The lymphatic system is made up of a body-wide network of tiny vessels and small organs called lymph nodes. Lymphedema occurs when part of the lymphatic system gets blocked or damaged, and the lymph vessels are no longer able to drain lymph fluid from an area. This causes the lymph fluid to pool in the body’s soft tissues, which leads to swelling.
At UCHealth, our Certified Lymphedema Therapists (CLTs) are specially trained to treat lymphedema.
Causes of lymphedema
There are two major categories of lymphedema: primary and secondary.
Lymphedema occurs when part of the lymphatic system gets blocked or damaged and the lymph vessels are no longer able to drain lymph fluid from an area. This causes the lymph fluid to pool in the body’s soft tissues and leads to swelling.
Primary lymphedema is lymphedema that is hereditary and develops at birth or later in life – like during puberty, pregnancy, or perimenopause – often without specific damage to the lymph system.
Secondary lymphedema is more common. It happens when damage or disease affects the lymphatic system. Its causes include:
- Cancer. Tumors growing in or near lymph nodes can cut off the circulation of the lymphatic system.
- Radiation therapy for cancer. Radiation is a common treatment for cancer. It can cause scar tissue to form within the lymphatic system, blocking the flow of lymph fluid.
- Surgery. Sometimes, cancer treatment involves surgically removing lymph nodes. The resultant scarring can sometimes lead to lymphedema.
- Parasites. In certain parts of the world, lymphedema is caused by an infection with parasites that block the lymph vessels.
- Obesity. Extreme obesity can sometimes lead to lymphedema of the legs.
People who have breast cancer or who have received radiation or surgical treatment for breast cancer are at risk for developing lymphedema of the arms. People who have or have received treatment for colon, uterine, prostate, and vulvar cancer are at risk for developing lymphedema of the legs. Head, neck, and throat cancers and cancer treatments can sometimes lead to lymphedema of the neck.
Symptoms of lymphedema
Lymphedema symptoms can include:
- Swelling of the arms, legs, neck, stomach, breasts, groin, fingers, or toes.
- Swelling only in one limb or on one side.
- A feeling of fullness or puffiness in the limbs and groin.
- Aching or burning in the limbs.
- Difficulty moving joints of the arm or leg, or restricted movement of the limbs.
- Feeling like jewelry, shoes, or clothes are tight.
- Hardening of the skin of the affected area (fibrosis).
- Tightness or warmness in the skin of the affected area.
- Recurrent skin infections (cellulitis).
If you have any of these symptoms, call your health care provider. They will be able to refer you to rehabilitation therapy for treatment.
Find specialized therapies for lymphedema at UCHealth.
UCHealth Lymphedema Program: a Center of Excellence.
UCHealth strives to provide the highest level of care for persons with lymphatic disorders. In October 2021 we were recognized as a Center of Excellence through the Lymphatic Education and Research Network (LE&RN).
Being diagnosed with a chronic condition can be upsetting and challenging. This is especially the case for lymphedema, which many medical professionals are unfamiliar with.
Our Certified Lymphedema Therapists. At UCHealth, we have over 30 lymphedema therapists who understand and specialize in treating this condition. They have trained many hours to achieve a special recognition: Certified Lymphedema Therapists (CLTs).
In addition, we have several surgeons who perform specialized lymphatic surgeries, and all of our providers are constantly learning new ways to better treat this underserved population.
The specially-trained therapists and specialists at UCHealth help you manage lymphedema and get back to living your life to the fullest. Our treatments for lymphedema include:
Complete Decongestive Therapy (CDT)
The most common treatment for lymphedema is complete decongestive therapy (CDT). CDT is done by a certified lymphatic specialist (CLT) who has received special training in treating lymphedema. The goal of treatment is to reduce your symptoms and teach you how to manage them on your own.
CDT consists of managing swelling by performing five key components:
Manual lymphatic drainage
This is a special kind of massage that stretches the skin to help move the lymphatic fluid out of swollen areas. It is done by a certified lymphatic therapist (CLT). As the treatment progresses, the CLT will teach the patient/caregiver how to perform this at home.
Gentle exercises of the affected limbs can help move lymph fluid out of swollen areas. Your CLT will help guide you through these exercises and teach you how to perform them at home. Over time, your CLT may work with you to incorporate other exercises, like aerobics and strength training, into your routine.
Compression can help encourage lymph fluid drainage and is an important part of lymphedema treatment. Your CLT will work with you to either apply special compression bandages (compression wraps) or get fitted for a compression sleeve or garment. UCHealth cannot sell patients compression garments; however, your therapist will work with you to get you fitted for compression and direct you to vendors who can purchase your garment.
- In some cases, your therapist may recommend a pneumatic compression pump. These pumps are worn as a sleeve over the affected area. The sleeve intermittently inflates, applying gentle compression to encourage fluid drainage. Compression levels can be increased over time.
- Some insurance companies cover the cost of these garments. Currently Medicare and Medicare supplements do not cover the cost of compression. Your therapist will help determine the most cost-effective way for you to get the compression you need.
Skin and nail care
Lymphedema can impact your skin and nails and increase your likelihood of developing skin infections (cellulitis). Your CLT will help you learn how to best care for your skin and nails.
Your doctor may prescribe you antibiotics to keep on hand in case symptoms develop.
Lymphedema is a chronic condition, meaning it will need to be managed over time. Our therapists will help you become independent in all components of complete decongestive therapy (CDT) including self-manual lymph drainage, self-bandaging, applying compression garments, and exercise.
In addition, they will emphasize skin/nail care and infection prevention by teaching lymphedema risk reduction techniques.
Physical and occupational therapy management of lymphedema
In some cases, you may need surgery to help manage your lymphedema. Surgeries for lymphedema can include:
Removal of fibrous tissue. Lymphedema can lead to hardening of the skin and soft tissues of the body. These hardened tissues may need to be removed to promote better limb function. This is often done with laser therapy or liposuction. In severe cases, it may be done with a scalpel.
Liposuction. Lymphedema can cause fibrous tissue and fluid build-up in fatty parts of the body. Liposuction is a procedure that involves removing fat deposits with suction. It is sometimes used to treat lymphedema that occurs under the chin, around the neck, and near the breasts
Creating new drainage paths (lymphovenous bypass). This is a special procedure in which new connections are made between the lymph vessels and nearby blood vessels, permanently increasing drainage.
Lymph node transplant. This is a surgical procedure in which lymph nodes from one part of the body are moved to the affected area. This treatment can be especially helpful in the early stages of lymphedema and lessen the need for compression treatments.
Center for Disease Control and Prevention (CDC). Lymphedema (https://www.cdc.gov/cancer/survivors/patients/lymphedema.htm)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Lymphedema (https://www.ncbi.nlm.nih.gov/books/NBK537239/)
National Cancer Institute (NCI). Lymphedema (https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-pdq)
MedlinePlus: National Library of Medicine. Lymphedema (https://medlineplus.gov/lymphedema.html)