What is Lymphoedema?

Condition and Treatment - The Lymphatic System

The lymphatic system is a network, similar to your blood system, of thin walled blood vessels that transport fluids of the body to the blood circulation. This system plays a fundamental role in the distribution of fluids and nutrients in the body, filtering out organisms that cause diseases, as well as generating antibodies. Lymph is an almost colourless fluid containing many white blood cells, which is collected from the tissues of the body and transported into the lymphatic system.

Lymphatic vessels carry lymph into the nodes where waste products are filtered out. Lymphatic vessels are located near the veins and have valves to prevent backward flow. A human has between 500 to 1500 lymph nodes, which are mainly located in the head and neck region, armpits, chest, abdomen, pelvis, and groin.

90% of the tissue fluid returns to the cellular beds to become plasma again and continue its journey as a part of the blood circulation. The other 10% is lymph and is left behind. The amount of lymph left behind circulating through the body accounts for one to three percent of the total body weight.

When lymphatic tissue or lymph nodes are destroyed, disturbed, or removed, the lymph cannot drain areas properly. Access lymph now accumulates, resulting in swellings, which is one of the main characteristics of lymphoedema.

Lymphoedema

Lymphoedema is a chronic disorder that can be described as the abnormal swelling due to the presence of excess lymphatic fluids within the tissues. This usually occurs when the lymphatic system malfunctions or is damaged and lymphatic fluids cannot drain as quickly as they are produced. In addition lymphatic fluids contain large amounts of protein which makes the body easily susceptible to infections.

Lymphoedema is a disorder that affects 100 million people around the world. Lymphoedema can be treated, however not cured. It is mostly seen in the extremities of the body, such as the arms or legs, however it can also affect the trunk, breast, abdomen, neck, head, and genitals.

Lymphoedema can be classified in two different types; primary and secondary lymphoedema. Primary lymphoedema is a hereditary abnormality of the lymphatic system, which occurs to approximately one in six thousand people. Secondary lymphoedema is the result of a blocked or damaged lymphatic system. In this case the swelling usually starts within the body and moves towards the externalities. The causes of secondary lymphoedema could be; cancer treatments, scars, trauma, chronic venous insufficiency, or those who are obese. Cancer treatments can cause secondary lymphoedema due to the removal of lymph nodes or their destruction due to radiation or chemotherapy. Large damage done to the skin due to scars, burns, radiation treatments, or other damage can also cause secondary lymphoedema. Traumas causing secondary lymphoedema can include all types of accidents, injury, and surgery that damages the lymphatic system.

The onset of lymphoedema can be sudden, gradual, or delayed so that it appears years after the causative event. Without treatment the lymphoedema symptoms become more progressive and serious. The seriousness of the condition can be classified in three stages.

Stage one, also referred to as early lymphoedema, is characterized by pitting oedema, where tissue is soft to the touch and leave an indentation when pressure is applied. This type of swelling may temporarily be reduced by elevation, however unless treated the swelling quickly returns. At this stage the conditions can be greatly improved with early treatment.

Stage two, also known as moderate or non-pitting lymphoedema, oedema and fibrosis are both present and the tissue is no longer soft to the touch. Fibrosis is the formation of fine scar-like structures that causes the tissues to harden and reduces the flow of fluids through these tissues. At this stage, the tissue feels firm or even hard, and pressure will only leave a slight indentation. The risks of more swelling, tissue infections, and skin problems are now present. At this stage lymphoedema could be improved, however this would require intensive treatments.

Stage three, also known as lymphatic elephantiasis, there is a major increase in the amount of swelling and fibrosis. The tissue may finally hang down in folds, however this access skin can be removed surgically. At this stage lymphoedema can be improved however this condition is rarely revised.

Treatment for Lymphoedema

Kinesio Taping® is very effective in treating acute or chronic oedemas. With 24hr use, Kinesio Taping® augments treatment by opening up lymphatic pathways - even when the patient is not in clinic. In the UK it is recognised as an effective and successful treatment for lymphoedema reduction. Drainage is achieved by using specialised application techniques to lift the skin in an affected area. The tape increases the space in which lymphatic fluid flows, resulting in decreased pressure and irritation on neural/sensory receptors. Applications can also encourage lymphatic fluid to move from areas of high pressure to low pressure and towards working lymph nodes. Kinesio Taping® can also help to facilitate the stretch response of the angions, with movement or muscle contraction.

Manual Lymph Drainage is a gentle massage technique. It uses a series of rhythmic, light strokes in a specific sequence along the lymphatic vessels and surrounding tissues. These movements help reduce the swelling in the affected area and aid in returning lymph to the circulatory system. Kinesio Taping® is extremely effective when used in conjunction with this technique.

Compression bandaging creates higher working pressure to move lymph during exercises, and it prevents stagnant lymph from accumulating the affected lymph after it has been cleared by MLD. There are two different types of bandages, short-stretch and long-stretch, to treat different conditions.

Compression garments are two-way stretch sleeves or stockings that aid in controlling swelling by providing additional support for the lymphatic system. The stretch and resistance of these garments increase the help that lymphatic vessels receive from the movement of muscles and blood vessels during exercise and the performance of daily activities.