Treatments

Lymphoedema / Chronic Swelling Treatment

Introduction

To understand what lymphoedema is and how it is treated, it is important to first understand how the lymphatic system works. Lymphatics form part of your immune system, helping cope with infection by cleansing/detoxifying your body's tissues.

Unlike the circulatory system, where the heart pumps blood around the body, lymph vessels rely upon hundreds of tiny muscular units called lymphangions contracting throughout the lymph vessels to propel the flow of lymph fluid. This enables the transport of numerous substances (i.e., proteins, toxins, hormones, fatty acids, immune cells) to the lymph nodes, which process them.

There are 400-700 nodes in the human body. Almost one half is located in the abdomen alone. Many nodes also are located in the area of the neck. The main groups of nodes can be found in the major articulation folds of the body i.e.: armpits and groin, but excluding the wrists. Lymph nodes have various specific functions:

• They are filtration and purification stations for the lymph circulation.
• They capture and destroy toxins of the body.
• They concentrate the lymph, reabsorbing about 40% of the liquids present in the lymph
• They produce lymphocytes (immune cells). (The production of lymphocytes is increased when the flow of lymph is increased through the nodes. The use of manual techniques such as Lymph Drainage Therapy/Manual Lymph Drainage increases the production of lymphocytes).

Having passed through these nodes, lymph drains into the venous system and is eventually removed from the body as urine via the kidneys. If any part of the lymph system gets damaged due to surgery, trauma, burns, infections, fatigue, or stress lymph circulation often stagnates, fluids, proteins, cells and toxins accumulate, and cellular functioning is significantly compromised.

This means the vessels are not able to adequately drain lymph and when this occurs the amount of fluid in an area becomes greater than the capacity of the lymphatic system to drain/transport away and lymphoedema occurs.

Types of Lymphoedema:

There are two types of lymphoedema; primary & secondary.

Primary:

Primary Lymphoedema is usually determined from birth and arises due to a possible underdevelopment of some part of the lymphatic system. It may develop without any obvious cause at any stage in life, but more commonly in adolescence.

Secondary:

Secondary Lymphoedema is the result of outside causes i.e. something that happens to the body/lymphatic system in order for its break down. Examples are:

• Surgery - especially when there is lymph node involvement such as dissection/removal after treatment for cancer: breast, prostate, gynaecological, and head or neck.
• Radiotherapy - this kills cancer cells but may also cause fibrosis similar to scar tissue. Lymph cannot flow through fibrotic tissue.
• Accidental trauma/injury or infection may compress and damage lymph vessels.
• Chronic venous insufficiency results in the lymph system becoming overloaded and is unable to function properly.

How Does Lymphoedema Progress?

Secondary lymphoedema can take anything from 3 weeks - 20 years from the initial trauma/event to appear. It is recommended to start preventative Lymph Drainage as soon as possible after the initial trauma or event in order to establish lymph re-routes and for lymph to start flowing again. This may delay and possibly prevent the onset of lymphoedema. However if lymphoedema does occur it is unfortunately irreversible and as such there is currently no known cure. Appropriate treatment can be implemented to reduce the swelling and keep it to a minimum and improve quality of life dramatically.

What Treatment is Available?

It is vital that lymphoedema is correctly diagnosed. Petra , a fully qualified & certified Lymphoedema therapist will give a full assessment to ascertain the actual cause and stage of the swelling in order to determine which treatment is right for you. There are 4 stages of lymphoedema:

Stage 0: Sub clinical stage (latent stage) : lymphoedema is not revealed clinically and may not yet be noticeable.

Stage 1 : Reversible Lymphoedema: accumulation of protein-rich fluid.

Stage 2: Spontaneously Irreversible Lymphoedema: Protein-rich oedema fluid. Connective and scar tissue

Stage 3: Lymphostatic Elephantiasis: Protein-rich oedema. Connective and scar tissue. Hardening of skin. Papillomas

Complete Decongestive Therapy

While all treatments for lymphoedema should be tailored specifically to the patient, CDT treatment includes at least two phases, which are equivalent in all therapies. These phases need to be repeated after about 4-6 months.

This usually takes two to four weeks of treatment until a plateau of decongestion has been reached.

Phase 1: Intensive

• Manual Lymph Drainage
• Compression bandaging
• Exercises
• Skin & Nail care
• Self care

During the first phase of acute decompression the bandages are kept on the limb(s) at ALL times except during MLD sessions.

Phase 2: Maintenance

After the plateau of decompression, we can switch from bandages to compression garments during the day. Your therapist can measure you for made-to-measure garments.

• MLD replaced by self-drainage. Therapist is seen less often
• Compression garments (worn during the day)
• Bandaging (at night)
• Skin & nail care
• Exercise

Phase 3: Follow up (as required)

As in phase 1.

Components of CDT

Manual Lymph Drainage (MLD)

MLD is the use of specific massage techniques, which mobilises the skin and stimulates the lymphatic system. It facilitates lymph flow into the venous circulation utilizing lymph vessels and existing lymphovenous anastomoses. However it is found to most effective when combined with compression bandaging, skin care and exercises.

Multilayer Bandaging

In the intensive phase of treatment, multilayer bandaging is used to provide support for underlying tissues, preventing re-accumulation of fluid. It can also reduce fibrosis and reshape the limb.

Exercises

The aim is to enhance the efficiency of the muscle pump, hence increasing lymph circulation. Each patient is given individually tailored exercises suited to their particular requirements.

Skin care

Good skin care is essential to maintain skin integrity and reduce risk of infection. The components of good skin care are meticulous hygiene, use of emollients, monitoring for cuts and abrasions and prompt action at the first sign of infection.

Compression Garments

Towards the end of the intensive phase patients are recommended that they be measured for an appropriate compression garment. During the maintenance phase, containment of the affected limb is achieved through the daily wearing of these compression garments. These should be replaced after 6 months.

To enquire about lymphoedema management & treatment please contact Petra either by telephone or fill in the enquiry form.