Health Library

Lymphedema

The lymphatic system is a very important system in the body. It helps with circulation and immune function, and is made up of vessels and nodes. These vessels and nodes help drain water, waste products, fat, and protein from the tissues. If the lymph vessels are unable to drain this protein-rich fluid, it can cause swelling. This swelling is known as lymphedema. It will not go away without treatment.

What Causes Lymphedema?

Lymphedema is classified as ‘Primary’ or ‘Secondary’:

• Primary Lymphedema: This is caused by malformations that are present at birth. Swelling may be seen at birth, or may develop later in life (such as during puberty or pregnancy). It is most common in the legs, but may occur in other body parts.
• Secondary Lymphedema: This is caused by damage or trauma. This can include: cancer, untreated vein problems, infection, radiation, or surgery. Swelling may develop right away or it may develop years later

How is Lymphedema Treated?

Although there is no cure for lymphedema, it can be effectively managed. Treatment is known as complete decongestive therapy (CDT). CDT can vary, depending on the amount of swelling and the condition of the skin.

Complete Decongestive Therapy (CDT)

Benefits:

• Decreased heaviness and size of affected limbs
• Improved function of affected limbs
• Improved skin condition and decreased risk of skin infections
• Improved body appearance and image
• Education to be able to manage this condition at home

Treatment consists of two phases:

• Intensive Phase - The intensive phase requires a considerable time commitment. During this phase, you will be under the care of a certified lymphedema therapist. You will have three to five treatment sessions each week for several weeks. For some people this phase can last for several months. During each session you will:
• Receive manual lymph drainage (MLD) – a type of gentle massage used to help lymph drainage
• Learn proper skin care
• Do special exercises
• Receive compression bandaging
• Once the swelling has gone down, you will begin the self-management phase.
• Self-Management Phase - This phase is where you are managing your care at home. Therapy visits will be scheduled as needed. During this phase you will:
• Complete manual lymph drainage
• Perform proper skin care
• Do special exercises
• Wear a compression garment that provides support and helps with swelling

Treatment Considerations

• Evidence suggests that treatment that is started early is more effective.
• CDT requires a large time commitment.
• You will need three to five treatment visits per week for several weeks to reduce swelling. Families that cannot make the time commitment now may want to wait until a future date.
• You will need a referral from your doctor that says “Complete Decongestive Therapy”. This can be faxed to OT / PT at 513-803-1111.
• An evaluation will be needed before starting treatment.

Is Therapy Covered by Insurance?

Please contact your insurance company for information on coverage.

General Care for Lymphedema

Skin Care:

• Patients with lymphedema are prone to dry skin. Use a gentle lotion (free of alcohol and fragrances) to maintain healthy skin and decrease the risk of infection.
• Practice good hygiene with daily bathing. Be sure to clean between fingers and toes.
• Avoid any injuries to the skin. Injuries, even small ones, may lead to infections.
• Avoid scratches when playing with pets.
• Wear gloves when working outside or doing housework.
• Do not cut your cuticles.
• Wear insect repellent (to prevent mosquito bites).
• Wear sunscreen (to avoid sunburn).
• Avoid irritating cosmetics or lotions.
• If you do get a cut or scratch, clean it well with soap and water and cover it with a Band-Aid.

Clothing:

• Avoid clothing that is too tight (shirts, bras, underwear, socks).
• Make sure jewelry fits loosely.

Travel:

• If you have a compression garment, it is especially important to wear it when traveling.
• Make sure to get up and walk around every so often.

Nutrition:

• Eat a healthy diet.
• Drink plenty of water!

Exercise:

Exercise is very beneficial for your body, but there are a few things to remember:

• Wear compression garments during exercise.
• Beneficial exercises include: walking, yoga, swimming, water aerobics, cardio machines, low intensity jogging and cycling.
• Avoid exercising during the heat of the day.
• Avoid or use caution when performing strenuous, repetitive movements and activities:
• High-risk activities for arms
• Golf
• Tennis
• Shoveling snow
• Carrying groceries
• Weightlifting
• High-risk activities for legs
• Running
• Soccer
• Hockey
• Intense cycling
• Sitting or standing for long periods
• Weightlifting

Heat:

Increasing your body temperature may increase swelling. Avoid:

• Very hot showers and hot tubs
• Sunbathing and saunas
• Deep massage
• Extreme changes in temperature

Medical Precautions:

• Avoid having blood pressure taken in the swollen extremity
• Avoid blood draws and injections in the swollen extremity

See Your Doctor:

• If you have any signs of infection (such as a fever, chills, skin that is red and hot, or fungus growth)
• Unusual changes that may be related to lymphedema