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The Lymph System

The Lymph System

To understand lymphedema, it helps to understand the function of the lymphatic system, which includes an extensive network of lymph vessels and lymph nodes.

The lymphatic system helps coordinate the immune system’s function to protect the body from foreign substances.

Here’s how the lymphatic system works: Excess fluid is collected from the space between tissues in the body and moves through the lymph vessels. The fluid (now called lymph) isn’t pumped through the body like blood, but instead is “pushed” through the lymph system as the vessels are compressed by surrounding muscles. These vessels are different from arteries and veins, which carry blood.

Filters called lymph nodes remove certain harmful substances from the lymph fluid, such as bacteria and debris. The fluid from most tissues or organs is filtered through one or more lymph nodes before draining into the bloodstream.

What is lymphedema?

Lymphedema is an abnormal buildup of fluid that causes swelling, most often in the arms or legs. The condition develops when lymph vessels or lymph nodes are missing, impaired, damaged or removed.

There are two types of lymphedema: primary and secondary.

  • Primary lymphedema is rare and is caused by the absence of certain lymph vessels at birth, or abnormalities in the lymphatic vessels.
  • Secondary lymphedema occurs as a result of a blockage or interruption that alters the flow of lymph through the lymphatic system and can develop from an infection, malignancy, surgery, scar tissue formation, trauma, radiation, or other cancer treatment.

Lymphedema can occur within a few days, months or years after lymphatic injury.

What are the signs and symptoms of lymphedema?

Symptoms of lymphedema include swelling in the arms, hands, fingers, shoulders or legs. The swelling may occur for the first time after a traumatic event (such as bruises, cuts, sunburn, and sports injuries), after an infection, or in the part of the body that was treated for cancer.

If you have any of these symptoms, talk to your health care provider. Prompt treatment can help manage the condition before complications occur.

How is lymphedema diagnosed?

Lymphedema is diagnosed after a careful evaluation of your medical history, including past surgeries and treatments, an evaluation of current medications and symptoms, and a complete physical examination. Sometimes, additional tests may be needed.

How is lymphedema treated?

Lymphedema treatments vary, depending on the stage and cause of the condition.

If the initial signs and symptoms of swelling are caused by infection, antibiotics may be prescribed.

Your doctor may refer you to a physical or occupational therapist who specializes in managing lymphedema. The therapist will assess your condition and work with you to develop an individual treatment plan. Therapy may include:

  • Specific exercises or a complete exercise program
  • Limitation of certain activities that are vigorous or repetitive
  • Manual lymphatic drainage therapy, a gentle form of skin stretching/massage
  • Complex decongestive therapy (specialized wrapping techniques)
  • Compression sleeve or stockings
  • Mechanical pumping devices, as needed in some cases

General guidelines for patients with lymphedema

Lymphedema can be prevented or managed by following the recommendations listed below, including: maintaining good nutrition, exercising regularly, avoiding infections, avoiding tight clothing, shoes or jewelry; avoiding heavy lifting with the affected arm, and practicing good skin care.

Maintain Good Nutrition

Maintaining good nutrition is an important part of your overall health care. Here are some general guidelines:

  • Reduce foods high in salt and fat.
  • Include at least two to four servings of fruits and three to five servings of vegetables in your daily meal plan.
  • Eat a variety of foods to get all the nutrients you need.
  • Use package label information to help you to make the best selections for a healthy lifestyle.
  • Eat foods high in fiber such as whole-grain breads, cereals, pasta, rice, fresh fruits and vegetables.
  • Drink plenty of water - eight 8-ounce glasses of water are recommended per day.
  • Maintain your ideal body weight. A registered dietitian or your health-care provider can help calculate your ideal body weight.
  • Avoid alcoholic beverages.
Exercise Regularly
  • Always check with your physician first before starting a new exercise program. Generally, strenuous exercises involving the affected limb should be avoided. Your physician can provide specific instructions about the activities that are safe for you.
  • To improve cardiovascular fitness, you should perform aerobic activities, such as walking, swimming, low- impact aerobics or specially prescribed exercises, for 20 to 30 minutes most days of the week.
  • Take time to include a 5-minute warm-up, including stretching exercises, before any aerobic activity and include a 5- to 10-minute cool down after the activity. Exercise Regularly
  • If your normal exercise routine includes weight lifting with your arms, check with your doctor about the best time to resume this activity and ask if there are any weight restrictions.
  • Discontinue any exercise that causes unexpected pain. If your affected arm or leg becomes tired during exercise, cool down, then rest and elevate it.
Avoid Infections

  • Frequently wash your hands with soap and warm water, especially before preparing food, and after using the bathroom or after touching soiled linens or clothes.
  • Wear gloves while doing housework or gardening.
  • Avoid cutting your cuticles when manicuring your nails. Use care when cutting your toenails. Treat athlete’s foot with antifungal powder.
  • Protect your skin from scratches, sores, burns and other irritations that might lead to infection. Use electric razors to remove hair and replace the razor head frequently.
  • Use insect repellents to prevent bug bites.
  • Immediately report any signs of infection to your physician, including:
    • Fever over 100 degrees F (38 degrees C)
    • Sweats or chills
    • Skin rash
    • Pain, tenderness, redness or swelling
    • Wound or cut that won’t heal
    • Red, warm or draining sore

Treat minor injuries immediately by washing the area with soap and water, applying antibiotic ointment, covering the area with a bandage and calling your doctor for medical advice.

Avoid Tight Clothing Shoes or Jewelry

  • Women should wear well-fitted bras; bra straps should not be too tight, avoid underwire styles, and wear pads under the bra straps if necessary.
  • Wear comfortable, closed-toe shoes.
  • Avoid tight hosiery and socks.
  • Wear watches or jewelry loosely, if at all, on the affected arm.
Avoid Heavy Lifting with the Affected Arm

Avoid repetitive movements of the affected arm (such as scrubbing, pushing or pulling). Do not carry a purse or bag on the affected shoulder.

Keep Your Skin Meticulously Clean

  • Dry your skin thoroughly (including creases and between fingers and toes).
  • Apply lotion to surrounding skin, but not in between your toes.
Take Precautions During Visits to Your Doctors

  • Ask to have your blood pressure checked on the unaffected arm.
  • Avoid injections or blood draws on the affected side when possible.

What can I do if I already have lymphedema?

To help decrease the risk of further swelling, continue following the recommendations for preventing lymphedema listed above. In addition:

  • Avoid extreme temperature changes. Do not use hot tubs, whirlpools, saunas or steam baths. Use warm, rather than very hot, water when bathing or washing dishes.
  • Always wear sun protection (at least SPF 15) when going outdoors.
  • When traveling by air, ask your health care provider if you should wear a compression sleeve on your affected arm or a stocking on your affected leg to minimize swelling. For long flights, additional bandages may be needed. Talk to your health care provider before traveling.
  • Continue to see your health care provider for frequent follow-up visits, as recommended.

Outlook for the Future

Lymphedema cannot be cured. However, with proper care and treatment, the affected limb can usually be restored to a manageable size and shape. In addition, lymphedema can be managed and controlled so that it does not progress further.

If left untreated, lymphedema can lead to increased swelling and a hardening of the tissue, resulting in decreased function and mobility in the affected limb. It can also lead to chronic infections and other illnesses.

It is important to receive treatment promptly if you recognize symptoms of lymphedema.

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

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Reference: #8353
Reviewed: 05/16

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