Treatments

Lipoedema - What is lipoedema?

Lipoedema is a disease of unknown etiology which predominately affects women. Lipoedema manifests itself at menopause, or during pregnancy. It is described as a bilateral, symmetrical flabby swelling of the legs that arises from deposition of adipose tissue starting at the hips and ending at the ankles. There are two different forms: a column shaped, cylindrical (stage 1) form and a lobular form (stages 2 & 3). Both can be either descending, or ascending but most commonly descending. Additional signs are: tenderness to pressure in the lipoedematous region; a minor trauma would cause a bruise.

Prognosis

Regarding mortality, the prognosis of uncomplicated lipoedema is good; however, regarding healing, the prognosis is poor unless adequate treatment is provided. If patients receive appropriate treatment before they reach 35 years old, the likelihood of recovery is good. Otherwise the process progresses and after 17 years after onset, on average, the combination form of lipo-lymphoedema may develop. The prognosis for this combination form is the same as that of lymphoedema.

Therapy/treatment

It must be stressed that lipoedema is not a ‘subjective problem’. It is not a matter of ‘fat legs’ in healthy women. Lipoedema is a disease that requires treatment and dieting will NOT improve the disease, however a calorie conscious, low fat, low-carbohydrate diet along with exercise is recommended. In lipoedema treatment must be preceded by a thorough comprehensive consultation and examination is always necessary. For example the treatment of choice, complete decongestive therapy (CDT) would initially be contraindicated in the case of an older women with congestive heart failure. CDT could only be begun after successful treatment of the heart failure. High blood pressure must be normalised and in the combination form of lipoedema-plus-obesity, it is essential that CDT be accompanied by a well supervised weight loss programme; otherwise CDT will not be successful

Regarding phase 1 – the initial, intensive phase of decongestion CDT should be performed without compression bandages if the patient is hypersensitive. After a few days compression bandages can cautiously and gradually be applied. Even if the oedema is not pitting, phase 1 often results in noticeable reduction of leg volume. The transition from phase 1 to phase 2, the maintenance phase must be absolutely seamless. In this second phase wearing of compression garments is and absolute requirement. For further explanation of the treatment see treatment section in Lymphoedema/chronic swelling section.