The localization of the edema
Depending on the cause of the lymphedema, the legs are often the first part of the body that the affected person notices. The reason for this is that the body has to work against gravity in the legs to transport the lymph and also the oxygen-poor blood back to the center of the body. Gravity is therefore an additional obstacle to the actual cause of lymphedema.
This also explains the observation of many patients that the leg edema in the first stage recedes as soon as the patient puts his legs up. Especially in the legs, developmental causes such as the lack of venous valves or valves of the lymphatic vessels are a major risk factor, as these normally counteract gravity. Those affected often have severe pain in their legs and also develop skin complaints in their legs.
In the case of lymphedema, both legs do not necessarily have to be affected because the cause, such as a broken lymph vessel caused by an accident, is one-sided. In the case of swollen legs, it must always be clarified whether it is actually lymphedema or some other kind of oedema, since hypofunctions of the heart also lead to oedema without it necessarily being lymph. Lymphedema affecting the legs almost always starts at the foot and goes up to the discharge disorder.
So if the outflow disturbance is in the lymph vessels in the lower leg, lymphedema permanently affects only the foot, while an outflow disturbance in the groin means lymphedema in the whole leg.Due to gravity, lymph fluid always collects first in the subcutaneous fatty tissue of the foot. One examination option for diagnosing lymphedema is therefore the mobility of the toes. This is already restricted at an early stage in the case of slight lymphedema.
Affected persons have difficulty walking and can hardly wear normal shoes. In about half of those affected, both feet are edematous because the cause lies above the junction of the two drainage channels. In the first stage, the edema subsides when the affected person puts his or her legs up.
The edema reoccurs after exercise. Tight clothing and particularly tight belts in the legs and feet can increase the formation of edema and should therefore be avoided in known lymphedema cases. In the case of the feet and legs, if the edema occurs on both sides, it must always be considered that it is a cardiac edema, as it usually begins in the legs.
In contrast to the legs, lymphedema in the arms almost always occurs on one side only. In the legs, the outflow paths of the lymph vessels in the trunk are connected, while the arms have their own outflow paths. In most situations the arms are also low-hanging during the day and therefore the body must move the lymphatic fluid against gravity.
An edema on an arm is most likely a lymphedema, since a heart-related edema is always first visible in the legs. Also in the arms, the edema is initially reduced when the arm is raised. A common cause of lymphedema in the arm is surgery for breast cancer.
In most cases, lymph nodes in the armpit area are also removed, which are also stations for lymph drainage of the arms. This operation can cause permanent damage to the lymph channels and thus trigger lymphedema. At the beginning of the disease, lymphedema can be examined by measuring the circumference of the arm on both sides.
As a preventive measure, breast cancer patients should not wear tight clothing after the operation, as this is considered an additional risk factor. In principle, lymphedema can occur throughout the body. After a breast cancer operation, which usually also involves the removal of lymph nodes and/or radiation therapy, lymphedema can also occur in the breasts.
However, the occurrence of lymphedema in the breast is significantly less frequent than in the arms or legs. Often, slight lymphedema in the breast area is not noticeable either, as the breast size can increase even with weight gain and is not always the same on both sides. In the face, lymphedema is very rare, but it does occur.
The causes range from cancer diseases to congenital discharge disorders. Unlike in the legs, facial edema is more pronounced in the morning than in the evening. This is due to the fact that during the day, gravity helps with drainage.
The lymph targets venous blood vessels below the collarbone and thus below the face. The biggest problem with facial lymphedema is social exclusion and the associated depression. Lymphedema can also develop in the abdominal area.
However, since there are many different reasons for an increase in volume in the abdomen and also for abdominal pain, this is often not recognized as lymphedema. To be on the safe side, other causes for the increase in volume must be excluded. Lymphedema is rather rare in the abdomen because the lymph vessels there are large and the way to the vein angle, the destination of the lymph, is not far away.
In most cases, the legs are also affected, since the lymph accumulates and the lymph vessels in the abdomen are fed by those in the leg. Lymph can accumulate in the scrotum just like in the rest of the body. During operations in the groin area, lymph vessels can be injured, resulting in lymphedema.
A lymphedema in the testicles is also a typical symptom of parasite-related elephantiasis, which is more common in tropical regions. Elephantiasis describes a clinical picture characterized by a massive swelling of body parts as a result of lymph congestion. In Europe, tumor removal in the genital area or the groin region is more likely to be a cause of lymphedema. In extreme cases, many liters of fluid can accumulate in the scrotum.
