Lymphedema: Causes, Symptoms and Treatment for the Home
Lymphedema is a chronic, progressive condition in which excessive protein-rich fluids accumulate in the interstitium, the space between the cells. The condition occurs from impairment of the lymphatic system’s ability to drain fluids and proteins from the spaces in between cells and transport this fluid, known as lymph, back to the circulatory system. Lymphedema is classified as either primary or secondary.
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Primary lymphedema may be caused by congenital malformations of the lymphatic system and can be hereditary. Although primary lymphedema has largely been attributed to genetic causes, lymphedema is also classified as primary when no known cause can be identified (idiopathic).
Secondary lymphedema is more common. It is an acquired condition caused by a known disruption to the lymphatic system, such as:
- Cancer treatments (removal of lymph nodes and/or
- Benign or malignant tumor growth
- Chronic venous insufficiency
- Filariasis (parasitic)
- Iatrogenic causes
Symptoms of lymphedema may include:
- Swelling of the arms, legs or torso
- Hardening and thickening of the skin
- Recurring infections
- Pain and decreased range of motion
There is currently no cure for lymphedema. Untreated lymphedema can worsen, leading to increased swelling and pain, progressive hardening of affected tissues (fibrosis), and recurrent infections (cellulitis). Lymphedema can decrease mobility, dexterity, range of motion and the ability to perform daily activities. With effective treatment, however, patients can manage their symptoms, minimize infections, and improve their health and quality of life.
Compression therapy is well-established as a cornerstone of lymphedema therapy. Compression to the limb may be applied in various ways including multi-layer bandaging, elastic compression stockings, custom compression garments and intermittent pneumatic compression devices. Barriers to effective compression, including difficulty in self-application of bandaging and compression stockings as well as inability to tolerate some forms of compression, must be thoroughly evaluated so each patient is provided with a compression therapy that is effective and compatible with the individual’s self-care ability.
Complete Decongestive Therapy (CDT)
CDT is a multimodal treatment approach consisting of intensive in-clinic treatment provided by a certified lymphedema therapist, followed by an at-home treatment program. The focus of in-clinic CDT is to reduce limb volume and fibrosis and provide the patient with tools and knowledge for at-home self management of this lifelong condition.
Components of in-clinic CDT may include:
- Education on the condition
- Compression bandaging/garments
- Manual lymphatic drainage therapy
- This key component of CDT employs a sequence of hand motions, consistent with established anatomic and physiological principles, which redirect fluid from congested and swollen areas to functioning lymphatic regions.
- Intermittent pneumatic compression (IPC) device (Flexitouch®)
- Development of at-home self management program
At-Home Self Management
Upon discharge from in-clinic therapy, the patient is responsible for maintaining the benefits achieved during in-clinic treatment. Home treatment components are customized to meet each patient’s needs and may include:
- Intermittent pneumatic compression device (Flexitouch)
- Meticulous skin and nail care
- Daily decongestive exercise
The Flexitouch system, an advanced intermittent pneumatic compression device based on the physiologic principles of the lymphatic system, is the only IPC device with direct evidence that it improves lymphatic function. The Flexitouch system can be used in combination with other treatment components enabling patients to maintain reductions in limb volume between clinic visits.
Studies have demonstrated the clinical benefit of reducing limb volume associated with lymphedema when intermittent pneumatic compression is added to both in-clinic as well as at-home therapeutic programs. Lifelong in-home maintenance therapy with Flexitouch intermittent pneumatic compression is intended to sustain gains achieved during the initial decongestive phase as well as to limit the progression of the disease.