Lymphoedema Service

Lymphoedema is a chronic (long term) condition that causes swelling to appear. It can affect any part of the body but most commonly develops in the arms or legs.

The role of the lymphatic system is to move fluid around our bodies, remove waste products and support our immune system.

This function is gained via a network of vessels, nodes and organs that work alongside the veins/venous system to remove all fluids that leak out of blood vessels. This fluid is called lymph and is passed around the body with a push from lymphatics, a squeeze of the muscles and with the help of gravity to pass it as waste into urine.

Lymphoedema most commonly develops due to the lymphatic system being damaged, blocked, or overloaded. This is known as secondary lymphoedema , because it is secondary to events such as trauma to the lymphatics/veins, surgery to the lymphatics/veins, removal of lymph nodes, obstruction due to cancer cells and overloading of the system due to conditions such as cardiac failure. A reduction of movement or sudden weight gain and obesity can also cause secondary lymphoedema. The body needs to move often to drain and excess fatty tissue restricts drainage.

Finally, a parasite can also enter the body and reside in the lymphatics, again restricting drainage. This is known as filariasis which is more common in tropical countries.

Primary lymphoedema is less common but is caused by alterations (mutations) in genes that are responsible for the development of the foetal lymphatic system in utero. This commonly develops from birth but can manifest at times of hormone change such as puberty, pregnancy, or menopause.

Unfortunately, we are still unable to predict who is most likely to develop lymphoedema, so when you come to the clinic, we will take a detailed history to try and enable the correct cause and treatment to help you manage your lymphoedema.

Lipoedema is a painful bi-lateral (symmetrical) limb swelling, mainly affecting the legs and thighs but sometimes arms too. It is thought to occur because of an abnormal accumulation of fat cells (unrelated to diet) in the tissues under the skin.

Patients generally present with very large lower limbs that are similar in shape and size on both sides. The thighs, hips and buttocks often tend to be disproportionate (much larger) than the rest of the upper body – the waist is much smaller and the feet and hands are hardly ever affected.

The tissues of the limbs tend to be very tender or painful to touch.

At present, we do not understand why lipoedema occurs, however a family history suggests a genetic basis. It seems to affect females exclusively and it is usually first noticed when there is a hormonal change, such as at puberty or pregnancy, or even the menopause.

Despite the name, oedema is not a feature of lipoedema. However, oedema may be present if the patient has other co-morbidities, such as venous or cardiac insufficiency, reduced mobility or general obesity. It can often be mistaken for other conditions, in particular obesity, as well as Lymphoedema .

There currently is no known cure for lipoedema, but the progression can be minimised by implementing treatment as soon as possible. Getting a diagnosis is therefore essential and will enable women to have the best possible information to manage this often distressing condition. Stabilising weight is thought to be very helpful in preventing progression of the disease.

Assessment is vital to ensure a correct diagnosis is given and appropriate, realistic and achievable goals instigated.

Treatment will include:

• Goal setting
• Support garments, such as sport leggings
• Support with psychological issues
• Movement/exercise
• Managing/stabilising weight (no diets)
• Education to self-manage the condition.

Lipoedema

• Painful swelling of the lower limbs/arms, which is bi-lateral and symmetrical (the same on both sides)
• General body shape is usually disproportionate (small torso, narrow waist and larger hips/thighs)
• Feet or hands are usually not affected
• Pitting (firm pressure on the skin leaving obvious indentations) of the skin is absent
• There is often a family history of the condition
• Generally affects females only
• Losing weight will not make a noticeable difference to the affected areas
• Limbs will often bruise easily and through no apparent cause
• There is sometimes a pad of fat just under the knees and hips.

Lymphoedema

• Swelling may be unequal on each side of body – one limb is often much larger than the other
• Feet are frequently affected and there will be a positive Stemmers sign (inability to pick up a fold of skin at the base of a digit)
• Pitting of the skin will be present – especially in the early stages of the condition
• No pain is felt if pressure is applied to the skin, but there is often a feeling of tightness in the tissues
• Limbs do not tend to bruise easily
• Increased risk of infection (cellulitis) in affected, swollen areas
• Can affect females and males of any age
• The affected skin is often thickened and may have other features such as warty change or papillomatosis (cobble stone effect on the skin)
• Losing weight usually has a beneficial effect on the swelling.