Lymphoedema is a swelling of one or more body parts due to abnormal accumulation of protein rich fluid in the tissues. It can affect any part of the body but is most commonly seen in an arm or a leg. Although thought to be relatively uncommon, a recent study estimated that at least 100,00 people in the UK may be affected by this condition.
The lymphatic system
The lymphatic’s for part of your immune system helping to deal with infection, and they are responsible for cleansing your tissues and maintaining a balance of fluids in the body.
It can be compared to a waste disposal system, taking tissue fluid, bacteria, proteins and waste products away from the tissues around the skin, fat, muscle and bone.
Once inside the lymphatic vessels (which initially are barely visible, just under the surface of the skin) the tissue fluid becomes known as ‘lymph’ and it is then transported in one direction by increasingly larger and deeper lymphatic vessels. Movement of lymph depends on muscle movement (exercise) and contraction of the vessels themselves. Gentle massage known as manual lymphatic drainage and deep breathing can also help move the lymph more effectively.
Lymph passes through lymph nodes, or glands, located in the neck, armpits and groins where lymph is filtered and cleansed, so that the waste matter and harmful cells can be identified and removed by the body’s defence system. The lymph then drains back into the large veins in the neck. From here it goes back to the heart and eventually is removed from the body through the kidneys.
We are now the only service that is able to treat primary and secondary lymphoedema no matter what its origin is. Our patients travel from as far south as Portsmouth and Gosport, west from Salisbury, east from Farnham and Camberley, up to the edge of Berkshire.
We work very closely with Hampshire PCT to ensure that if a patient requires an assessment they will be seen by the lymphoedema nurse specialist initially and if they require complex treatment or can potentially be dealt with nearer to home then this can be arranged. We hold a clinic at Basingstoke Hospital once a week and at Alton Community Hospital once a week.
Causes of lymphoedema
Primary Lymphoedema – This is where the lymphatic system does not develop properly, there is often family history of the condition. It may develop without any obvious cause at different stages in life, but most often it starts in adolescence.
Secondary Lymphoedema – this is the result of a problem outside the lymphatic system that prevents it from working properly, for example:
Surgery, especially when lymph nodes are removed after cancer treatment.
Radiotherapy, this kills cancer/tumour cells but it can also create scar tissue that can interrupt the normal lymphatic flow.
Accidental trauma, Injury or infection, that may damage the lymph vessels and therefore reduce the lymphatic drainage.
Venous insufficiency, (Varicose veins or problems after deep vein thrombosis), this can result in the lymphatic system becoming overloaded and unable to function efficiently
Reduced mobility or paralysis, muscle contractions during exercise and activity are important to help the lymph to move
Cancer, may also result in a blockage of the lymphatic system
Obesity, the combination of reduced mobility and abnormal pressure can cause the lymphatic system to be overloaded.
Most of the causes of lymphoedema are irreversible and there is currently no known cure. How ever the right treatment and education can help reduce the swelling and keep it to a minimum and improve quality of life.
Treatment and care
The aim of the treatments is to maintain comfort, promote self care, prevent the condition from progressing and prevent infection.
The British Lymphology Society (LSN) has a directory of services which will list your nearest specialist centre.
There are generally four areas of care that will be recommended to people with mild to moderate swelling of their limbs:
Skin care: to help keep the skin and tissues in good condition, to prevent and/or reduce the risk of skin infection.
External support or compression: in the form of elastic compression garments to help prevent the swelling from building up the limb.
A programme of exercise and movement: to try and maximise lymph drainage with out over exertion (this could cause the swelling to worsen).
Simple lymphatic drainage – gentle massage technique that is based on the principles of manual lymphatic drainage. It involves the use of simple hand movements to try and move the swelling out of the affected area. It is designed to be carried out by patients themselves or with the help of relatives and carers.
For people with more severe swelling additional treatments may be recommended.
CDT (Complex Decongestive Therapy), a more intensive therapy may be recommended. This treatment may last for a number of weeks and combines a number of treatments, for example:
Manual lymphatic drainage – a specialised form of massage carried out by a trained therapist to move the skin in specific directions based on underlying anatomy and physiology of the lymphatic system.
Multi layer lymphoedema bandaging - a multi layer system of bandages applying a rigid casing for the muscles to work against which help improve the size and shape of the swelling.
Intermittent sequential pneumatic compression therapy – they has been available for many years but there is no real proof it works. Caution should be taken when using these machines and should be used under supervision of a trained practitioner.
Drug Therapy – research remains ongoing, but drug therapy for lymphoedema is very limited.
Surgery – traditional de-bulking operations are rarely beneficial for lymphoedema, though there are certain situations where it may prove essential, for example eye lid or genital swelling. If required surgeons should have experience with lymphoedema and the lymphatic system.