Information about lymphoedema
Lymphoedema is a chronic medical condition that causes swelling. It often occurs in an arm or leg, but can also affect the head and throat, chest or genitals. It is caused by the accumulation of lymphatic fluid in the body's soft tissues. It may be the result of illness, trauma, malformation, surgery or radiotherapy.
Lymphoedema may result in significant functional impairment, as it may restrict your movement and ability to work, as well causing pain and a feeling of heaviness or tightness. It also increases the risk of infection and may cause psychological and cosmetic problems.
While there is currently no known cure for lymphoedema, effective treatment can alleviate the symptoms. Left untreated, lymphoedema may become more severe and more difficult to treat.
There are various ways to treat lymphoedema. A conservative approach involves various forms of compression therapy and manipulation. You will also receive general recommendations concerning self-care, weight loss and motion therapy
What is lymphoedema?
The symptoms of lymphoedema
Early signs of lymphoedema include:
- an aching, heavy feeling in or close to the affected area;
- visible swelling; and
- fatigue in the affected area of the body.
If you have one or more of these symptoms, you should book an appointment with your doctor. You may be referred to a lymphatic therapist. Lymphoedema is a chronic condition. It must be treated not ignored.
Who suffers from lymphoedema?
It is impossible to predict who will suffer from lymphoedema. Studies have shown that the number of lymph nodes and lymphatic vessels varies from person to person, as does the capacity of the lymphatic system.
The oedema clinic at Uppsala University Hospital examines and treats lymphoedema patients from across the Uppsala region. You must be referred to the clinic by a doctor.
Compression therapy using compression stockings or bandages increases circulation, helping the body to move fluid and prevent it from accumulating and causing swelling. Compression is usually applied using a sleeve or stocking to maintain circulation in an area with a lymphoedema.
Compression must be applied in exactly the right area, otherwise lymphatic flow may deteriorate further. It is therefore important to individualise compression. Different types of oedema require different amounts of pressure. Compression devices therefore come in four compression classes, CCL I–IV. The most common is CCL II.
It should be noted that standard compression stockings are not adapted to lymphoedema but to impaired venous function, such as during pregnancy or when flying.
Practical advice when using compression stockings
- Wearing rubber gloves when applying compression provides better grip and reduces the risk of damaging the stocking.
- There are various types of donning aid on the market so if you have difficulty putting on your compression device, speak to your lymphatic therapist.
- Shower and moisturise in the evening rather than the morning.
- If you use skin cream, allow the skin to dry thoroughly before applying compression.
- Wash the stocking every day to maintain elasticity. Follow the manufacturer’s washing instructions.
- Put on the stocking in the morning before swelling increases.
- The compression stocking must be smooth against the skin. Avoid wrinkles and folds, as these may damage the skin and further impair lymph circulation.
Different types of compression
Flat-knit compression products are best for assisting lymphatic flow during activity such as exercising.
Circular-knit compression products are more elastic but may occasionally cut in, impairing lymphatic flow. For some people, it may be appropriate to switch between flat knit and circular knit depending on what they are planning to do.
Your lymphatic therapist will help you find the right type of compression product for your needs.
How can I find the level of compression that suits me?
A lymphatic therapist will assess your compression needs after you are referred by a doctor.
How can I tell that a compression product is correctly applied?
A compression product should not cause more swelling. Nor should it cause any red folds around, for example, the elbow. You put on a compression product in the morning and take it off again in the evening, or as advised by your lymphatic therapist.
Will I be able to move normally when wearing a compression product?
It is important that you move around! Especially if you have a sedentary job.
How often will I need a new compression stocking/sleeve?
Under normal circumstances, you will need to replace your compression product once or twice a year.
At this time, you will usually meet with your lymphatic therapist for a check-up so they can assess how your self-care and compression is going.
This therapy is tried on more severe oedema. It is an intensive therapy that uses an air pump to apply pressure over the course of several consecutive days. Your lymphatic therapist may decide to prescribe an air pump for self-care at home.
