Treatment of Patients with Lymphoedema

Lymphoedema, also known as lymphatic obstruction, describes the swelling that most commonly affects the limbs but can occur anywhere in the body. It is a condition of localized fluid retention caused by a compromised lymphatic system.

According to the British Lymphology Society, lymphoedema can occur for different reasons and can be classified as primary or secondary depending on the cause. Primary lymphoedema may be inherited, develop at puberty or in midlife, and relates to the abnormal functioning of the lymphatic system due to poorly developed or missing lymph nodes and channels in the body.

Secondary lymphoedema may occur following treatment for cancer, surgery, radiation therapy, recurrent infections or trauma. It is most frequently seen after lymph node dissection in which damage to the lymphatic system is caused during the treatment of cancer, most notably breast cancer. This condition usually develops months or even years after treatment has concluded.

Lymphoedema affects both men and women equally. In women, it is most prevalent in the upper limbs after breast cancer surgery and lymph node dissection, occurring in the arm on the side o the body in which the surgery is performed. It may also occur in the lower limbs or groin after surgery for colon, ovarian or uterine cancer in which the removal of lymph of lymph nodes is required.

In men, primary lymphoedema of the lower limb is more common, occurring in one or both legs. Surgery and treatment for prostate, colon, and testicular cancers may result in secondary lymphoedema, particularly where lymph nodes have been removed or damaged.

Although lymphoedema is not curable, there are ways to control and manage the condition. The most common treatment for lymphoedema is a combination of complete decongestive therapy or manual lymphatic drainage massage, and other techniques including skin care, pressure garments and specific exercises.

The manual lymphatic drainage massage enables to help stimulate the flow of lymphatic fluids by slowly and gently massaging it to a node point that is not obstructed. The excess fluid is filtered out by the kidneys and eliminated from the body through urination. The treatment is very gentle and a typical session involves drainage of the limbs, neck and trunk. The manual lymphatic drainage massage takes at least an hour to complete. If the patient is overweight or obese, it may take longer.

The lymphatic circulation is almost twice as slow as blood circulation. When doing the massage, physiotherapists have to use slow movements as fast movements will render the massage not effective. Even though the massage is done with light strokes, it is tiring as the therapist will have to maintain control because there is tendency to press harder and go faster. That is why it is very difficult massage to do. It takes a lot of time and can be very frustrating.