Lymphedema – swelling of the arms and legs

Lymphedema – swelling of the arms and legs

Heavy legs are a frequently mentioned symptom of lymphedema, i.e. a build-up of lymphatic fluid that often occurs in the legs. However, lymphedema often accompanies significantly more symptoms and limitations for those affected. Lymphedema can also occur in other body parts, such as the arms, leading to unpleasant complications. In this article, you will learn how lymphedema develops, why it should be treated and how you can get your symptoms under control with a suitable therapy plan.

What is Lymphedema?

Lymphedema is caused by disrupted “wastewater transport” in the body. The technical term for this “waste water” is lymph or lymph fluid. The word oedema generally refers to an accumulation of fluid. Lymphedema is, therefore, an accumulation of lymphatic fluid.

Lymph is a fluid that forms between cells in the human body. Usually, it is taken up by a complex system of small vessels (the lymphatic system) and returned to the blood. On the way, the lymph passes through several stations, the so-called lymph nodes. Here, the lymph is filtered, and foreign components are “examined” by the immune system.

If the drainage of the lymph back into the blood is disturbed, to put it simply, lymphatic congestion occurs. The affected area swells, feels heavy, and the skin is tight.

Lymphedema occurs particularly frequently on the arms or legs and the back of the hands or feet because, in these areas, the lymph has to travel a long way against gravity to the centre of the body. Lymphedema in the face and neck, on the thighs, in the groin area, or in the genital area is also less common.

 

What are the causes of lymphedema?

The causes of lymphedema are very different. A distinction is made between primary and secondary lymphedema. In addition, lipedema can also result in lymphedema. Read what these terms mean below.

Primary Lymphedema

A small part of the lymphedema is the so-called primary lymphedema. Less than ten per cent of lymphedema is believed to fall into this category. Primary lymphedema is either hereditary, i.e., inherited from the parents, or there is a spontaneous mutation in the genes – in both cases, they are genetic. Affected people usually have problems with swollen legs or arms from a young age.

 

Secondary Lymphedema

Secondary lymphedema makes up the majority of lymphedema. Edema occurs after damage to the lymphatic system. This can be the case, for example, after an operation in which lymphatic vessels were damaged or removed or after radiation therapy after cancer.

The so-called malignant lymphedema also belongs to the category of secondary lymphedema. A cancerous tumour causes narrowing or even destruction of the lymphatic vessels, so the lymph can no longer drain away.

lipoedema

Lipedema is a unique form of lymphedema. The causes of this congenital lipid metabolism disorder have not yet been clarified. What is certain is that this disease leads to an increase in the subcutaneous fatty tissue in certain parts of the body, mainly on the legs. Instead of lymph fluid, in this case, it is a fat storage.

The increased fat tissue can also block the lymphatic vessels. There is a lymph drainage disorder and, thus, a combined lip lymphoedema. You can find more information about lipoedema here.

Stages and symptoms of lymphedema

Depending on the progression of the disease, lymphedema can be divided into four stages. These are characterized by different pronounced symptoms, which become more and more evident as the course progresses:

  • Stage 0 – In the so-called latency stage, no swelling is visible, but changes in the lymphatic system are already present. A feeling of heaviness may already occur. A diagnosis is rarely made at this stage.
  • Stage I – This stage is described as spontaneously reversible, which means Swelling already occurs, but this goes down through elevation.
  • Stage II – In this stage, there are increased changes in the surrounding connective tissue. It is described as not spontaneously reversible because the Swelling no longer disappears through elevation. In addition, dents on the skin may be visible.
  • Stage III – The area affected by lymphedema is severely swollen and stiff. The fabric is no longer depressible. Dents and wart-like changes are often visible on the skin. The risk of skin inflammation is high.

 

Doctor visit and diagnosis

A Stemmer’s sign test can help confirm the diagnosis if you see signs of lymphedema in your leg. Here, an attempt is made to lift a fold of skin on the second toe with the thumb and forefinger. If this is impossible, Stemmer’s sign is positive, indicating lymphedema.

In the case of symptoms that raise the suspicion of lymphedema, the family doctor can first carry out an orienting examination. If the diagnosis is more challenging, referring you to a specialist practice, such as a specialist in vascular medicine, may make sense.

Lymph scintigraphy can be used to determine whether it is lymphedema. Here, the patient has to drink a radioactively marked liquid that is only processed via the lymphatic system. It is then possible to visualize where the lymph accumulates and how it is transported away.

