Lymph is a colorless fluid forming in the tissues of the body and normally draining back into the blood circulation, through a network of vessels and nodes called the lymphatic system. Lymph nodes act as filter stations and play an important part in the body’s defence against infection, by removing excess protein, dead or abnormal cells and bacteria.
As the flow of lymph is dammed up behind damaged or blocked drainage routes, fluid accumulates in surrounding tissues and swelling occurs. Unlike other forms of oedema, lymphoedema is not solely due to water remaining in the tissues. Stagnant lymph forms a solid component, making the control of swelling more difficult.
Brief facts about lymphoedema
There are Two types of Lymphoedema:
- Primary – from congenital defect in lymphatic system.
- Secondary – from damage or removal of lymph nodes, usually cancer related.
There is a grading system used to help identify the severity and appropriately treat Lymphoedema.
Stage 0 / Latency Stage
This first stage is often difficult to classify as there are only minor signs and symptoms at this point. The ultimate goal is to keep patients in stage 0. In the case of Primary Lymphoedema, family history may be an indicator in drawing attention to the possibility of the condition in this phase. With Secondary Lymphoedema, medical advice will hopefully have been given to patients to alert them to what to look out for.
- · There will be no visible swelling.
- · Sensory dysfunction, referred to as paresthesia is often felt. Tingling and numbness in affected limb.
- · Connective tissue changes at microscopic level.
Manual Lymph Drainage, exercise therapy and compression garments are recommended at this stage to avoid progression.
- · Visible swelling appearing in one limb when compared to other side.
- · Swelling reduces completely when the affected limb is elevated.
- · The skin can be deeply depressed by ones finger, leaving a temporary indentation (known as pitting)
- · No hardening or visible skin changes.
A more intensive treatment plan is required at this stage to reduce volume increase and keep the Lymphatic system from being further comprised.
- · An area of scarring and hardening under the skin, known as Fibrosis develops.
- · The swelling does not completely reduce when the limb is elevated.
- · It becomes harder to leave an indentation on the skin.
- · There may be pronounced superficial skin changes such as excessive tissue and hardening.
Treatment strategy is difficult to generalise at this point due to the nature of complications associated with stage 2 Lymphoedema.
- · At this point, the patient will find mobility very difficult due to extreme swelling.
- · The skin’s surface will have changed considerably with pain and compression damage.
- · The amount of fatty tissue will have increased.
- · There is a risk of skin infections.
Once Lymphoedema occurs, it is permanent – however it is manageable. Best response to treatment is at early onset. 30-50% of people with lymphoedema have significant pain in the affected extremity/limb. With breast cancer, delayed auxiliary wound healing, obesity, postoperative infections and cellulitis of the upper extremity increase the risk of post-treatment Lymphoedema.
Lymphoedema can occur years after damage or removal of lymph nodes.
Maintaining a healthy weight and lifestyle including regular exercise enhances successful treatment of Lymphoedema.
Any occurrence or re-occurrence of infection during MLD treatment by a therapist must be discontinued and the patient referred to a doctor for consultation before treatment can resume.
Because Lymphoedema weakens the immune system of the affected limb(s), skin must be kept clean and moist. It is recommended that a low pH skin lotion that contains no perfumes or other irritants should be applied to the skin and nails daily to combat bacteria, viruses and other infections.