Lymphedema is a blockage of the lymph vessels resulting in an accumulation
of lymph fluid, which leads to chronic swelling of the arms, legs or other
body parts.
The lymphatic system is responsible for removing lymph fluid, consisting
of fat, protein, water and cell waste, from the tissue spaces. When lymph
vessels become blocked or damaged, excess lymph fluids begin to accumulate.
Lymphedema can affect infants, children, women and men of all ages. If
left, untreated, lymphedema will progress and increase in severity.
The symptoms of lymphedema vary with each individual. However, some common
symptoms include:
- Swelling
of the Arm(s), Leg(s) or Other Parts of the Body
- A Feeling
of Heaviness or Discomfort in the Affected Body Part, Which May Result
in a Loss of Mobility
- Recurrent
Infections in the Affected Area
- Hardening
or Thickening of the Skin in the Affected Area
- Lymph
Fluid Leaking Through the Skin
Patients experiencing lymphedema have either primary or secondary lymphedema.
Primary Lymphedema
Primary lymphedema is a result of congenital malformation of the lymphatic
system. Primary lymphedema may be present at birth, occur later in life,
depending on the type and degree of malformation present. This is usually
hereditary and affects females more often than males.
Secondary Lymphedema
Secondary lymphedema is a result of damage to the lymphatic system caused
by infection, radiation, surgery or other trauma. Common causes are treatment
for breast cancer and chronic circulatory problems of the lower extremities.
The recommended treatment for lymphedema is Complete Decongestive Therapy
(CDT) comprised of four components. It is performed in two phases. Treatment
at St. Rita's Lymphedema Program is provided on an outpatient basis by
an experienced therapy staff certified in CDT.
Manual Lymph Drainage (MLD)
This is a gentle manual treatment performed directly on the skin to improve
the activity of the lymphatic system. Manual treatment stimulates the
lymph vessels in the trunk that carry lymph fluid to the other lymph nodes.
Next, the lymph fluid in the congested limb is gently directed toward
the healthy nodes. From there, the lymph is transported back into the
blood system.
Compression Bandaging
After each MLD session, the affected limb or body part is wrapped with
bandages to prevent re-accumulation of lymph fluid in the affected area.
These bandages are short-stretch bandages, which apply a graded pressure
to the limb.
Patients are taught this wrapping technique and instructed to wear the
bandages until the next treatment session during phase one.
Exercise
Gentle exercise is incorporated into treatment to improve the lymph vessel
activity and improve the lymph circulation. These exercises are performed
while the bandages are in place. This provides a semi-rigid barrier for
the muscles to pump against, which in turn improves lymph circulation.
Skin & Nail Care Education
Diligent skin and nail care are important in the management of lymphedema.
As the affected limb swells, the body's ability to fight infection in
that area is decreased, resulting in frequent infections. These infections
occur as cellulitis, lymphangitis or fungal infections of the nails.
Patients are taught skin care precautions, including the use of low
pH, lanolin based lotion. This keeps the affected region well hydrated
and decreases the chance of skin cracks through which infection can enter.
Phase I
Phase one involves daily therapy (five days a week) with a goal of maximum
decongestion of the involved area. Patients in this phase wear short stretch
compression bandages at all times except during manual lymph drainage.
Once the amount of lymphedema decreases and begins to stabilize, patients
are fit for a compression garment and progress into phase two.
Phase II
In phase two, treatment focuses on progressing patients to independent
home management of their lymphedema. The frequency of visits is gradually
decreased until the patient is independent. Patients in this phase wear
their compression garments during the day and bandages at night. This
self-maintenance will last a lifetime.
There is no cure for lymphedema; therefore it is essential to treat and
manage the condition effectively. Complete decongestive therapy can help
to decrease swelling of the affected area, decrease the incidence of infections
and improve function of the affected arm and leg.
