What is lymphedema?

Edema is a medical term for swelling, and refers to a collection of fluid beneath the skin. Swelling can be a common occurrence in response to injury or infection. It can also occur during pregnancy or after sitting for a prolonged period, such as when traveling. Leg swelling is especially common with aging as the tiny valves in leg veins become leaky.

When swelling does not go away, or is accompanied by skin changes and discomfort, it may indicate a condition called lymphedema.

What is lymphedema?

Lymphedema is a long-term or chronic condition that causes abnormal and persistent swelling in your body. The swelling is usually seen in the extremities (arms and legs), but can also occur in the face, neck, trunk, and genitals.

Lymph is a fluid that surrounds the body's tissues and contains white blood cells, proteins, and nutrients. Your lymphatic system contains lymph nodes and vessels that carry this fluid and move it into the bloodstream. When problems arise with this transport system, fluid may collect in the tissues, leading to edema (swelling).

Persistent swelling also encourages your body to produce more collagen (a protein found in connective tissues) and fat, causing these areas to feel heavy and look enlarged. Swelling can lead to dry, thickened, or cracked skin that increases the risk for skin infection.

In contrast to normal swelling, lymphedema may not improve significantly with elevation of the extremity, or with fluid pills (known as diuretics) prescribed by your doctor.

What causes lymphedema?

Lymphedema occurs when the lymphatic system is damaged or not functioning properly. This can be caused by a genetic defect you are born with, or can result from another cause such as cancer (or its treatment), injury, and infection. If the vessels in the system are damaged or obstructed, the lymph fluid can't circulate and drain properly, leading to fluid buildup. Causes include:

• inherited genetic conditions
• cancer, most commonly breast cancer
• cancer treatments including radiation therapy and lymph node removal
• infection
• injury or trauma
• obesity
• autoimmune disease
• arthritis
• certain medications including calcium channel blockers, and certain antibiotics and chemotherapy drugs used to treat cancer.

The most common causes of lymphedema in the US are cancer and cancer treatments. It is estimated that one in five breast cancer survivors will develop lymphedema.

Symptoms of lymphedema

Symptoms of lymphedema usually occur gradually, so you may not notice them at first. The main symptom of lymphedema is swelling, usually in the lower legs, feet and ankles, or arms. The swelling can affect one or both sides of the body. Other common signs and symptoms include:

• aching pain
• discomfort
• a feeling of heaviness or tightness
• enlargement of the affected area
• decreased range of motion
• firm, thickened skin
• dry skin, sometimes with bumps and blisters
• skin discoloration
• recurrent skin infections.

As the swelling worsens, symptoms may begin to impact walking and activities of daily living.

When lymphedema is caused by cancer and certain tumors, the swelling may occur in other areas. For example, cancer of the head and neck may lead to edema in the face and neck, while abdominal and pelvic tumors may cause swelling in the belly, genitals, or legs.

How is lymphedema treated?

Lymphedema is a chronic condition with no cure. Treatment can help to manage pain and swelling and minimize complications. Certain lifestyle changes and self-care techniques are also recommended to prevent worsening.

Complete decongestive therapy (CDT) is the most effective treatment for lymphedema. CDT consists of two phases: active therapy and maintenance therapy. Active therapy sessions are performed by a licensed lymphedema specialist in a medical facility. The specialist will teach you how to perform these techniques yourself so you can do them at home during the maintenance phase.

CDT consists of:

• Exercise. Exercise helps to promote a healthy weight and encourages circulation. Your lymphedema specialist can help tailor an exercise regimen based on your needs and abilities.
• Skin care. Skin irritation and infection can worsen lymphedema. Gently clean the affected skin and dry thoroughly. Apply moisturizers daily to help with dryness and cracking.
• Compression therapy. To manage short-term swelling, wrap compression bandages firmly around affected areas. Compression garments (such as stockings or arm sleeves) are used for long-term management and prevention of swelling. Ensure garments are properly measured and fitted to your body by a specialist. Wear these daily, even during exercise, as directed by your doctor.
• Advanced pneumatic compression (APC) therapy. APC devices actively compress your arm or leg to mimic muscle contraction and encourage fluid movement.
• Lymphatic drainage. Manual lymphatic drainage is a hands-on massage technique to help drain and circulate lymphatic fluid.

In extreme cases, surgery can be used on the lymph nodes and lymphatic vessels to improve circulation, or to remove excess fat or tissue from the affected area.

It is important to monitor your condition because of the increased risk of skin infection with lymphedema. If you notice more swelling, pain, or redness in at-risk areas, or if you develop a fever, seek immediate medical treatment. Your doctor may prescribe an antibiotic if they suspect an infection.

The National Lymphedema Network provides resources on how to find a lymphedema specialist or treatment center in your area.

Lymphatic drainage massage

Lymphatic drainage massage is a specialized type of massage used to prevent and treat lymphedema. It uses light skin stretching to coax lymph fluid out of the tissues and mobilize the lymphatic system. Benefits of lymphatic drainage massage include:

• decreased swelling
• improved lymphatic function
• softening of firm, thickened skin
• pain reduction
• muscle relaxation.

Lymphatic drainage massage is performed by a licensed lymphedema specialist. However, you can ask your specialist to teach you techniques to use at home. The idea is to massage non-swollen tissue to create space for the congested lymph fluid to move.