Causes and Treatment of Lymphedema
Management of Localized Accumulation of Lymphatic Fluid
Jul 17, 2009
Lymphedema is an accumulation of protein-rich fluid in tissues due to problems with the lymphatic system. The condition often affects the extremities, though other areas of the body may also be involved. Individuals of any age can have lymphedema, which has been documented in many places around the world.
Causes
Normally, some fluid from the blood gets pushed out of the capillaries and into the interstitial space between cells. This protein-rich fluid, called lymphatic fluid, makes it way back into the bloodstream by traveling through the lymphatic system, consisting of lymph nodes eventually draining into the thoracic duct that terminates where the left subclavian vein and left internal jugular vein meet. Lymphedema occurs when a compromised lymphatic system impedes this drainage of lymphatic fluid.
The causes of lymphedema are considered either primary or secondary, defined as follows:
- Primary Lymphedema: Primary lymphedema occurs as a result of underdeveloped lymphatic channels. There are three types of primary lymphedema depending on what age the lymphedema appears: congenital lymphedema at birth (Milroy's disease), lymphedema precox in puberty, and lymphedema tarda during adulthood.
- Secondary Lymphedema: Secondary lymphedema appears as a complication of another condition disrupting the lymph nodes or channels, such as radiation and lymph node dissection as part of breast cancer treatment (the most common cause of secondary lymphedema in developed countries) and the worm infection filariasis (the most common cause of lymphedema worldwide).
Diagnosis
Lymphedema is characterized by localized swelling in the arms, legs, face, trunk, or genitalia. This swelling may feel soft or firm depending on the stage of the condition. Other associated symptoms may be seen, such as pain and skin changes. The diagnosis of lymphedema is clinical and does not require any laboratory and imaging studies unless the cause of the condition is not clear.
Treatment
The treatment of lymphedema has two components: addressing the underlying cause, if possible, and reducing the swelling. Medications, such as diuretic drugs, have not been shown to be effective in treating lymphedema. Therefore, therapeutic options for lymphedema are nonpharmacologic, including the following:
- Exercises: Various exercises can be performed to move lymphatic fluid into the lymphatic channels through muscle contraction.
- Garments and Bandages: Wearing garments or bandages that provide compression over the site of lymphedema can push lymphatic fluid into the lymphatic system and prevent new accumulation of fluid.
- Massage: Also termed manual lymphedema drainage, massage therapy is another method to apply pressure and propel lymph fluid into lymphatic channels.
- Lymphedema Pumps: Intermittent pneumatic compression pumps are devices that, when worn, inflate and press on the surface of the swelling to move lymphatic fluid.
- Surgery: As a last resort, lymphedema is treated surgically through a variety of techniques that attempt to remove lymphedema and prevent new fluid collection.
References
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