Treatment of Lymphedema
Although lymphedema may have different causes, the treatment for all types is the same
Unfortunately, there is no cure for lymphedema. Treatment for lymphedema focuses on minimizing the associated symptoms. When a person is afflicted lymphedema, they should speak to their doctor, who will advise the most beneficial methods of treatment. If your doctor initially is hesitant to recommend treatment, I encourage you to persist. Lymphedema is an under-recognized problem that slowly and insidiously develops into a worse and worse problem. Getting treatment as soon as possible will greatly increase your quality of life!
The following are all methods of treatment a person can pursue:
- Gentle exercise, such as squeezing the muscles, which may help fluid in the affected area dissipate,
- Bandage wrappings applied to the arm or leg promote movement of accumulated fluids away from the affected area,
- Compression stocking or sleeves, worn on the arms or legs, respectively, are another way to promote movement of accumulated fluids away from the affected area, and help reduce swelling.
- A pneumatic compression sleeve is worn on the arm or leg and connected to a pump which inflates the sleeve and puts gentle pressure on the affected limb. These pneumatic compression sleeves help encourage fluid to flow away fromfingers and toes, thereby reducing swelling in the limbs.
A massage designed specifically for those suffering from lymphedema called manual lymph drainage can help dissipate fluid in an affected limb. This massage technique may not be appropriate for everyone with lymphedema.
Decongestive therapy is designed to unblock and increase the flow of the lymphatic fluid away from the extremities. Professionals use a variety of exercise, massage and compression wraps and garments to manipulate the fluid and reduce the swelling. The massage doesn’t actually move the fluid manually it facilitates the lymphatic system so that it can pump. Complete decongestive therapy works in two phases. The first phase involves moving the lymphatic fluid out of the affected region and thus reducing the swelling, using compressive bandaging and massage to move the fluid. Once the fluid is moved, the patient is fitted with a graduated compression garments to keep the swelling at a minimum.
In rare instances where lymphedema is deemed severe, a doctor may recommend surgery to remove excessive tissue in the affected area. This procedure reduces the swelling associated with lymphedema, but cannot cure it. This course of action is usually thought to be more harmful than helpful as it can make the lymphedema worse, because it tends to strip away the lymph system that can move fluid away from the affected area. This “solution” should be carefully considered if it is recommended and I would suggest that anyone who is told to have this surgery should get a qualified second and third opinion.
Persons who have been treated for cancer should take special care of the limb or limbs involved, to reduce their risk of developing acquired, or secondary, lymphedema.
Massage and physical therapies have been used with variable effectiveness in treating lymphedema. Complex decongestive physiotherapy includes “Manual Lymph Drainage,” bandaging garments such as elastic wraps, and exercises. Complex decongestive physiotherapy requires therapy that is usually performed by physical therapists who specialize in lymphedema treatment, and some rehabilitation centers offer this specialty treatment.
Currently, the position paper of the International Society of Lymphology recommends complex physiotherapy by a physician, nurse, or physical therapist who has been professionally trained. It should be noted that compression bandaging, if done incorrectly, may be harmful or useless.
Complex physiotherapy treatment consists of two phases. The first phase involves preventive skin care, manual lymph drainage, range-of-motion exercises, and compression with multilayer wrapping. The second phase, which must be initiated promptly after phase one, includes use of a compression sleeve, remedial exercise, and repeated light massage as needed. Cancer patients are advised to wear the compression garments when flying because pressure changes may trigger lymphedema, even if not present before.
Pneumatic compression devices have been used for treating lymphedema, but insufficient evidence exists to support or reject this treatment. In addition, these devices are expensive and can cause cases of cellulitis or deep vein thrombosis. These devices are not recommended by most professionals.