Can lymphedema regress? Is lymphedema curable?

Lymphedema can regress with consistent therapy, and the symptoms of lymphedema can now be brought under control. However, lymphedema does not go away independently, so treatment is always required. Lymphedema is also a chronic disease. To prevent progression, lymphedema must be monitored and treated continuously.

First of all, the goal of therapy is to decongest the affected limbs, i.e. to dissolve the accumulation of fluid. If this is successful, maintenance therapy follows to prevent the recurrence of lymphedema. Lymphedema can be well controlled with this consistent therapy, but it can not be cured. Therapy is always necessary.

This news is difficult for many of those affected to cope with at first because treating lymphedema requires a lot of personal responsibility and time. Nevertheless, it is worth taking all the components of therapy seriously. Complex therapy can often prevent lymphedema from worsening with complications such as open wounds and maintain the quality of life of those affected.

How is lymphedema treated?

Lymphedema therapy consists of many components. All these building blocks together are called “complex physical decongestion therapy”.

First, compression stockings or arm bandages are essential to the therapy. These are specially adapted for the person concerned and help maintain the lymphatic drainage in the still functioning vessels while reducing the accumulation of lymph.

Manual lymphatic drainage is also very helpful in treating lymphedema. It consists of four basic moves that help to transport the lymph away. Those affected usually receive a doctor’s prescription for regular appointments for lymphatic drainage in a physiotherapy practice.

There is currently no effective drug therapy for lymphedema. Water pills, also known as water pills or diuretics, are not used for lymphedema because they may make it worse.

Surgical interventions are also possible in the case of severe lymphoedema. They are recommended to those affected who, despite complex physical decongestion therapy lasting more than six months, do not show any improvement in their condition. Depending on the cause of the lymphedema, there are various surgical procedures aimed at reconstructing the lymphatic drainage as well as possible.

 

Which sport is good for lymphedema?

Those affected should not neglect physical activity because exercise is also part of self-treatment and can support lymphedema therapy. Many exercises can help to activate the so-called muscle pump – i.e. the support of blood transport through the movement of the muscles. The activation of the muscles leads to an increase in pressure and, thus, to an increase in lymphatic drainage.

For lymphedema in the legs, suitable exercises include climbing stairs or using a home trainer such as the stepper. Nordic walking, cycling or water aerobics also help to decongest the legs.

Exercises for lymphedema

Targeted decongestion exercises for the legs often also use gravity. A good exercise is, for example, to stretch your legs as vertically as possible in the air while lying on your back and paddle alternately with each foot.

Helpful exercises for lymphedema in the arms are, for example, “picking apples”. Those affected should reach up into the air for an imaginary apple. Then pull him towards you and then open your hand again. This movement should be repeated alternately with the other arm for about five minutes.

Skincare: What should sufferers pay attention to?

Patients with lymphedema should observe the following skin care tips:

  • The skin around lymphedema is more susceptible to inflammation and skin infections with germs or fungi, which can develop into deep sores. Accordingly, daily inspection and care of the skin of those affected with lymphedema should become routine.
  • pH-neutral soaps are very suitable for cleaning the skin.
  • The skin can also dry under the compression stockings or arm bandages. A nourishing cream with increased fat can help against brittle, dry, itchy skin.
  • Wounds can cause lymphedema to worsen. That is why those affected should react quickly and disinfect minor wounds. If in doubt, you should always seek medical advice.

 

Influence of diet and weight

There is no evidence that diet influences lymphedema. However, it has been proven that obesity leads to a significant deterioration in lymphatic vessel function. Thus, obesity can be regarded as a risk factor for the development of secondary lymphedema.

Those affected by lymphedema should ensure they eat a healthy and balanced diet. In obese people, weight loss has been shown to help prevent the disease from progressing.

Preventing obesity and paying attention to sufficient physical activity that activates the muscle pump also helps to prevent lymphedema.

Home remedies for lymphedema – what helps?

Additional small home remedies for lymphedema are:

  • Kneipp’sche foot baths, but temperatures that are too high should be avoided
  • wide shoes or clothing that do not impede the drainage of the lymph
  • Elevation of the legs or arms
  • Avoiding hot temperatures, such as in the sauna or at warm holiday locations

With all these components of the therapy and a healthy lifestyle, those affected can reduce their symptoms to a minimum for a long time and lead a life with a high quality of life despite lymphedema.

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