Lymphedema Explained: Advanced Physical Therapy
What is lymphedema?
Lymphedema is the abnormal accumulation of fluid in an area of the body. It is typically in the arms or legs but can also occur in the abdomen and genitals. The lymphatic system picks up extracellular/interstitial fluid (becoming lymphatic fluid) and drains it back into the blood circulation where it can eventually be eliminated. When this system cannot drain properly, fluid builds up in the tissues causing swelling.
Deeper Dive: “But, what IS lymphedema”?
First, what is lymphatic fluid and where does it come from? Very simply, Lymphatic fluid is a protein-rich fluid that is naturally occurring and is being produced 24/7 by our bodies. The lymphatic system picks up extracellular/interstitial fluid and it becomes lymphatic fluid. It is made up of water, protein, and cell particles. It drains into the blood circulation and eventually is eliminated through urination. When the system doesn’t pick up the fluid, it builds up in the tissues causing swelling i.e., lymphedema. It typically occurs in the arms or legs but can also occur in the abdomen and genitals.
Lymphedema is an abnormal accumulation of lymphatic fluid in an area of the body.
Two Categories of Lymphedema:
Primary and Secondary
Primary Lymphedema occurs when there is a malformation in the structure of the lymphatic system causing it to be inefficient. Swelling may present at birth or it may occur later in life when the lymphatic system can no longer manage the demands made on it.
Secondary Lymphedema occurs due to an injury to the lymphatic vessels leading to decreased efficiency and effectiveness of the lymphatic system. Often this happens due to cancer or cancer treatments such as lymph node removal, radiation, and chemotherapy. It can also occur after physical trauma or infection. Secondary lymphedema may present quickly after an injury to the system or many years later.
Common secondary lymphedema occurs with breast cancer after lymph nodes have been removed from the armpit. Unfortunately, when one or several lymph nodes are removed, the ability of the lymphatic system to do its job decreases in this area. This area can also be further affected when radiation has been administered in the armpit, chest/breast, upper torso.
The lymphatic system is vast but it is naturally “divided”, so if someone has lymph nodes removed from the right armpit or has radiation to that area, they will not develop swelling in other areas of their body, only the right arm and torso would be at risk for lymphedema.
So that naturally leads us to say that lymphedema in the leg(s) may occur due to cancers of the prostate, anal or gynecological cancers (ovarian, cervical, vulvar, etc). The swelling will often occur on the side affected most by treatment, which may include lymph node removal, radiation, or both. Some patients may experience abdominal and genital swelling, as well.
Swelling in the legs may also occur due to chronic venous insufficiency (CVI). This swelling is typically in both legs though it may be worse on one side. There also may be a darkening or discoloration (hemosiderin staining) in the lower legs. Swelling in a leg can also occur after deep vein thrombosis (DVT) - this is called post-thrombotic syndrome.
If you are having swelling as a result of Lymphedema, it can be managed! The sooner you get treatment the easier it is to treat and to manage.
Lymphedema is not curable but it is very manageable, especially if it is treated early. The longer the swelling is present it is more difficult to manage. Also, though, don’t let long-standing swelling keep you from seeking treatment. Treatment in the late stages of lymphedema can make it more manageable and reduce further progression.
OLIVIA MCKEE, OTR/L, CLT-LANA
Olivia McKee is our Lymphedema Specialist on our Advanced Physical Therapy team. Olivia helps patients in the Little Rock area and Central Arkansas. Explore our other articles about Lymphedema and how Olivia can help! If you have any questions, concerns, or would like to book an appointment with Olivia McKee, call our Advanced Physical Therapy office: 501-224-5454.