Many people know the feeling when they come home from a strenuous day in the evening: Legs and feet ache and are swollen. Normally, these symptoms disappear after a few hours, at the latest the next day. However, if the swelling does not only occur after exertion and does not disappear, then caution is advised. It may be a case of lymphoedema.
The text below takes a closer look at what lymphoedema is, how it develops and how it can be treated.
Like blood, lymph consists of fluid (lymph plasma) and cells (corpuscular parts). The difference between blood and lymph is that the lymph transports larger cells that cannot pass through blood vessel walls.
The smallest lymph vessels (so-called lymph capillaries) have gaps at the end between the cells of the lymph vessel wall, which is why, compared to the venous blood vesselsystem (which also transports fluid from the tissues remote from the body towards the heart), larger components of the tissue fluid can be absorbed and transported.
Typical examples of larger cells transported with the lymph fluid are
The lymphatic system consists of lymphatic channels in which the lymph is transported towards the heart. These lymphatic channels are initially very small(lymphatic capillaries) and only visible under the microscope. The closer you get to the heart, the larger the lymphatic vessels become, so that they eventually become visible even to the naked eye. Finally, all of the body's lymphatic vessels flow into a large lymphatic vessel(thoracic duct), which flows into the subclavian vein just before the heart.
Filter stations are installed so that all foreign bodies and pathogens are removed from the lymph fluid before it flows into the blood vessel system. These are also called lymph nodes and swell when there is an increase in pathogens that need to be removed (e.g. in the case of inflammation). One example of this is palpably enlarged cervical lymph nodes in diseases of the upper respiratory tract or a tooth.
Lymphoedema is an accumulation of fluid in the interstitial space. The body produces approx. 2-3 liters of lymph fluid per day. The cause of lymphoedema is the inadequate removal of lymph fluid. This leads to congestion in the interstitial spaces. The swelling very often occurs on one or both legs. However, other areas of the body, such as the arms, can also be affected. Lymphoedema can also occur on the neck, head, trunk or genitals, but is less common here.
There are various congenital and acquired causes and diseases that lead to lymphoedema.
Lymphoedemashould not be confused with lipoedema. Lipoedema is also a swelling, but it is not caused by an increased accumulation of fluid, but by an increase in fatty tissue.
A distinction is made between primary and secondary lymphoedema.
Primary lymphoedema is hereditary, i.e. it is not caused by other diseases or external influences. In medical terms, this is also referred to as hereditary (genetically determined) lymphoedema. In women, it often becomes noticeable during pregnancy. In some cases, there are also diseases in which lymph vessels are missing in certain areas of the body, i.e. they are not created by mistake. This then leads to lymphatic fluid drainage disorders.
Secondary lymphoedema can have various causes, for example metabolic diseases such as diabetes mellitus or chronic skin diseases. Tumor diseases (and also tumor removal), accidents and infestation with viruses, bacteria, worms and fungi can also be included in this group. The same applies to radiological irradiation, surgical scars or chronic venous insufficiency.
Another cause of secondary lymphoedema is surgery. In medical terms, this is iatrogenic lymphoedema (i.e. caused by the doctor). A common example of this is breast cancer surgery, in which affected lymph nodes in the armpit are removed. This is important in order to prevent further spread of the tumor and, depending on the number of lymph nodes affected, to determine any necessary therapeutic measures (chemotherapy, radiation).
However, when the lymph nodes are removed, important lymphatic channels in the armpit are usually damaged, which is why the drainage of the lymph fluid may subsequently be impaired. The same also applies to operations in the groin (e.g. in the case of vasoconstriction), during which lymphatic channels can be injured. As the lymphatic vessels are not visible to the naked eye, lymphoedema (also known as lymphatic fistulas) is a typical complication of surgical procedures.
Lymphoedema is very easy to see due to the bulging accumulation of fluid. The leg or arm is thickly swollen and appears swollen. This oedema can also be felt. While you can still press a dent into the skin in the first stage, the oedema is firm in the advanced stage. A dent can now no longer be pressed into the tissue, or only with difficulty. Stemmer's sign is one way of diagnosing the condition. If the skin fold above the second and third toe - or the fingers - can no longer be lifted, this test is considered positive. Lymphoedema is generally divided into several stages:
In principle, it is recommended that you first consult your family doctor, who is best placed to investigate the history and causes. Lymphatic complications following surgery should be monitored by the surgeon who performed the operation. Sometimes another operation (so-called revision surgery) is necessary in order to close the opened lymphatic channels again. This is usually done with a so-called coagulation of the wound surfaces (heat sclerotherapy); direct exposure of opened lymphatic channels is also rarely possible during revision surgery.
The following treatment methods are available:
The therapy depends not only on the cause, but also on how advanced the lymphoedema is. At a very early stage, elevation - of the leg, for example - can support lymph drainage. Consistent compression therapy is also a top priority, as this can usually prevent the disease from progressing. In the case of open wounds, inflamed tissue and very sensitive and painful skin, elastocompressive wrapping is initially recommended. This usually needs to be changed several times a day, especially in the case of heavily weeping wounds. The latter also usually require the application of special skin-compatible and highly absorbent wound dressings. The expertise of a wound expert (wound manager) can be very helpful here.
In the case of inconspicuous skin conditions (e.g. arm swelling due to lymphoedema following breast cancer surgery), wearing a medical compression stocking is recommended instead of an elastocompressive wrap. These are fitted in a medical supply store. Such stockings are also available for the legs. However, these are very strong, firm stockings (compression class III, pressure approx. 40-45 mmHg), which are sometimes difficult to put on and take off and should be put on with a so-called donning aid. Less tight stockings (compression class II, approx. 30mmHg), which are easier to change, are usually sufficient for venous disorders.
Lymphatic drainage has also proven to be very effective. This is a special massage technique that stimulates the lymphatic system and thus improves the removal of fluid. This technique is also used after operations with severe swelling and is carried out by a physiotherapist.
In some cases,diuretics are prescribed to reduce the swelling. Diuretics are drugs that support the elimination of water. Typical indications for diuretics are kidney and heart failure, where their use is often important and life-saving. However, extreme caution is required when using them for lymphoedema, as these drugs also have more or less severe side effects and cannot combat lymphoedema!
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