What Is Lymphedema

Lymphedema: A condition described by an accumulation of excessive lymphatic fluid and swelling of subcutaneous tissues due to obstructions, destruction, or hypoplasia of lymph vessels.  It may affect one territory or multiple territories, meaning an arm, a leg, the breast,  abdomen, face or any combination or areas.

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Potential contributing factors to Lymphedema onset include: (but not limited to) Lymph node removal during surgery, excessive damage to lymphatic vessels due to an injury or surgery, or may be primary lymphedema, meaning a malformation of the lymph system present from birth.   

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Stages of Lymphedema:

Stage 0: Subclinical or Latent stage

• Timeline: Starts once lymph nodes are removed or lymph system is damaged
• Defined by: Reduced transport capacity of the lymphatic system, yet still sufficient to handle the current lymphatic load
• Characterized by: normal consistency of lymphatic fluid and no swelling is currently present
• Notable Symptoms: May feel sensations of heaviness, achiness, warmth, fatigability in the “at risk” limb when overloaded
• Prevention strategies for progressing to next stage: some text
  • Maintain healthy skin integrity by washing/ drying and applying lotion to skin with gentle, toxin-free cleansers that are fragrance free 
  • Prevent skin infections by properly treating cuts/ scrapes/ bites
  • Maintain a healthy muscular balance and range of motion in the affected region
  • Complete regular exercise including cardiovascular/ strengthening/ stretching,
  • Avoid tightly fitting clothing that could create a tourniquet
  • Avoid high sodium/ salty foods 
  • Stay well hydrated
  • Wear a properly fitting compression garment when travelling by air 

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Stage 1: Acute lymphedema 

• Timeline: Present for less than 3 months and is reversible with elevation 
• Defined by: the presence of pitting edema that can be reversed with elevation and/or treatmentsome text
  • Pitting edema- assessed by pressing one finger pad into the swollen area for 1-2 seconds and if an indentation is left in the skin that takes > 1 second to return to normal, it is considered “pitting” edema or soft edema
• Swelling tendency: The involved area seems swollen at the end of the day, but after they sleep overnight it is improved. 
• Characterized by: reduced transport capacity of the involved lymphatic territory, and the current lymphatic load is more than the capacity can handle.  The amount of load that surpasses capacity is what leads to the back up of fluid, which manifests as swelling.
• Notable symptoms: feeling of heaviness/achiness, fatigue, (gradual onset)
• Texture of the limb: puffy, skin is taut, pitting edema
• Potentially triggered by: temperature, extremes, overexertion, injury, infection, constriction, and/or air pressure changes
• Treatment: Typically involves work with a Certified Lymphedema Therapist (CLT) to go through a round of treatment that includes Complete Decongestive Therapy (CDT).  some text
  • Phase 1: Decongestive Phase- Focus is on getting the limb(s), trunk or breast smaller by decreasing that swelling that is present
  • Phase 2: Maintenance phase- Focus is on maintaining the improved size of the limb(s), trunk, breast, or face for long term. This is typically achieved through use of one or a combination of daytime compression garments, night time garments, and/or pneumatic compression pump, in addition to regular exercise.
• Prevention strategies for progressing to next stage: some text
  • Maintain healthy skin integrity by washing/ drying and applying lotion to skin with gentle, toxin-free cleansers that are fragrance free 
  • Prevent skin infections by properly treating cuts/ scrapes/ bites
  • If the skin becomes red/ warm/ painful in a small or enlarged area, seek the advice of a medical professional to treat potential onset of cellulitis.  
  • Maintain a healthy muscular balance and range of motion in the affected region
  • Complete regular exercise including cardiovascular/ strengthening/ stretching,
  • Avoid tightly fitting clothing that could create a tourniquet
  • Avoid high sodium/ salty foods 
  • Stay well hydrated
  • Wear a properly fitting compression garment when travelling by air 
  • Remain consistent with your maintenance phase prescribed by your treating Certified Lymphedema Therapist 

