Condition Guides Lymphoedema – A Guide

Lymphatic system

The lymphatic system plays a vital role in maintaining fluid balance between the blood and tissues of the body. It also plays a crucial role in fat absorption and transport, and in immunity by transporting infection-fighting white blood cells around the body (Liao and Padera, 2013).

Fats, and white blood cells are transported in a fluid called lymph, which passes through the lymph vessels and circulates the body in much the same way that blood travels in the blood vessels.

On its journey, lymph passes through the many lymph nodes around the body. The lymph nodes serve two functions: to filter the lymph as it passes through, removing foreign particles and cancer cells, and to launch an immune response if needed (Liao and Padera, 2013).

Causes, Signs & Symptoms

Common Causes Lower limb(s)

  • Chronic venous insufficiency
  • Thrombophlebitis
  • Surgery
  • Deep vein thrombosis
  • Traumatic injury
  • Obesity
  • Cancer
  • Immobility
  • Pregnancy
  • Chronic skin conditions and inflammation.

Common Causes Upper limb/trunk

  • Breast cancer surgery and/or radiotherapy
  • Obesity
  • Chronic skin conditions and inflammation
  • Hypertension (Lymphoedema Framework, 2006).


  • Clothing or jewellery feeling tighter than usual
  • Feeling of heaviness, tightness, fullness
    or stiffness (Lymphoedema Framework, 2006).


  • Distortion of limb shape
  • Permanent swelling
  • Hard, wood-like skin
  • Reduced mobility
  • Skin folds
  • Wart-like growths (papillomatosis)
  • Leaking fluid (lymphorrhoea)


Lymphoedema is a progressive, chronic condition that cannot be cured and that requires long-term management. The best outcomes are achieved if the person with lymphedema works in partnership with healthcare professionals.

Management should address all aspects of living with lymphoedema, including management of pain, nutrition and any psychosocial issues. It should also focus upon reducing fluid build-up in the tissues. This is achieved using a combination of:

Exercise and/or movement

Exercise and movement help to move lymph and blood from the tissues back into the lymphatic and blood vessels.

There is evidence that exercising while wearing compression increases this beneficial effect (Lymphoedema Framework, 2006).

Manual lymphatic drainage

Like exercise, manual lymphatic drainage uses manual massage techniques to encourage the movement of fluid from the tissues (Lymphoedema Framework, 2006).

Skin care

Skin care is an important part of management since it helps to avoid breaks in the skin that may lead to infection (cellulitis).

Lymphoedema is a risk factor for cellulitis, and once skin infection has occurred, it is more likely to recur. This can result in hospitalization and a need for long-term antibiotic therapy.


A number of steps can be taken to prevent lymphoedema occurring in at risk individuals:

  • Good skin and nail care
  • The use of compression hosiery
  • Maintenance of optimal weight
  • Balanced nutrition
  • Exercise, movement and elevation of the affected limb.


If management and self-care is ignored, lymphoedema can deteriorate gradually, becoming increasingly more difficult to manage and taking longer to control. An increase in limb size can interfere with mobility and affect body image (Tobin et al, 1993).

There are also changes in tissue structure and an increased susceptibility to frequent episodes of acute cellulitis, often resulting in periods of hospitalisation and long-term dependency on antibiotics (Mortimer, 1995).

Compression therapy

Compression therapy is a key component of the management of lymphoedema. It can be used to prevent development of lymphoedema in at-risk patients, or to manage early symptoms, but it is most commonly used in long-term management (Lymphoedema Framework, 2006).

Compression works by supporting the limb and reducing swelling. It does this by providing a casing around the limb which provides resistance to the muscles when they move and contract.

If the swollen limb has maintained a proportional limb shape then compression hosiery may be used (following full nurse assessment). If there is significant swelling that distorts limb shape, or if there is a wound or skin changes, compression bandaging may need to be used initially until healing is achieved and/or swelling is reduced (Lymphoedema Framework, 2006). If you are unsure as to which product to use, seek the advice of a health-care professional.