edema:
The primary lymphedema on the leg is clearly visible on the toes that are also affected. Secondary lymphedema must be investigated for its cause. This is done by means of blood analysis, ultrasound and an examination of the lymph transport, called lymphatic drainage scintigraphy. In the past, the lymphatic system was x-rayed using contrast media, but this diagnosis is hardly ever carried out today.
Complications
In most cases, lymphedema causes complaints and complications in the extremities. The lymph nodes swell relatively strongly and lymphatic congestion can also occur. The affected regions of the body are severely swollen as a result, which can lead to various complaints and limitations in the patient’s everyday life.
In most cases, lymphedema also leads to water retention, which can occur in different parts of the body. In some cases, there can also be pain in the extremities, so that the person concerned suffers from significant limitations in everyday life and in carrying out usual activities. However, lymphedema can be identified relatively easily, so that treatment can take place quickly and at an early stage.
The treatment of lymphedema does not lead to further complications or symptoms. The symptoms themselves can be well limited by treatment. As a rule, however, further treatment of the underlying disease is necessary so that these symptoms do not occur again. The patient’s life expectancy is not reduced by this disease. In many cases, however, patients are dependent on various exercises.
When should you go to the doctor?
If you develop swelling, pain, feelings of pressure and tension, and other signs of lymphedema, you need to see a doctor. Unusual skin changes should be clarified by a dermatologist, especially in the case of sudden pain, redness or swelling. If erysipelas develops, this indicates that the disease is already well advanced. Those affected should see a doctor immediately and get their symptoms checked to avoid scarring and other potentially permanent complications.
In the worst case, lymphedema can lead to fistula formation, edema and nerve disorders. Growths and circulatory disorders are further warning signs that need to be examined by the family doctor on the same day. If you have severe pain or restricted movement, you should go to a hospital immediately or call an ambulance. Other contact points are internists, lymphologists and the responsible organ specialists. If there are also mental problems as a result of the physical changes, a therapist can be called in after consultation with the family doctor.
Treatment & Therapy
The treatment of lymphedema depends on the cause and the stage of the disease, which is to be determined in the diagnosis. A detailed diagnosis is therefore crucial for adequate treatment.
The basic treatment goal is to decongest the affected lymph nodes, which can be achieved by elevating the affected body part.
In addition, the patient should be careful not to wear tight clothing and avoid injuries so as not to further burden the lymphatic system.
In the case of secondary lymphedema caused by diseases, the underlying disease must be treated in addition to treating the edema.
The primary lymphedema requires a complex physical decongestion therapy from the pillars:
- lymphatic drainage
- Compression of the affected body part, for example with compression stockings or boots.
- Decongestion through gymnastic exercises and preventive skin and foot care
Other treatment options include taking diuretics, long-term treatment with antibiotics, and surgical repair of the affected lymphatic systems.
While there are good chances of recovery in the first and second stages, the patient in the third stage, the fibroma, must expect intensive and lengthy treatment. In the fourth stage, lymphostatic elephantiasis, which is associated with thickening and hardening of the skin, the lymphedema is irreversible, but progression of the disease can be prevented.
Outlook & Forecast
The prognosis of lymphedema depends on the underlying disease and the cause of the disorder. If the causative disease can be cured, lymphedema will recede on its own. In the case of inflammation, medical care can usually alleviate the symptoms. The prognosis in these situations is usually favorable, as recovery is possible after a few weeks or months.
When cancer is diagnosed, the prospect of a cure is linked to the treatment options and the stage of the disease. In particularly severe cases, the underlying disease leads to the premature death of the patient. If lymphedema develops as a result of being overweight, in many cases the symptoms can be alleviated without medical care. Losing weight often leads to an improvement in overall health. If the affected person suffers from a developmental disorder of the lymphatic system, the prognosis is unfavorable for a large number of patients. There is an impairment of the organism that persists for life.
Basically, a lymphoedema should be treated medically so that a stabilization and, if possible, an improvement in health can be achieved. Otherwise there will be limitations in mobility and often an increase in the existing symptoms. Incurring pain worsens the quality of life and can increase the risk of secondary diseases.
Prevention
It is not possible to prevent primary lymphedema. However, the risk of acquiring secondary lymphedema can be significantly reduced by avoiding obesity and regular examinations of the lymphatic system. It is also the task of a doctor operating on cancer to injure the lymphatic system as little as possible, even if the lymph nodes have to be removed.
Aftercare
The extent of aftercare depends on the circumstance that led to the development of lymphedema. In mild cases, this is limited to a few repeat appointments with the responsible doctor after the acute treatment in order to guarantee a positive course of recovery. The instructions must be followed. Sometimes a diet is necessary, which should be strictly adhered to and medically monitored. It may also be necessary to take tablets, whereby attention must be paid to the prescribed dosage.
If there is a fundamentally serious illness that could lead to the development of lymphedema, it is important to contain this possibility through appropriate treatment. Those affected are therefore advised to report possible changes to their body to the doctor at an early stage in order to avert further complications or symptoms.
You can do that yourself
When treating lymphedema, those affected can carry out some measures themselves to relieve the symptoms. The stimulation of the metabolism and the blood circulation is fundamentally important. This is the only way to stimulate the lymph flow and the associated detoxification of the organism. If slags and other waste products of the metabolism are sufficiently removed, this increases the general well-being.
Self-help measures can easily be integrated into everyday life as rituals. So the morning can be started with a brush massage. Always brush in the direction of the heart. The massage stimulates blood and lymph flow. Afterwards, stimulating oils ( ginger ) can be massaged into the skin. This also strengthens the connective tissue. Sufficient exercise is also fundamentally important in the treatment of lymphedema. Swimming is particularly good. The movements in the water have been shown to train, strengthen and regenerate both arterial and venous blood and lymphatic vessels. The affected body regions should also be elevated as often as possible. This facilitates blood and lymph flow.
Furthermore, tight-fitting clothing should be avoided, as this puts additional strain on the lymphatic system. Wearing compression stockings, on the other hand, is a very good treatment support. Naturopathy recommends taking five globules of Lycopodium clavatum 5 CH and Ginko bioba three times a day. Both facilitate the drainage of lymphatic fluid.