WHAT is Lymphedema?

Lymphedema is a lifelong condition caused by a buildup of lymph fluid. This happens when the lymphatic system is either faulty or damaged and cannot function as normal. It leads to chronic (long-lasting) swelling in the tissues where the lymph flow is blocked. Lymphedema most commonly presents in a limb  (arm/hand or leg/foot), but it can also be present in the breast, trunk, genitals, or head and neck.

Lymphedema can affect all persons and ages.

Primary lymphedema occurs when a person is born with a faulty lymphatic system. Signs of lymphedema may be present from birth or develop during puberty or later in life. The later development may be due to changes in hormones or body weight that put more of a burden on the lymphatic system.

Primary lymphedema is more common in women than men and occurs mainly in the legs.

Secondary lymphedema occurs when a person’s lymphatic system is damaged by trauma, surgery, radiation therapy or severe injury (e.g. a burn or skin infection). It can develop a short time after the damage occurs or many years later.

Cancer-related lymphedema is a common reason for occurrence of lymphedema in North America. Individuals with cancer (e.g. breast, prostate, gynecological, melanoma, lymphoma or other cancers) have a lifelong risk for lymphedema if they have had lymph nodes or vessels removed or damaged during treatment. The more damage there is to a lymphatic system, the greater the risk for development of lymphedema.

Secondary lymphedema develops even more often unrelated to cancer, secondary to trauma and/or damage to the lymphatic system, such as from venous disease, morbid obesity, severe trauma, recurring infections, lymphatic insufficiency, and/or limited mobility – each of which is considered a risk factor for development of lymphedema.

Filariasis is a severe type of secondary lymphedema resulting from insect bites; filariasis  while rare in North America, is more prevalent in certain tropical countries. For more information on filariasis, see http://www.who.int/mediacentre/factsheets/fs102/en/..

Watch out for early signs and symptoms of lymphedema. If you notice any of the following early signs (with or without visible swelling), see a health professional:

• Swelling that can be sudden, gradual or occasional most often the swelling is in an arm or leg, but it can also be in the chest, trunk of the body, head or neck
• Clothing, shoes or rings/watch may feel tighter, but not due to weight gain
• Feelings of heaviness, tightness, fullness or heat in the affected area
• Aches, shooting pain or pins and needles in the affected area
• Skin may feel tight or stretched, sometimes its texture feels thicker
• 
  

Lymphedema will get worse if it is not treated.

If you notice any of the following signs, see a health professional:

• Any of the early signs listed above
• Repeat skin infections in the affected area
• Clear fluid leaking from the skin
• Hardened areas under the skin
• Skin changes such as thickening, dry and/or rough areas, colour changes or hard, blister-like nodules on the skin’s surface
• Feelings of pins and needles in fingers or toes
• Decreased mobility and function in the joints of swollen limbs
• If you wear a compression garment that has become too tight, but not due to weight gain

With early diagnosis, treatment and taking charge of your health, you can control lymphedema and lower your risk of it getting worse.

Cellulitis is a sudden, non-contagious skin infection. It is treated with antibiotics and must be treated right away as it can spread quickly. When it is severe, people may spend time in hospital to have the infection treated.

Watch out for signs of skin infection and seek medical help right away:

• Rapid onset of skin redness, swelling or pain
• Skin that feels hot or painful to the touch or tingling
• Skin that is red or with a reddish rash or red streaks or swollen
• A feeling of tiredness or heaviness
• If cellulitis worsens, you may feel flu like symptoms; feelings of nausea, fever or chills

The lymphatic system is part of your body’s circulatory and immune systems. It works alongside the blood system to keep your body healthy.

Its main functions are to:

• Keep a healthy balance of fluid in the tissues
• Transport proteins and digested fats to provide your cells with nutrients
• Help fight infection by removing bacteria, viruses and other germs

 It moves lymph fluid towards the heart through a network of lymph vessels and lymph nodes.

• Lymph fluid is a clear liquid made up of water, proteins and white blood cells that fight infection
• Lymph vessels transport and drain lymph fluid back to the blood system and the heart
• Lymph nodes filter out bacteria, viruses, other germs and waste, to keep you healthy

 There are hundreds of lymph nodes in your body. You have clusters of them in your neck, head, armpits, stomach and groin. When you’re fighting an infection, you may feel the lymph nodes swell up in your neck, just below your jawbone. The exact number, size and location of lymph nodes vary from person to person. This may be why one person develops lymphedema and another doesn’t, even if they both have similar risk factors.

Whereas blood is pumped around the body by the heart, lymph fluid moves in a different way. It moves slowly, in only one direction, through valves in the lymph vessels. Rather than being pushed along by a big pump like the heart, what helps lymph flow is:

• Moving your muscles
• Deep breathing
• A special kind of gentle massage called manual lymphatic drainage

Lymph flow is restricted by your body’s natural bottlenecks, where it bends at your knee, ankle, armpit, elbow or groin. It is also restricted by tissue injury, where you have bruising, swelling or scarring.

We can’t change our bodies, but we can change our habits. To help your lymph flow, try to avoid:

• Sitting or standing for long periods
• Sitting cross-legged
• Being inactive
• Wearing clothing with heavy elastic (that leaves a mark) at your waist, ankles, wrists or another part of your body
• Carrying excess weight at your girth

Swelling can happen for many reasons, some relate to lymphedema but many do not, such as the early stages of venous disease. However, when the lymphatic system is faulty or damaged, the risk of swelling increases.

• When the lymphatic system is healthy, the lymph load is easily removed from the tissues. If your body moves the lymph load well, there is usually no tissue swelling.
• If your body is not able to move the lymph load well and there is a buildup of fluid, tissue swelling will occur.

When swelling occurs, the health of tissue and cells in that area gets worse, and the risk for infection increases. Early diagnosis and treatment by a trained and certified lymphedema therapist is the best way to manage lymphedema.

How do I find a certified lymphedema therapist?

Certified lymphedema therapists are experts in assessing and treating lymphedema. They are nurses, physiotherapists, occupational therapists and massage therapists who meet the Canadian Lymphedema Framework’s national training standards.

To certify, lymphedema therapists train for a minimum of 135 hours with a recognized school. They work in private clinics and some hospitals in Canada.

To find a certified lymphedema therapist in your area, contact your provincial lymphedema association

Used with permission- Canada Lymph. "What is it?" Retrieved from https://www.canadalymph.ca/what-is-it/ 

https://www.canadalymph.ca/signs-and-symptoms/

https://www.canadalymph.ca/provincial-lymphedema-associations/

Image source-Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/swollen-lymph-nodes/multimedia/lymphatic-system/img-20007995