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Lymphoedema is the progressive swelling of tissue as a result of the accumulation of fluid (lymph), fat and protein beneath the skin (Lymphoedema Framework, 2006; Br Med J, 2018). It occurs if there is a problem with the lymphatic system that prevents it from transporting lymph effectively away from the tissues, causing it to build up in the affected area. It commonly results in the swelling of one or more limbs, but can also affect the trunk, head and neck, and genitalia (Lymphoedema Framework, 2006; Br Med J, 2018).
lymphoedema is caused when a person is born with missing or malformed lymph vessels that prevents the effective transport of lymph. It is relatively rare (Lymphoedema Framework, 2006). Secondary lymphedema is the most common type. It results from damage to the lymphatic vessels and/or lymph nodes due to trauma, disease (malignant or venous), surgery, infection, irradiation or immobility (Browse et al, 2003; Lymphoedema Framework, 2006).
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 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).
Like exercise, manual lymphatic drainage uses manual massage techniques to encourage the movement of fluid from the tissues (Lymphoedema Framework, 2006).
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:
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 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.