Treat Lipedema

Women in particular often suffer from heavy, swollen legs in the evening. Thick legs can have different causes and are initially no reason for concern. However, if the legs are permanently swollen, a doctor should be consulted to rule out lipedema as the cause. Lipedema is a fat distribution disorder, also known as the riding pants phenomenon or pillar leg. With the right therapy, lipedema can be treated, but a cure is not yet possible.

What is lipedema?

Lipedema occurs almost exclusively in women. The condition causes accumulations of subcutaneous fatty tissue that lead to swelling in the affected areas of the body. As the disease progresses, the accumulations of fatty tissue become more extensive. The fatty deposits usually develop symmetrically on the thighs, hips, buttocks, inner knees or upper arms, and later also on the forearms and thighs and even the ankles. The backs of the feet and hands are affected only in cases of extreme severity. Typical for the clinical picture of lipedema is a slender upper body, so that the legs appear excessively thick.

Symptoms of lipedema

Lipedema patients usually suffer from thick legs with visible accumulations of fatty tissue. Especially after long periods of sitting or standing or on warm days, the legs often swell even more due to additional water retention. More rarely, the symptoms also occur on the arms. The following symptoms can also be observed on the affected parts of the body and help to recognize lipedema:

  • Pain when touched
  • Feeling of heaviness, pressure and tension
  • Bruises already after small impacts
  • Spider veins
  • Coarse, partly knotty skin and orange peel skin (cellulite)
  • Cool, poorly perfused skin
  • X-legs

Causes of lipedema

The exact causes of lipedema are not yet clear. A genetic predisposition and hormonal triggers are considered likely. Lipedema often first appears during or after puberty, pregnancy, or during menopause. Obesity is not one of the causes, but it can negatively influence the course of the disease. In men, lipedema occurs only in exceptional cases, such as hormone imbalance due to liver damage or hormone therapy.

Diagnosis of lipedema

The diagnosis of lipedema is made on the basis of visual and palpatory findings (inspection and palpation), the patient’s medical history and, if necessary, on the basis of ultrasound findings.Above all, a specialist should rule out the possibility that the symptoms are caused by other diseases. For example, the following conditions may be considered here:

  • Obesity (obesity), which often occurs together with lipedema.
  • Lipohyperthrophy (a harmless accumulation of fat), which can develop into lipedema.
  • Lymphedema (water retention), which usually occurs asymmetrically.

Whether it is lymphedema or lipedema, shows the so-called Stemmer’s sign. If the skin can be lifted at the folds of the toes or fingers, it is probably lipedema.

Stages of lipedema in the course of the disease.

Lipedema is not curable and may actually worsen as the disease progresses. Especially if they are left untreated. For example, in stage 1, the fat pads appear mainly on the hips, thighs and the inside of the knees. In this case, the skin is typically finely knotty (orange peel skin). As the disease progresses, the skin in stage 2 appears coarsely knotty with dimpling (“mattress phenomenon”) until finally, in stage 3, large skin flaps and bulges develop. Lipedema can extend to and overlap the ankles. This is then referred to as “pillar leg“. The last to be affected are the fingers and toes – this is the highest degree of severity.

Lymphedema as a result of lipedema.

As the disease progresses, the enlarged and deformed fat cells caused by lipedema increasingly obstruct the drainage of lymphatic fluid. This causes water accumulation in the spaces between the cells, known as lymphedema. These then also cause swelling of the hands and feet. If lipedema remains untreated for years, the large lymph vessels are also affected by this drainage disorder. We then speak of lymphedema or lipolymphedema, as a mixed form of lipedema and lymphedema.

Decongestive therapy against lipedema

The basis of treatment for lipedema is decongestive therapy. It requires daily wearing of compression stockings or bandages to reduce or keep the size of lipedema constant. Compression stockings should always be worn, especially during exercise, to support the tissues. Compression devices are also used as part of “appliance-based intermittent compression” (AIK). Compression of the lymphatic tissue can relieve pain and counteract the progression of the disease. Manual lymphatic drainage, a special type of massage, can additionally promote the removal of the edema. Lymphological physiotherapy also includes functional rehabilitation and respiratory physiotherapy. However, these special treatments should only be performed by specialists and not by masseurs who have no training in lymphatic drainage.

Other forms of treatment for lipedema

The affected lymphatic tissue cannot regress. In lipedema, only surgical liposuction can remove the abnormally changed fatty tissue. However, surgery for lipedema runs the risk of destroying the superficial lymphatic vessels, which can result in additional lymphedema. Surgery for lipedema in the form of liposuction often means only a temporary improvement, because the fatty tissue is more likely to form again more quickly than in healthy patients. A detailed consultation with a specialist is therefore indispensable. In addition, affected individuals should be aware that the costs of liposuction in stage 1 and 2 are usually not covered by health insurance. Since December 2019, affected persons suffering from stage 3 lipedema can, under certain conditions, have liposuction performed at the expense of the statutory health insurance funds. This regulation is initially valid for a limited period until December 31, 2024. In addition to the medical diagnosis, a prerequisite for the assumption of costs is that a conservative therapy has previously been carried out for at least six months without alleviating the symptoms. Liposection is to be performed only for a BMI below 40. In addition, if the BMI is 35 or higher, obesity treatment should be performed. In alternative medicine, such as homeopathy, Schüssler salts and jojoba oil, among others, are used to treat lipedema.

This is what lipedema patients can do themselves.

Exercise and a healthy diet are important elements of treatment for lipedema, even if they cannot reduce lipedema. However, regular exercise and long-term dietary changes help prevent additional excess weight. Gaining weight in the patient could promote the progression of the disease. Physical activity will also reduce water retention. Avoid targeted muscle building in the affected areas and sports that require jerky movements. Light walking or aqua gymnastics, for example, are suitable.

Skin care alleviates symptoms

Since the microcirculation of the skin may be disturbed in lipedema, it is more susceptible to inflammation and scarring changes. Therefore, care should be taken to provide appropriate skin care for lipedema. The sensitive skin areas should be carefully creamed with a special moisturizing lotion and not be additionally irritated by tight clothing or self-massage. Particularly suitable for care are pH skin-neutral soaps and creams containing urea or dexpanthenol.

Psychological consequences of lipedema

Lipedema often represents a heavy psychological burden for those affected. Sufferers suffer not only from physical pain, but also from psychological pain. The negative reactions of fellow patients, the impairment of quality of life, and the frustration caused by unsuccessful diets and exercise programs sometimes lead to depression or eating disorders. Psychological support is therefore always part of a successful therapy for lipedema.