What is Lymphedema?

Our cells live in a fluid environment. The fluid in which the cells live in is called the lymph fluid. The system that moderates the amount of this fluid in the body is called the lymphatic system.

The lymph fluid circulates through the body through lymph ducts. In the lymphatic system, there is no mechanism such as the heart or artery in the blood circulatory system that helps in the circulation. Instead, the circulation of the lymph fluid in the lymph ducts is provided by muscle movements (activitiy in our daily lives). If the accumulated fluid in the body is more than the lymphatic system can handle, lymphedema occurs. This disease is also called “Elephant disease-Elephantiasis”.

Factors that cause lymphedema

• By birth or at any age through unknown causes
• After operational procedures and/or radiotherapy
• Infections (insect bites, foot fungus, nail infections)
• After traumas that effect the lymph veins
• Recurring tumors
• Obesity
• Postoperative infections
• In some types of cancers, such as breast cancer, the lymph nodes may be removed as a part of the treatment. This can also cause lymphedema.

The Effects on the patient

• Swelling in arm, leg or other part of body
• A deterioration in general health
• Slowing down and limitations in movement
• Thickening of the skin and leakage of fluid through the skin
• Cosmetic problems, problems in finding appropriate clothing and shoes
• Change in life style, deprivation of sun and heat and limited activities

The stages of lymphedema

Stage 1
Known also as the subclinical or pre-phase. In this phase, the carrying capacity is below normal. There are no fibrotic tissue changes. The tissue leaves a flare. The edema increases during the day but decreases with elevation.

Stage 2
There is a permanant edema that doesn’t decrease with elevation. There are fibrotic tissue changes. The Stemmer sign is positive in stage 2.

Stage 3
(Lymphostatic Elephantiasis) The tissue is hard with no flare.There is a limitation in movement and also trophic skin changes.

Treatment of lymphedema

The treatment of lymphedema has 4 stages:

• Manual lymph drainage
• Skin care
• Applying bandage
• Exercise

Manual lymph drainage

In accordance with the anatomy of the lymphs, the aim is to provide the lymph fluid to join the circulatory system again by applying rhythmic and slow massage techniques to the area of the edema. This is provided by properly activating the lymph veins under the skin that travel throughout the body in the lymphatic web.

Skin care

The aim of this treatment is to eliminate the growth of bacteria and fungus that cause lymphangitis. The risk of infection is reduced by using low PH skin lotions.

Applying bandage

By applying bandage after manual lymph drainage, the decreased tissue pressure is increased, therefore stopping the lymph fluid from filling the affected arm or leg. At the end of the treatment when the arm or leg is back to normal or close to normal, the patient is asked to use compression hand socks.

Exercise

This stage activates the whole muscle groups and the joints in the swollen arm or leg and increases the lymph circulation.

• 30º degree elevation,
• Pumping exercises,
• Active joint movements from distal to proximal can be applied

Steps to avoid or control lymphedema

• The hygiene of the arm that is under risk and skin care. Skin should be washed and gently dried. The elasticity of the skin is important. Skin should be taken care of with non-oily creams, body milk or lotions.
• The affected arm/leg should be protected against all types of woundings, insect bites, cuts and burns. Protective gloves must always be worn when working in the kitchen or garden.
• Cutting the skin must be avoided when cutting nails. Unwanted hair must be removed by a shaving machine, razors should never be used.
• High heat or cold should be avoided (Turkish bath, sauna, hot shower) The healthy arm should be used for blood drawing, injections and taking blood pressure.
• Tight fitting gloves or tight elastic bands that put pressure on the wrist should not be used. Bras, underwear, other tight fitting clothing or jewellery should not be worn.
• Lying on the affected arm at night should be avoided. Handbags and other heavy things should be carried with the healthy arm.
• The doctor should be notified immediately if there is the smallest sign of infection such as; redness, pain, heat, swelling in the affected arm or fever.

Physiotherapist Merve Akçil