After pressotherapy, a bandage will usually be applied to maintain the increased lymphatic flow. A tubular gauze bandage will be applied closest to the skin, then wadding or foam rubber padding and finally a low-elasticity bandage to achieve a good level of pressure. The bandage is kept on until the following day’s pressotherapy.
It is useful to able to bandage oneself, especially during periods of high activity when swelling may increase.
To maintain elasticity and optimal effect, your compression garment should be rinsed every evening. It can be machine washed in a laundry bag once a week at 40°C. Unscented washing powder is better for your skin. You will need two compression garments so that you always have a clean one to wear.
Never use fabric softener, as this will damage the fabric. Always check the washing instructions for your specific compression product.
There are several types of donning and doffing aids available on the market to help you put on and take off your compression garment. Easy-glide socks make it easier to don compression stockings. Rubber gloves provide grip and protect fabric against sharp finger nails. Assistive devices are not covered by the high-cost reimbursement scheme.
Taking care of yourself and your body is an important element of preventing lymphoedema and avoiding deterioration and achieving improvement in existing lymphoedema.
Generally speaking, it is important to:
- protect yourself, especially the affected body part, against excessive heat and sun, as this dilates the blood vessels and increases the strain on the lymphatic system, which may aggravate lymphoedema. Protect your self by remaining in the shade, spraying cold water on the swollen area and dampening compression fabric with cold water;
- remain active and do things that you enjoy;
- avoid sudden heavy lifting, such as shopping bags or moving crates, although many people benefit from weight training with gradually increased loads; and
- alternate activity with periods of rest.
Physical activity and exercise
In the interest of wellbeing, it is important to remain physically active and to do things you enjoy and that make you feel good. You would be well-advised to follow the general public health guideline of 30 minutes of physical activity each day. Sometimes you may experience increased swelling during or immediately after exercise. This is entirely normal and presents no danger as long as the swelling goes down again.
Parts of the body affected by lymphoedema are more susceptible to infection. This is due to a combination of the skin becoming distended and less elastic and impaired immune function due to the impairment of the lymphatic system. Wearing a compression device often leads to dry skin. Taken together, this makes it especially important for lymphoedema patients to take good care of their skin.
What can you do to take better care of your skin?
- Keep your skin clean. Low pH shower gels are preferable.
- Dry yourself thoroughly after showering/bathing.
- If you become hot and sweaty, air your skin.
- Moisturise dry skin with a low pH cream/lotion. (Pharmacies stock products such as Eucerin, Propysal, Propyderm and Propyless. A fatter cream is Decubal.)
- Care for your cuticles, dry cracks and eczema. Keep an eye out for cuts. Clean them with soap and water and apply a sticking plaster if necessary.
- Protect your skin with gloves when performing household chores and gardening.
- If possible, avoid taking blood tests and acupuncture in swollen body parts.
- Take extra care when shaving; hair removal cream may be a better alternative.
Thanks to developments in microsurgical instruments and microscopes, surgery is now a more viable option for lymphoedema.
There has been some success internationally in alleviating symptoms and even restoring lymphatic function. The plastic surgery clinic at Uppsala University Hospital has begun using surgery to treat lymphoedema.
Currently available surgical treatments are:
- vascularised lymph node transfer, during which lymph nodes are transplanted from another part of the body to the area affected by lymphoedema;
Learn more about vascularised lymph node transfer in our patient information (in Swedish). (regionuppsala.se)
- lymphaticovenous anastomosis (LVA), during which the lymphatic vessels in the arm or leg are directly connected to the veins, providing the fluid with a direct route from the affected area back into the bloodstream.
Learn more about LVA in our patient information (in swedish). (regionuppsala.se)
The abovementioned surgical procedures are not possible if the fatty, protein-rich lymphatic fluid has already been converted into adipose tissue, in which case liposuction may be an option. (In Sweden, at present this treatment is only available in Malmö.) Even after liposuction, lifelong compression therapy will still be required.
Lecture on surgical treatments for lymphoedema
The lecturers are Hella Hultin, endocrinal and breast surgeon, and Maria Mani, a plastic surgeon at Uppsala University Hospital.
Referrals should be addressed to the oedema clinic.