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Stage 2: Chronic lymphedema

• Timeline: Present greater than 3 months and is not reversable with elevation 
• Defined by: Non-pitting and pitting edema is only partially reduced with treatment. Meaning the limb size does not return to the size of the un-involved limbsome text
  • Pitting edema- assessed by pressing one finger pad into the swollen area for 1-2 seconds and if an indentation is left in the skin that takes > 1 second to return to normal, it is considered “pitting” edema or soft edema.
  • Non-pitting edema- assessed by pressing one finger pad into the swollen area for 1-2 seconds and a firmness or sponginess if felt with no indentation is left.  This is considered fibrotic swelling and is more difficult to improve.
• Characterized by: 2 subgroups: some text
  • IIA: swelling is not reversible and pitting is present 
  • IIB: no pitting is visible and fibrosis and/or fat begin to emerge 
• Potentially Triggered by: temperature extremes, overexertion, injury, infection, constriction (i.e. Tourniquet by wearing a compression garment incorrectly), and/or air pressure changes (same as stage 1)
• Notable Symptoms: Skin tissue texture may feel rubbery, lumpy, thickened.  Area may feel heavy and achey at times. 
• Treatment: Typically involves work with a Certified Lymphedema Therapist (CLT) to go through a round of treatment that includes Complete Decongestive Therapy (CDT).  some text
  • Phase 1: Decongestive Phase- Focus is on getting the limb(s), trunk or breast smaller by decreasing that swelling that is present
  • Phase 2: Maintenance phase- Focus is on maintaining the improved size of the limb(s), trunk, breast, or face for long term. This is typically achieved through use of one or a combination of daytime compression garments, night time garments, and/or pneumatic compression pump, in addition to regular exercise.
  • May also include surgical intervention 
• Prevention strategies for progressing to next stage: some text
  • Maintain healthy skin integrity by washing/ drying and applying lotion to skin with gentle, toxin-free cleansers that are fragrance free 
  • Prevent skin infections by properly treating cuts/ scrapes/ bites
  • If the skin becomes red/ warm/ painful in a small or enlarged area, seek the advice of a medical professional to treat potential onset of cellulitis.  
  • Maintain a healthy muscular balance and range of motion in the affected region
  • Complete regular exercise including cardiovascular/ strengthening/ stretching,
  • Avoid tightly fitting clothing that could create a tourniquet
  • Avoid high sodium/ salty foods 
  • Stay well hydrated
  • Wear a properly fitting compression garment when travelling by air 
  • Remain consistent with your maintenance phase prescribed by your treating Certified Lymphedema Therapist 

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Stage 3: Late-stage Chronic Lymphedema  

• Timeline: Present greater than 6 months and is not reversable with elevation or compression
• Defined by: Non-pitting edema that is only partially reduced with treatment. some text
  • Non-pitting edema- assessed by pressing one finger pad into the swollen area for 1-2 seconds and a firmness or sponginess if felt with no indentation left in the skin.  This is considered fibrotic swelling and is more difficult to improve.
• Potentially Triggered by:  Infection or cellulitis, insufficient management of a Stage II Lymphedema 
• Characterized by: Swollen limb, trunk or breast that has started to show advancing skin changes (may include: thicken, hardened skin, distorted shapes, skin folds, growths, lobes)
• Characterized by:  Significantly enlarged limb, trunk or breast, loss of range of motion, heavy, full, and potentially achy. 
• Treatment: Typically involves work with a Certified Lymphedema Therapist (CLT) to go through a round of treatment that includes Complete Decongestive Therapy (CDT).  some text
  • Phase 1: Decongestive Phase- Focus is on getting the limb(s), trunk or breast smaller by decreasing that swelling that is present
  • Phase 2: Maintenance phase- Focus is on maintaining the improved size of the limb(s), trunk, breast, or face for long term. This is typically achieved through use of one or a combination of daytime compression garments, night time garments, and/or pneumatic compression pump, in addition to regular exercise.
  • May also include surgical intervention
• Prevention strategies for worsening in this stage: some text
  • Maintain healthy skin integrity by washing/ drying and applying lotion to skin with gentle, toxin-free cleansers that are fragrance free 
  • Prevent skin infections by properly treating cuts/ scrapes/ bites
  • If the skin becomes red/ warm/ painful in a small or enlarged area, seek the advice of a medical professional to treat potential onset of cellulitis
  • Maintain a healthy muscular balance and range of motion in the affected region
  • Complete regular exercise including cardiovascular/ strengthening/ stretching,
  • Avoid tightly fitting clothing that could create a tourniquet
  • Avoid high sodium/ salty foods 
  • Stay well hydrated
  • Wear a properly fitting compression garment when travelling by air 
  • Remain consistent with your maintenance phase prescribed by your treating Certified Lymphedema Therapist 

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Purpose of compression garments:

• Stage 0- Prophylactic- Primarily used in preventative manner during air travel
• Stage 1- Prophylactic- Primarily worn when experiencing symptoms of overload or when doing activities that could lead to overload (i.e. air travel)
• Stages 2 & 3: Containment- Worn to maintain the reduction of limb, trunk, or breast volume that is achieved during treatments with a Certified Lymphedema Therapist (CLT); and used to keep swelling from reoccurring during the maintenance phase of treatment.

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