Lymphedema or lymphatic obstruction is a chronic condition where excess fluid collects in tissues of the legs or arms causing edema (swelling). The swelling can occur in one or both of the arms and legs.

The lymphatic system is made of lymph vessels and lymph nodes which drain fluids from the body tissues. These fluids transport immune cells and toxins among other waste products to the lymph nodes. The lymph vessels return filtered lymph fluids to the bloodstream thus maintaining fluid balance in the body.

When the lymphatic system fails to work properly it causes tissues in the arms or legs to swell with fluid. The swelling is caused by blockage of the lymphatic system which prevents the lymph fluids from draining well. This is known as lymphedema.

Causes of Lymphedema

There are two types of lymphedema: Primary (hereditary) and Secondary lymphedema with each having different causes.

Primary lymphedema is far less common than secondary lymphedema and you can have if it a member of your family has it since it is hereditary. It can be caused by faulty genes in the lymphatic system.

Secondary lymphedema is more common than primary lymphedema and it can be caused by several factors such as:

• Cancer surgery: Cancer cells tend to spread to various body areas through the lymphatic system. Sometimes the lymph nodes have to be removed to stop the spread and this can affect the lymphatic system and lead to lymphedema.
• Infection: Infection of the lymph nodes can impair the flow of the lymph fluids and increase the risk of lymphedema.
• Radiation therapy: Using radiation to destroy cancer cells can cause damage to nearby healthy tissue such as the lymphatic system and lead to lymphedema.
• Inflammatory diseases: Inflammatory conditions such as eczema and rheumatoid arthritis which can cause tissues to become inflamed may damage the lymphatic system.

Symptoms of Lymphedema

The main symptom of lymphedema is mainly swelling in the legs, arms, fingers, or toes. The facial tissues as well as the neck may also be affected.

Other symptoms of lymphedema include:

• Limit in range of motion
• A dull ache or heaviness in the affected area
• Limb Tightness
• Recurring infections
• Fibrosis (thickening or hardening of the skin)
• Tingling sensation in the affected area
• Severe fatigue

If the head and neck are affected it can cause nasal congestion, ear pain, and affect vision. It can also lead to problems with swallowing, breathing, talking, and drooling.

Diagnosis of Lymphedema

Lymphedema is usually diagnosed based on the signs and symptoms especially if you are at risk such as if you’ve recently undergone cancer surgery involving the lymph nodes.

Diagnosis of lymphedema may also involve:

• A physical examination
• Your medical history
• X-ray to show any abnormalities in the lymphatic drainage system
• MRI can be used instead of x-ray
• CT scan can be used to reveal blockages in the lymphatic system
• Lymphoscintigraphy, which is the radionuclide imaging of the lymphatic system. It involves injecting a radioactive gel into the lymphatic system and using a nuclear scanner to show the dye’s movement through the lymphatic system and identifying any blockages.

Treatment of Lymphedema

The treatment goal for lymphedema focuses on controlling and reducing the pain.

Treatment for lymphedema includes:

• Exercises: Simple exercises that involve moving the affected area can encourage lymph fluid drainage. During exercise pressure is put on the lymph vessels, which as a result decrease swelling by aiding the fluids to move through these vessels.
• Compression garment: Wearing compression garments on the affected limb encourages the flow of the lymphatic fluid out of the affected area. Wearing the correct fitting is important and your practitioner can help you with this.
• Pneumatic compression: This is a sleeve that is worn on the affected limb and it is connected to a pump that inflates the sleeve intermittently thus putting pressure on the limb causing the lymph fluid to flow away.
• Lymphatic drainage massage: Also known as manual lymphatic drainage it is usually performed by a qualified lymphedema practitioner. It involves manipulating tissues in the affected area allowing the lymph fluids to move more freely.
• Comprehensive decongestive therapy (CDT): This involves combining lifestyle changes with therapies. It may include routine skin care, compression garments, lymphatic drainage massage, and limb exercises.
• Surgery: This is only done in severe cases of lymphedema to remove excess tissue in the affected limb to reduce swelling.

Next Step

At King’s College Hospital Dubai, we focus on offering an exemplary service. From initial consultation through to final diagnosis, treatment and beyond. Our multidisciplinary team of expert doctors, nurses, cardiologists and technologists are here to offer tailored management and treatment of your condition, and to answer any questions that you may have throughout your time with us. Whatever you need us for, we’re only a phone-call away.