Lymphedema

Lymphedema can be a debilitating and serious condition if not managed properly. There is no cure for lymphedema and once it develops, it can be a long-term uncomfortable and sometimes a painful condition requiring frequent treatment.

When lymphedema is not treated, the protein-rich fluid continues to accumulate, leading to even more swelling and hardening (referred to as fibrosis) of the tissues. This fluid is a good culture medium for bacteria; thus resulting in reoccurring infections when there are injuries to the skin, decrease or loss of functioning of the affected limbs, and skin breakdown.

Infections, referred to lymphangitis, can affect the connective tissue under the skin. Repeated infections may result in scarring, which in turn makes the tissue susceptible to more swelling and infection. Over time, these infections result in tissue hardening (fibrosis), which is a characteristic of advanced chronic lymphedema. In severe cases, untreated lymphedema may even result in a rare form of lymphatic cancer called lymphangiosarcoma.

Symptoms of lymphedema include:

  • Swelling of an affected limb, which may develop gradually or suddenly;
  • Tightness of the skin and a feeling of heaviness in the affected area;
  • Discomfort or a feeling of “pins and needles” in the affected area;
  • Pitting edema, which can be identified by observing a temporary indentation in the swollen area when pressure is placed on the affected area;
  • Aching in the adjacent shoulder or hip due to the increasing weight of the swelling limb; and
  • Tight fitting of a ring, wristwatch, or bracelet, without a gain in weight.

One cause of lymphedema is primary lymphedema, where the patient is born with a lymphatic system that is compromised. Primary lymphedema is an inherited condition. They lymphatic system may be absent or have pathways that formed incorrectly.

Secondary lymphedema, or acquired lymphedema, develops as a result of an injury to the lymph system. Specific causes include surgical treatment for certain types of cancers especially those cancers that currently require the removal of lymph nodes. Radiation treatment for cancer or for some AIDs-related diseases, such as Kaposi-Sarcoma, may also result in lymphedema, as radiation may damage or destroy lymph nodes or cause the formation of scar tissue that can interrupt the normal flow of lymphatic fluid

Specific cancers and their treatment that may result in lymphedema include malignant melanoma, breast (in both women and men), gynecological, head and neck, prostate, testicular, bladder and colon cancer. Other causes of lymphedema include trauma to the lymphatic system from burns, liposuction, tattooing, injuries, surgery, radiation, obesity, heart or circulatory disease and multiple sclerosis. Lymphedema in people at risk may not develop the condition immediately, but develops the condition weeks, months or even years later. Aircraft travel has been linked to the development of lymphedema in patients after cancer surgery, possibly due to the decreased cabin pressure.

Lymphedema is a chronic condition that cannot be cured, but it can be improved with treatment. There are several major components of a lymphedema treatment program, which should be administered by the health care provider in cooperation with an occupational therapist or physical therapist strained in lymphedema treatment. Complete Decongestive Therapy (CDT; also referred to as Complex Decongestive Therapy (CDT) or as Complete Decongestive Physiotherapy (CDP)) combines manual lymph drainage (MLD) with compression techniques and with patient education on self-care needs. The goals of the treatment program are to:

  • Remove the stagnant lymph fluids out of the tissues
  • Reduce and help control swelling
  • Soften fibrotic tissue; and
  • Improve the overall health of the patient.

Compression techniques include the use of garments, aids and bandages. These methods encourage natural drainage and prevent swelling by supporting tissues in a way that aids in drainage. Compression garments are knit, stretch sleeves or stockings. Compression aids are custom-fitting sleeves, stockings, or pads made of fabric-covered foam. Bandages are an effective flexible means of compression. They work when the patient is active or resting and can easily be adjusted to fit changing limb sizes. However, the bandage should be a special type of short-stretch bandage and not the long-stretch bandage that is commonly known as Ace bandages. Only persons who are trained in lymphedema therapy should tape or wrap swollen areas.

Self-care techniques are practiced by the patient or his or her caregiver at home, between visits to the therapists and may include self-massage, skin care to maintain healthy tissue, nutritious diet and exercise to increase lymph flow, increase mobility and to improve the patient’s general health.

Find Your Physician or Program Specialist
Contact
612 South Sibley Ave.
Litchfield, MN 55355
Phone: (320) 693-4528
Fax: (320) 693-4561
Providers

Jennifer Steinhaus, MA, OTR/L, ATP, CLT-LANA

Meeker Memorial Hospital Rehabilitation Services

Suzanne Hansen, MA, OTR/L, CLT – Rehabilitation Services Director

Meeker Memorial Hospital Rehabilitation Services

Joyce Carlson, APRN, CNS, CWOCN

Clinical Nurse Specialist, Wound, Ostomy, Continence Nursing Services