Lymphedema, caused by a disorder of the lymphatic system, most commonly occurs on the extremities (hands, feet, legs). However, it can also affect other parts of the body. Treatment depends on the form and progress of the disease.
What is lymphedema?
Lymphedema is a visible and palpable swelling of a part of the body and is caused by a buildup of lymph fluid. Lymphatic fluid is responsible for transporting lymph plasma and lymphocytes via lymphatic channels and the lymph nodes, the filtering and cleansing stations of lymph. If this transport is disturbed, the fluid backs up in front of a lymph node and lymphedema develops. This is a protein-containing water retention that causes the affected body part to swell severely and look bulging. The most common body parts affected are the arms and legs. The head, neck, trunk and genitals can also be affected. Lymphedema is considered to be rather rare, with women being affected nine times more often than men. According to age of onset, a distinction is made between early lymphedema, which occurs between the ages of 15 and 20, and late lymphedema in those over 35. Late lymphedema is very rare.
Causes
Basically, lymphedema results from blocked lymphatic channels that create pressure so high that lymph fluid leaks into surrounding body tissues. To narrow down the causes more precisely, medicine distinguishes between primary and secondary forms of lymphedema:
1. primary lymphedema occurs without objective causes and is usually limited to one extremity or is hereditary and can occur from birth or develop during life. The cause of hereditary lymphedema is a developmental disorder of the lymphatic system, which may occur without other symptoms or accompanied by short stature, mental retardation, and obesity. In secondary lymphedema, a cause can be identified, although the triggers are manifold. Basically, injuries and consequences of operations can be identified as causes. Cancer, blood stasis, inflammation of the lymphatic channels and parasites are also conceivable causes.
Typical symptoms and signs
Symptoms of lymphedema can vary depending on which part of the body is affected, but there are symptoms that occur with all lymphedema. The area of the body where lymphedema occurs is bulging with fluid and is severely swollen, and the skin may be retracted. At 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 similar (secondary lymphedema). Primary lymphedema spreads upward from the toes, through the foot and lower leg on both sides, toward the thigh. In summer and in women also during the days, the swelling is more pronounced. The toes look square (box toes) and the skin cannot be lifted (Stemmer’s sign). As the disease progresses, lymphedema can lead to misshapen legs (elephantiasis) and the skin may be prone to warts and infections. Secondary lymphedema can be similar, but it causes different symptoms and moves from top to bottom from the armpit to the hand or from the groin to the foot. In secondary lymphedema, the front of the foot and toes are not affected by lymphedema.
Diagnosis and course
Lymphedema is easily diagnosed based on the presenting symptoms, but the physician must distinguish between primary and secondary edema:
Primary lymphedema of the leg is clearly evident in co-affected toes. Secondary lymphedema must be investigated for its cause. This is done by means of blood analysis, ultrasound and an examination of the lymphatic transport, called lymphatic drainage scintigraphy. In the past, the lymphatic system was x-rayed using contrast media, but this diagnostic procedure is rarely performed today.
Complications
Lymphedema causes discomfort and complications in the extremities in most cases. The lymph nodes swell relatively strongly in this case and lymph congestion can also occur. As a result, the affected regions of the body are severely swollen, which can lead to various complaints and restrictions in the patient’s daily life. In most cases, lymphedema also leads to water retention, which can occur in various parts of the body.In some cases, there may also be pain in the extremities, so that the affected person suffers from significant restrictions in everyday life and in performing ordinary activities. However, lymphedema can be identified relatively easily, so that rapid and early treatment can also take place. Treatment of lymphedema does not lead to further complications or discomfort. The symptoms themselves can be well limited by treatment. However, treatment of the underlying disease is usually still necessary to prevent these symptoms from recurring. The patient’s life expectancy is not reduced by this disease. In many cases, however, patients are dependent on various exercises.
When should one go to the doctor?
When swelling, pain, feelings of pressure and tightness, and other signs of lymphedema develop, it must be examined by a physician. Unusual skin changes should be clarified by a dermatologist, especially if there is sudden pain, redness, or swelling. If erysipelas forms, this indicates that the disease is already well advanced. Those affected should see a doctor immediately and have the symptoms clarified in order to avoid scarring and other, possibly permanent complications. In the worst case, fistula formation, edema and nerve disorders can occur as a result of lymphedema. Growths and circulatory problems are other warning signs that need to be examined by a primary care physician the same day. With severe pain or restricted movement, it is best to go immediately to a hospital or alert the emergency physician. Further points of contact are internists, lymphologists and the relevant organ specialists. If there are also psychological problems as a result of the physical changes, a therapist can be called in in consultation with the family doctor.
Treatment and therapy
The treatment of lymphedema depends on the cause and, to be determined in the diagnosis, stage of the disease. Therefore, a detailed diagnosis is crucial for adequate treatment. The basic goal of treatment is to decongest the affected lymph node, which can be achieved by elevating the affected body part. In addition, the patient should take care not to wear tight clothing and to avoid injuries so that they do not further stress the lymphatic system. In the case of secondary lymphedema caused by diseases, the underlying disease must be treated in addition to the therapy of the edema. Primary lymphedema requires complex physical decongestive therapy from the pillars:
- Lymphatic drainage
- Compression of the affected body part, for example with compression stockings or boots.
- Decongestion by means of gymnastic exercises and preventive skin and foot care.
Other therapeutic options include taking diuretics, long-term treatment with antibiotics and surgical restoration of the affected lymphatic systems. While in the first and second stage there is a good chance of recovery, the patient in the third stage, the fibroma, must expect intensive and prolonged 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 and prognosis
The prognosis of lymphedema depends on the underlying disease present and the trigger of the disorder. If a cure for the causative disease can be achieved, lymphedema will resolve on its own. In the case of inflammation, medical treatment can usually alleviate the symptoms. The prognosis in these situations is usually favorable, as recovery is possible after a few weeks or months. In the case of diagnosed cancer, the prospect of recovery is tied 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 due to obesity, in many cases relief can be achieved without medical care. Weight loss 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 in a large number of patients.There is an impairment of the organism that remains for life. In principle, lymphedema should be treated medically in order to achieve stabilization and, if possible, an improvement in health. Otherwise, there will be restrictions on movement and often an increase in existing complaints. Incurring pain worsens the quality of life and can increase risks 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 physician operating for cancer to cause as little injury to the lymphatic system as possible, even when lymph nodes must 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 appropriate physician after acute treatment to ensure a positive course of recovery. The instructions must be followed. Sometimes a diet is necessary, which should be strictly followed and medically supervised. It may also be necessary to take tablets, paying attention to the prescribed dosage. If there is a fundamentally serious disease that could cause the development of lymphedema, it is important to contain this possibility by appropriate treatment. Affected people are therefore advised to report possible changes in their body to the doctor at an early stage to avert further complications or discomfort.
What you can do yourself
In the treatment of lymphedema, affected individuals can perform some measures themselves to alleviate the symptoms. It is fundamentally important to stimulate the metabolism and blood circulation. 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 be easily integrated into everyday life as rituals. Thus the morning can be begun with a brush massage. Brushing is always done 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 suitable. The movements in the water have been shown to exercise, strengthen and regenerate both arterial and venous blood and lymph vessels. The affected body regions should also be elevated as often as possible. This facilitates the flow of blood and lymph. Furthermore, tight-fitting clothing should be avoided, as this places additional strain on the lymphatic system. Wearing compression stockings, on the other hand, is a very good treatment support. Naturopathy recommends an accompanying intake of five globules of Lycopodium clavatum C5 and Ginko bioba three times a day. Both facilitate the drainage of lymphatic fluid.
