What is Lymphoedema?
Lymphoedema is diagnosed where there is tissue swelling caused by an accumulation of lymph fluid over time, usually a period of three months or longer.
Lymphatic fluid, or lymph, is much like blood plasma and tends to be watery and transparent with a slight yellow tinge. It is made up of lymphocytes, bacteria, cellular debris (dead tissue cells), plasma proteins, and other cells. The lymphatic system is part of your Immune System.
Blood vessels 'leak' fluid (lymph) through its walls into the interstitial tissue carrying nutrients and proteins and is then usually collected and drained out through the body's lymphatic system, carrying with it dead cells, bacteria and any excess fluid. This 'waste' is then returned to the blood stream for disposal through the body's own waste disposal unit - the liver and kidneys as urine and stool. If the lymphatic system is not 'emptying or draining' the lymph fluid as it should, swelling occurs. It most commonly affects legs, but can also affect the arms, chest wall, abdomen, neck and genitals.
LYMPHOEDEMA STAGES
Symptoms of Lymphoedema
Lymphoedema can present with the following symptoms:
- Swelling of part or all of the arm or leg, including fingers or toes
- Heavy, achy limbs with tightness or a feeling of being 'stretched' in the skin
- Restricted mobility, or limb movement
- Recurring skin infections (cellulitis)
- Hardened or thickened skin with a 'waxy' feel
- Thickened folds or creases developing in the skin
- Wart-like growths on the skin
- Fluid leaking through the skin, or 'wet legs' (lymphorrhoea)
Types of Lymphoedema
Primary and Secondary Lymphoedema
Primary lymphoedema occurs when there is a gene mutation in the development of the lymphatic system as a foetus. This can sometimes be congenital – but can also sometimes be hereditary.
The lymphoedema may not develop for some time and can be triggered by trauma near the area of mutation (infection or injury). In some cases, the lymphoedema is present at birth.
Secondary lymphoedema develops from a normal and fully functional lymphatic system that has been damaged through causes such as:
Surgery: Any major surgery can affect the lymphatic system, but it is most commonly found with any cancer related surgery, particularly when lymph nodes are removed.
Radiotherapy: This involves high but controlled doses of radiation to destroy cancerous tissue – this also damages healthy tissue, including the lymphatic vessels and nodes. There is always a risk that the damage can be permanent.
Infections: Cellulitis is more common amongst the elderly or less active, mobility impaired people. This infection is usually found on the lower legs and is often referred to as a ‘skin infection’ and if severe or severely recurrent, can cause scarring in the tissue around the lymphatic vessels, leading to lymphoedema.
Lymphatic filariasis: (also known as elephantitis) A parasitic disease which causes blockage in the lymphatic system, not usually found in the United Kingdom. (i.e.mosquito bites common in tropical or sub-tropical countries)
Psoriasis or eczema: Inflammation caused by conditions like psoriasis or eczema can cause permanent damage to the lymphatic system
Venous disorders: These can lead to an overflow of fluid from the blood vessels into the tissue, causing the lymphatic system to be overwhelmed and unable to cope with the drainage of excess fluid. (compression garments are sometimes contraindicated for venous disorders)
Obesity: Can cause the development of lymphoedema in some people. If severe enough, the excess adipose tissue (fat) can have an impact on the lymphatic system, causing blockages and restriction in the natural flow of the lymphatic veins, vessels or capillaries. The lymphatic system does not have a pump (such as the heart which pumps blood around the circulatory system) and so if a person does not move - the lymphatic system will not function effectively.
The lymphatic system requires body movement as the muscles contracting and expanding help to 'pump' lymphatic fluid therefore if a person is not physically active - their lymphatic system will also remain inactive, potentially causing a build up of lymphatic fluid and swelling, particularly in the feet and lower legs (gravitation).
Exercise or reasonable regular physical activity plays a vital role in prevention, or worsening, of lymphoedema.
Trauma / injury: Some trauma or injuries can sometimes cause damage to the lymphatic system, leading to lymphoedema.