Lymphoedema is a swelling in the tissues in one or more parts of the body caused by a build – up of fluid and proteins and is a sign that the Lymphatic System is not working properly.
What Causes Lymphoedema?
This can be the result of a Primary Lymphoedema caused by congenital conditions resulting in a poorly formed Lymphatic System. Swelling is typically seen in the lower extremities. 1 in 6,000 people develop Primary Lymphoedema.
The most common cause of Lymphoedema is called Secondary Lymphoedema and may develop after any type of surgery or cancer treatment, where there has been damage to the lymphatic system, removal and / or radiation to lymph nodes. Secondary Lymphoedema may also occur in conjunction with traumatic injuries, Venous Disease, Infections such as Cellulitis, Immobility and Obesity. According to the Centres for Disease Control and Prevention (CDC) the incidence amongst cancer survivors is between 20-40%. Swelling after the treatment for Breast cancer may be seen in the arm or chest on the operated side. In Prostate, Uterine and Pelvic cancer, it may develop in one or both legs and the pelvis. Lymphoedema can also occur after Malignant Melanoma, Sarcoma and Head and Neck Cancers.
Unfortunately the risk of developing Lymphoedema does not reduce with time but is a lifelong risk.
How Can Lymphoedema Be Treated?
Lymphoedema is a Chronic Progressive Condition with a number of stages from mild to severe. Treatment is most effective in the early stages. In the early stages symptoms may include heaviness with or without swelling, aching, tightness in the tissues, reduced range of movement and sometimes pain. People may notice that clothing and Jewellery have become tight. Symptoms in a limb or body part may increase as the day progresses but then reduce overnight. Symptoms can increase with over use, prolonged inactivity or heat. As the condition progresses skin begins to thicken and tissues become firm. Early intervention is recommended to reduce symptoms and its progression.
Management of Lymphoedema is known as Combined or Complex Decongestive Therapy (CDT) and consists of Manual Lymph Drainage (MLD), Compression Bandages/Garments, Exercise and Skin Care and is divided into an intensive and maintenance stage. The aim is to reduce symptoms by increasing Lymph flow from congested areas, reducing tissue changes and the risk of infection whilst improving range of movement and quality of life. Laser Therapy and Lymphatic Taping are incorporated as required. CDT is also beneficial for Lymphoedemas of mixed origin such as Phlebolymphoedema (Chronic Venous-Lymphatic Insufficiency/oedema) and Lipolymphoedema (Combination of Lipoedema and Lymphoedema).
Manual Lymph Drainage
This is to clear the backlog of lymph, help the lymphatic system to work better and redirect lymph to nearby healthy lymph vessels. This is a light technique but firmer techniques are also used to help soften tissues that have become firm.
Compression Bandaging/ Garments
In the intensive CDT stage a multi- layer re-useable bandaging system is used which consists of a cotton layer, a foam bandage layer followed by short stretch compression bandages. The bandages are applied following MLD and remain on throughout the day and night. They are removed the following day to allow for showering or bathing. MLD is repeated and bandages reapplied. CDT is performed daily and generally lasts between 2 – 4 weeks or until the affected limb or area has been decongested as much as possible. Progress is checked by measuring limb volume. In the maintenance phase which follows the intensive phase, clients are fitted with medical compression garments which are generally worn all waking hours. Compression bandages and garments help to improve the pumping of the veins and lymph vessels, prevents lymph fluid from refilling in the limb, maintains any reductions gained during MLD and softens areas of firm tissue.
Daily exercise when wearing compression bandages increases the uptake of lymph in the tissues and improves the pumping of the lymph vessels when the muscles contract and relax against the pressure exerted by the compression bandages. Appropriate methods of exercise will be discussed with you.
Ensuring the skin is as healthy as possible reduces the risk of infection such as keeping skin well moisturised with a pH neutral non fragranced moisturiser and taking care to reduce the incidence of skin damage during certain activities.
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