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What Is All This Swelling About? An Update on Lymphedema for Healthcare Providers and Patients
Swelling or edema is common. It can result from certain diseases, infections, conditions, trauma, or injury, and even medication.1 Typically, the swelling goes away on its own. Sometimes, however, the swelling continues and can worsen over time.
This article serves as a guide to help patients and caregivers understand what swelling is and when medical help is necessary. We will educate patients and their caregivers about lymphedema including common risks and contributing factors. This article will also provide general treatment recommendations for lymphedema and provide general and disease-specific resources for individuals affected by lymphedema.
When Should I Seek Medical Help?
Most of the time, swelling goes away, and it can feel better with moving and/or when using rest, ice, compression, and elevation or raising your arm or leg above your heart.
At times, the swelling does not get better and can even get worse quickly or slowly. This is when you should see your doctor.
You should see a doctor right away if you have sudden swelling, especially on one side of the extremity, redness or discolored skin changes, warmth, and pain as these may be indicative of a blood clot.2
What Treatments Are Effective?
If you have swelling that is not going away or getting worse, your doctor may do a thorough exam including asking you questions and ordering tests. These tests do not hurt, but they can give the doctor an idea about the health of your circulation/blood flow by checking your arteries and veins.
The doctor may find the swelling is related to a medical condition that you have. Proper care of that condition will help the swelling go away.
More information on what causes swelling and whether it is serious can be accessed here.
What Is Lymphedema?
Sometimes, the swelling may be an actual disease called lymphedema, that can be treated and managed by specially trained healthcare providers.
Current research states “… lymphatic failure is responsible for all forms of peripheral edema …”3 and that the lymphatic system is responsible for managing all the fluid in your body.4 Just as your circulatory system (heart, arteries, veins) controls blood flow, your body’s lymphatic system controls fluid. Think of your lymphatic system like the body’s recycling system. It keeps swelling under control and manages all the waste products.4
Sometimes, the lymphatic system can get overwhelmed. An ankle sprain is a good example. The injury causes swelling to happen at the ankle and the lymphatics in that area work harder to manage the fluid. In time, this goes away.
The lymphatic system can be damaged and not function properly. This can be a problem you are born with or it can happen later in life. This can happen from trauma, surgery, radiation or even infection.4 When the lymphatic system is damaged, it can lead to a condition or disease called lymphedema.4 Lymphedema is due to a chronic swelling caused by a build-up of fluid. Unlike regular swelling, it does not go away over time.4
Click here to view common lymphedema risk factors/contributing factors.
Who Can Help With Lymphedema?
If you have swelling that will not go away or notice a heaviness in your leg or arm, you should go to your doctor for a checkup. Your doctor can determine if you have lymphedema or some other reason for the chronic swelling.
If you do have lymphedema, your doctor should refer you to a certified lymphedema therapist (CLT). These healthcare providers are usually physical therapists or occupational therapists with special training and education on the lymphatic system. For a listing of CLTs in your area, click here.
How Do You Treat Lymphedema?
Lymphedema is best treated by complete decongestive therapy (CDT).5–7 Complete decongestive therapy is delivered in two phases.5–7
• Phase I is clinician-driven (managed by the CLT) until your arm or leg has reduced in size and stabilized.5–7
o This can take 2–8 weeks depending on how often you receive CDT.
• Phase II is patient-driven and requires lifelong management to prevent the swelling from returning.5-7
o Lymphedema is a disease without a cure (currently) so self-management is life-long.
Both phases involve patient education, skin and nail care, manual lymphatic drainage, compression, and exercise.5-7
o Education involves learning about the lymphatic system, lymphedema and how you can manage this disease and maintain your quality of life.
o Skin and nail care teaches you how to protect and take care of your skin and nails to prevent infection and complications.
o Manual lymphatic drainage is like a massage, and it helps to move the fluid to healthy areas where it can drain.
o Compression involves the use of snug bandages to support the decrease in fluid, so the swelling does not return.
o Exercise is whatever activity you like to do while wearing compression. Walking and yoga are great activities.
Other Considerations
Think about it this way: The body’s lymphatic system, when healthy, is like a pickup truck. It has a large capacity to handle cargo/loads.8 If the pickup truck needs servicing, you may get a smaller rental car that has a reduced capacity to handle cargo/loads. Although inefficient, the rental car still has the capacity to carry cargo or a load. However, the car is smaller and therefore must take more trips or work harder.8 Eventually, you will get your pickup back and resume normal transport capacity.8
If for some reason, while driving the small rental car you get in an accident you now have a damaged capacity to handle the remaining cargo or load.8 Sometimes, the small car may remain functional though impaired, or it may be completely totaled in that it cannot function.8
In either case, the transport capacity is impaired. When the lymphatic system’s transport capacity becomes damaged, the edema becomes stagnant and chronic leading to the disease of lymphedema.
Additional Resources
Many resources exist to assist healthcare providers and patients alike with respect to lymphedema. Proper identification and diagnosis are essential so proper treatment or referral can be made. Some resources include:
Lymphedema Association of North America
Lymphatic Education & Research Network
American Vein and Lymphatic Society
National Lymphedema Network
Lymphoedema Support Network:
Lymphedema Blog
Lymphedema People
Lymphedema Treatment Act
International Lymphedema and Wound Training Institute
Academy of Lymphatic Studies
Disclaimer
This information is not meant to replace the advice of a medical professional and should not be interpreted as a clinical practice guideline. This information/education page may be reproduced for noncommercial use for health care professionals and other service providers to share with their patients or clients. Any other reproduction is subject to approval by the publisher.
Heather Hettrick, PT, PhD, CWS, AWCC, CLT-LANA, CLWT, CORE, is a Professor, Admissions Committee Chair, and Faculty Residency Mentor in the Department of Physical Therapy at Nova Southeastern University.
Archana Vatwani, PT, DPT, MBA, CLWT, CDP, CLSSBB, PMP is an Associate Professor in the Department of Physical Therapy in the Dr. Pallavi Patel College of Healthcare Sciences at Nova Southeastern University
Primary email address contact: hh124@nova.edu
Click here to download a PDF of this article.
References
1. Fletcher J. Swelling: Is it serious? Symptoms, causes, and treatment. [online] Medical News Today. Published 2021. Accessed April 19, 2021.
2. Mayo Clinic. Deep vein thrombosis - Symptoms and causes. Published 2021. Accessed April 14, 2021.
3. Mortimer P, Rockson S. New developments in clinical aspects of lymphatic disease. J Clin Invest. 2014; 124(3):915–921. Diagnosis and treatment of primary lymphedema consensus document of the International Union of Phlebology (IUP) 2013.
4. Foldi M, Foldi E. 2006. Foldi's Textbook of Lymphology. Muchen: Elsevier.
5. Framework L. Best practice for the management of lymphedema. International consensus. London: MEP Ltd., pp. 3–52.
6. Executive Committee. The diagnosis and treatment of peripheral lymphedema: 2016 consensus document of the International Society of Lymphology. Lymphology. 2016;49(4):170–84.
7. Bjork R, Hettrick H. Lymphedema: new concepts in diagnosis and treatment. Current Dermatology Reports. 2019; 8(4):190–198.
8. Hettrick H. 2021. Phlebolymphedema: the inter-relationship between the venous, lymphatic and integumentary systems. Mölnlycke Advantage. [online] Accessed April 19, 2021.
