There is no cure for lymphadema, but there are treatments to minimize swelling and reduce discomfort. These treatments are conducted under a single therapy called complete decongestive therapy (CDT). It has three elements: manual lymph drainage, compression therapy, and self-management techniques.
The lymphatic system consists of three parts: protein-rich lymph fluid, lymph vessels, and lymph nodes containing infection-fighting cells, or lymphocytes. The system begins by disseminating lymph fluid throughout the body. This fluid flows through the lymph vessels, collecting waste products, bacteria, and viruses and conducting them to the lymph nodes where they are filtered and drained out by lymphocytes.
Lymphadema occurs when there is a blockage in the lymphatic system, preventing natural drainage of the fluid. It accumulates, resulting in an abnormal swelling of tissues in the arms or legs. There are two types: primary lymphadema, which is an inherited disorder, and secondary lymphadema, which is an acquired disorder caused by damage or trauma to the lympathic system. Both can be treated with CDT.
Manual lymph drainage (MLD) is a specialized massage technique performed by qualified therapists. The massages stimulate the flow of lymph fluids from damaged lymph nodes and redirect them into healthier ones so that fluids can drain normally. MLD treatment lasts between 30 minutes to an hour, depending on the severity of the problem in the affected limb. Four to 14 treatments over two to four weeks reduce swelling in the limbs.
Some patients feel the need to urinate often after MLD, because excess lymph fluids are processed by the kidneys and pass out of the body as urine. As a result, drinking plenty of water before and after the treatment is important to prevent dehydration. MLD should be avoided by people who have received cancer radiation therapy in the affected areas, and patients should speak with a medical professional before proceeding with MLD if they have skin infections, congestive heart failure, blood clots, cellulitis, or active cancer.
Compression therapy is conducted between MLD treatments to maintain and enhance the progress already made. Various compression methods place pressure on the tissues in the affected limb, aiding in the natural drainage of excess fluids. Compression also minimizes and prevents additional swelling. Lymphadema can be compressed with bandages, compression aids and garments.
Bandages are most effective, since they are adjustable to the different sizes of the affected limb pre- and post-treatment. Furthermore, bandages are flexible, as they can be worn when a person is active or resting. Compression garments, such as knit two-way stretch sleeves or stockings, are worn only while the patient is awake, and they assist in controlling swelling and moving lymph fluids from the affected area. Compression aids are custom-made of fabric covering a layer of foam. These aids include pads, sleeves and stockings and are worn in the evening or during sleep.
Lymphadema treatments are supplemented with self-care techniques such as regular decongestive exercises, a consistent skin care regimen, and self-massage between MLD treatments. Decongestive exercises move lymph fluids out of the affected limb, and a healthcare professional can provide advice on an exercise plan. A skin care regimen is crucial to prevent skin infections, such as cellulitis and fungal attacks. Patients should keep the skin clean and moisturize it with low pH lotions.
An essential technique to manage lymphadema is self-massage. Self-massage methods are similar to MLD massages and stimulate lymph vessels to improve flow and drainage of excess lymph fluids. A qualified therapist can provide patients with instructions on a daily self-massage program, and it should only be done as often as advised by the therapist.
CDT treatments are typically non-invasive, reliable, and effective, but in severe cases, a therapist may recommend surgery to remove excess tissues in the limbs.