What are the treatments for lymphoedema and leg swelling?
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It is vital to seek specialist advice for chronic condition lymphoedema as soon as possible, according to leading consultant vascular surgeon Michael Gaunt.
The sooner a patient is treated, the more chance they have of managing the condition, says Mr Gaunt, who runs clinics in Cambridge, Bury St Edmunds and Harley Street in London.
Q: What is lymphoedema?
Lymphoedema is when the lymphatics in the legs (or arms, where it can occur in women after breast surgery) have been disrupted and are unable to clear the lymph fluid. If this happens, every time blood goes from the arterial system, filtering through the muscles and tissues into the venous system, it leaves lymph fluid behind. We actually produce about two litres of lymph fluid per leg per day and you don’t need much to go wrong with the system to start to accumulate fluid. It can come on slowly or quickly.
Q: Is leg swelling always caused by lymphoedema?
No. Other causes of leg swelling can include serious problems with the heart, kidneys, liver and some other rare conditions. If it is in one leg and comes on quickly and painfully, with discolouration, for example, then it might be deep vein thrombosis. It is important to seek medical advice quickly if swelling does occur. If all these other medical conditions are excluded, then the problem may well be lymphoedema and then you need specialist advice. This is because if treatment can begin quickly, then the lymphatics can possibly be improved and the more chance you have of a better long-term outcome.
Q: Who suffers from lymphoedema?
Men and women can both be affected but it does occur more frequently in women. It can be genetic, or it can occur when something happens within the body to affect the lymphatics. This might be surgery or radiotherapy, for example, or someone might get an insect bite or have a minor trauma to the leg and then develop an infection where the leg swells up. The infection might be treated successfully but the swelling doesn’t reduce because the lymphatics have been overwhelmed. The lymphatics get less efficient as you age, so lymphoedema following something like this is more likely as you get older, but congenital lymphoedema can be present at birth and can occur at any point in life.
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Q: What are the symptoms of lymphoedema?
Swelling often occurs in both legs but one leg may be worse than the other. It makes the legs feel very heavy and tired. The swelling might go down a little at night but then go up again during the day. Most people report that it gradually gets worse. In some cases, it can become very severe and ultimately result in disability.
Q: Are there any effective treatments?
Yes. The simplest, least invasive and most effective treatment is a special type of massage called manual lymphatic drainage (MLD). There are lots of practitioners available, but their training and experience varies greatly. It is best to be assessed first by a lymph specialist to make sure the diagnosis is right. Typically, people start with a treatment phase where they have regular massages and possibly use bandaging and compression stockings to get the swelling down as much as possible. After that, they go into a maintenance phase where they might have a massage once or twice a week, depending on how bad the problem is, quite possibly forever. There is also equipment that simulates MLD and for people with lesser degrees of lymphoedema these can be quite useful at keeping things under control.
Q: Is there anything else that can help?
Exercise, in combination with the massage and compression hosiery, can be beneficial. The more you exercise your heart and lungs, the more it helps the lymph fluid to move as it should. One treatment that is not helpful in the long term is water tablets or diuretics. This has been a big mistake over the years because lymphoedema is a high protein oedema, which means the fluid contains protein as well as water. The tablets take away the water but leave the protein behind. Initially you might see some improvement but eventually you turn a soft, reversible oedema into a hard, woody, irreversible oedema. Diuretics should therefore only be used very short term.
Q: What about liposuction?
There is a specialised form of lymphoedema called lipoedema which only effects women. Part of the lymph system in the leg also moves fat around the body and when the lymphatics in this particular form of lymphoedema are defective then this does not happen as it should. There are varying degrees of lipoedema and it can be very distressing for sufferers. About 25 per cent of the swelling is due to fluid so massage can help but it won’t cure it. Some sufferers have tried liposuction and some groups have claimed success with this. But liposuction does damage the lymphatics even more, so opinion is split. It may be useful for a specific patch of lymphoedema, but once again, it is vital to seek advice from a medical specialist first.