Lymphedema and Leg Swelling

What is lymphedema?

Lymph vessels and lymph nodes along with the clear lymphatic fluid running through them, make up the body’s lymphatic system. Lymph vessels function by collecting fluid (made of fats, wastes, proteins and water) from the cells of your body and delivering them to the lymph nodes.  This fluid is filtered by the lymph nodes for foreign materials and wastes, and then the filtered fluid is returned to your blood. Damaged or missing lymph nodes restrict the free movement of the fluid through the lymphatic system. This causes the fluid to build-up in the tissues of the body leading to a condition called lymphedema in the affected legs and arms.

What are the types of lymphedema?

Lymphedema are of two types:

  • Primary or inherited lymphedema is a condition in which the lymph nodes and lymph vessels are absent from birth. This causes swelling in your foot or calf during adolescence. Milroy’s disease is rare form of primary lymphedema that develops in infancy.
  • Secondary or acquired lymphedema is a more common condition in which your lymphatic system becomes injured and causes lymphedema. 

Chronic lymphedema is a condition in which your body becomes vulnerable to infection and causes lymphangitis. Even a minor injury such as an insect bite, a scratch or a cut may lead to lymphangitis.

What causes lymphedema?

Certain surgical procedures like surgery or radiation therapy for breast or testicular cancer, surgery on the blood vessels in your limbs or liposuction may cause lymphedema.

What are the symptoms of lymphedema?

Symptoms of lymphedema do not appear immediately. Sometimes, an injury to the lymphatic system can show symptoms after 15 or more years. Symptoms include:

  • One of your limbs may become weak, heavy or may be painful
  • Reduced flexibility of the affected limb
  • Swelling of the affected extremity

How is lymphedema diagnosed?

Your doctor will enquire about your health, symptoms you experience and medical history. Your doctor will physically examine the affected limbs and may order some of the following tests to confirm on the diagnosis of lymphedema:

  • Lymphoscintigraphy is a procedure in which low-dose radioactive substance is injected into the lymphatic vessels. The flow of fluid through these vessels is traced.
  • Imaging tests such as computed tomography (CT) scanning and magnetic resonance imaging (MRI) create images of internal tissues to detect lymphedema.
  • Duplex ultrasound is a procedure performed to rule out blood clots in the leg. The procedure involves viewing the real-time blood flow through the vessels by using high-frequency sound waves and Doppler technology.
  • Lymphangiography is a less frequently performed procedure, involving the injection of a contrast dye directly into the lymphatic vessels to view the flow of lymph. 

How is lymphedema treated?

The initial course of therapy for lymphedema involves taking precautions to prevent or lessen the symptoms caused due to lymphedema. Some precautionary steps include:

  • Regularly clean and keep the affected limb dry
  • Avoid walking barefoot
  • Avoid crossing your legs while you sit
  • Carry out activities such as cooking and gardening while wearing gloves
  • Avoid carrying hand bags with the affected arm
  • If you are prone to lymphedema, avoid injections and blood pressure measurements on the affected limb and notify the medical personnel of your lymphedema risk by wearing a special necklace or bracelet.

Your doctor may also suggest complex decongestive therapy, a combination of lifestyle changes with the following treatments:

  • Massages to manually drain lymph from chronic lymphedema
  • Special exercises performed while wearing bandages or compression stockings
  • Using external pumps to stimulate the flow of fluid through your body

Your doctor may also prescribe medications to treat infections which worsen lymphedema.

In some cases, when your limbs become large and heavy, restricting your movement, your surgeon may recommend surgery to excise excessive tissue.

You should participate actively during lymphedema treatment. Individual counselling or joining support groups may benefit you in providing the necessary social and emotional support that you require.