Lymphedema Support Group

Lymphedema (or "Lymphoedema", "lymphatic obstruction") is a condition of localized fluid retention caused by a compromised lymphatic system. The lymphatic system (often referred to as the body's "second" circulatory system) collects and filters the interstitial fluid of the body. Lymphedema has been barely recognized as being a serious health problem; however, this is slowly changing due to education and awareness. The danger with lymphedema comes from the constant risk of developing an uncontrolled infection in the affected limb. Still, physicians and medical staff who practice in fields where this disease is uncommon may fail to correctly diagnose the condition due to the apparent lack of information regarding this disease.

Lymphedema may be inherited (primary) or caused by injury to the lymphatic vessels (secondary). In the United States it is most frequently seen after surgery and/or radiation therapy, in which damage to the lymphatic drainage system is caused during the treatment of cancer. It is especially common after surgery or radiation therapy are used in combination to treat breast cancer. Lymphedema may also be associated with accidents or certain diseases or problems that may inhibit the lymphatic system from functioning properly. Many cancer patients find this condition may develop after their therapy has concluded. In tropical areas of the world, a common cause of secondary Lymphedema is filariasis, a parasitic infection.

While the exact cause of Primary Lymphedema is still unknown, it is usually manifested by poorly-developed or missing lymph nodes and/or channels in the body. Lymphedema may be present at birth, develop at the onset of puberty (praecox), or not become apparent for many years into adulthood (tarda). Some cases of Lymphedema may be associated with other vascular abnormalities. In the lower extremity it will be unilateral or bilateral. If it is bilateral, one leg may be worse than the other.

Lymphedema affects both men and women. In women, it is most prevalent in the upper limbs after breast cancer surgery and lymph node dissection, occurring in the arm on the side of the body in which the surgery is performed, and in the lower limbs or groin after surgery for colon, ovarian or uterine cancer requiring the removal of lymph nodes. In men, lower-limb Lymphedema is most common, occurring in one or both legs or occasionally in the genitals following treatments for prostate, colon and testicular cancers, particularly where lymph nodes have been removed. Lymphedema can also occur in those who are obese, as the lower abdominal area can hang and cause a disruption in the lymph flow, which may cause swelling in the abdomen and/or legs due to accumulation of lymph.

Therapists can receive certification in Manual Lymph Drainage massage through special classes conducted by organizations such as Academy of Lymphatic Studies, Klose Training and Consulting, and The Lymphology Association of North America.

Increasingly, Complete Decongestive Therapy (CDT) is being used to treat Lymphedema. CDT consists of manual lymphatic drainage, short stretch compression bandaging, therapeutic exercise, and skin care.

MLD was initially pioneered by Dr. Emil Vodder in the 1930s for the treatment of chronic sinusitis and other immune disorders. MLD is now recognized as a primary tool in Lymphedema management. Sessions involve gentle, rhythmic massaging of the skin to stimulate the lymph nodes to open and drain. The treatment is very comfortable and nonaggressive. A typical MLD session will involve drainage of the neck, abdomen, trunk, and involved extremity and lasts approximately 40 to 60 minutes, depending on the severity and extent of the lymphedema.

Compression bandaging is the application of several layers of compression garments to the involved area(s), which includes one or more short-stretch bandages. Short-stretch bandages are preferred over long-stretch bandages (such as Ace(r) bandages as the long-stretch bandages cannot produce the higher tension necessary to safely reduce Lymphedema. The bandages allow comfortable wear during sleep and rest in most cases, unlike Ace(r) wraps which can become very tight and cause cutoff of blood circulation without regular body movements. During activity, the short-stretch bandages provide increased resistance against the affected areas and, therefore, help to soften fluid-swollen areas as the muscles push out during exercise and daily activities.

Therapeutic exercise is used to help improve lymphatic flow while compression bandaging is worn. Also, some patients with chronic Lymphedema or large, swollen areas will have poor strength or range of movement. These patients benefit from exercise prescribed specifically for them by their therapist to help improve their function and comfort.

Skin care is an important component of CDT. People with Lymphedema or who have had lymph nodes removed are at a higher risk for infections of the affected areas. Teaching higher risk sufferers about the signs and symptoms of infections is key to early identification and treatment. Untreated infections can further damage an already impaired lymphatic system and lead to more severe Lymphedema and skin ulcers.

Initially, CDT involves frequent visits to a certified therapist with a doctor's prescription. Once the Lymphedema is reduced, increased patient participation is required for self care along with the instruction and use of compression garments to further reduce the swelling.

The use of compression pumps is sometimes used in the treatment of Lymphedema. Special care needs to be taken to ensure that the involved trunk quadrant is properly treated with manual lymphatic drainage before the application of a compression pump for patients with Lymphedema. If adequate treatment of the trunk is not carried out, the edema may be pushed into the upper portion of the leg, genitals, or arm. If a patient's Lymphedema worsens during a course of treatment of compression pumping, reassessment for adequate trunk MLD is necessary.