Lymphoedema is a lifelong condition which cannot be cured which will usually respond well to careful management. Lymphoedema is limb swelling due to a build up of fluid (lymph) in the leg. Normally this fluid drains out of the leg via a network of tiny tubes (lymphatics). Legs are affected more commonly than arms and one leg is often worse than the other and sometimes only one leg is affected.
The most common cause of lymphoedema in Ireland is being born without enough lymphatic vessels. If there are very few lymphatics then the swelling may start as a teenager or even earlier (Milroy's Disease). In less severe cases, the lymphatics may be able to cope initially and only start to fail when you are older (lymphoedema praecox if it happens before 35 years of age) and lympoedema tarda if it begins after 35 years.
Secondary Lymphoedema
Lymphoedema can also be caused if the lymphatics of the arm and leg are damaged by surgery or radiation treatment. Sometimes, this is an unavoidable side effect of cancer therapy. Very rarely, tropical parasites (Filariasis) may invade and block the lymphatics but this cause does not occur here in Ireland.
Diagnosis
The diagnosis of lymphoedema is usually made by your doctor on the basis of your history and physical examination. Certain tests may be useful where the diagnosis is uncertain such as:
- Venous (duplex) ultrasound may help to outrule venous obstruction
- Ultrasound or CT scanning will help outrule the compression of either veins or lymphatics inside in the pelvis which can also cause swelling.
- Lymphoscintigraphy uses a small amount of radioactive material to measure the function of the lymphatic system. A small amount of radioactive fluid is injected between the toes in both feet. This travels towards the body in the lymphatics and the progress can be tracked using a special gamma-camera.
Treatment
There is no real cure for lymphoedema and surgery is rarely effective. Careful management of the problem may help prevent progression of the disorder and avoid complications. These include swelling, cellulitis and, occasionally ulceration.
Swelling
The swelling itself may progress over time. In early stages, it will often reduce over night but later on the tissues under the skin become thickened and the swelling becomes irreversible – the use of compression stockings (strong Class 2 or 3 stockings which will be prescribed for you) may be of help in preventing this. Sometimes, special compression bandaging may be required for severe swelling or where there are skin problems. We can make arrangements for you to be assessed, measured and supplied with custom compression garments if "off the shelf" garments are not suitable for you.
You should elevate the legs when you can – for 15 – 20 minutes twice during the day and in the evenings.
Exercise therapy and manual lymphatic drainage may be of benefit, especially in those with more severe disease. We provide a separate list of therapists who can provide this service elsewhere on this website or visit the MLD Ireland website (https://www.mldireland.com/).
Some patients may benefit from the use of adjustable compression wraps (farrow or Jobst warps). These are ordered by your public health nurse and are currently available from Healthcare21 (https://www.healthcare21.eu/product/jobst-farrow-wrap/)
Cellulitis
The swelling impairs the ability of the skin to fight off infection and skin infection (cellulitis) is quite a common problem. These episodes of infection are slow to respond to antibiotics in patients with lymphoedema and can lead to blistering and the formation of ulcers. It is important to keep the skin in good condition (using moisturisers like emulsifying ointment); and to avoid trauma to the feet and fungal infections by keeping the skin between the toes clean and dry
Remember the mainstays of treatment are:
- Elevate your legs when you can
- Wear compression stockings all day (and have your fitting checked regularly)
- Exercise and avoid putting on weight – physiotherapy may also help
- Keep the skin in good condition by using plenty of moisturising cream to prevent dryness.
For Further Information visit the Lymphoedema Ireland website (http://www.lymphireland.com/)
