What Triggers Lymphedema?

Lymphedema, or swelling caused by lymph accumulation, can have a variety of causes, from genetic malformations of the lymph system to cancer, surgery or infection.

Lymphedema is abnormal swelling in the tissues just beneath the skin due to accumulation of lymph fluid in the body. The lymph system serves to drain and carry fluids and cells from the body’s tissues to help fight infection. If the lymph system is not functioning properly, fluid is unable to drain as it should, and swelling can occur. 

Symptoms of lymphedema may include:

• Swelling of arms, legs, or other body parts 
• Swelling may develop quickly or it may progress slowly and worsen over several months
• The skin in the swollen area feels tight
• Tingling sensation
• Heavy feeling in arms or legs
• Clothing fits more snugly on the affected area
• Thick or leathery appearance of the skin over the lymphedema area 

Lymphedema can be considered primary or secondary. 

Primary lymphedema is caused by hereditary or genetic abnormalities that cause malformation of the lymphatic system. 

\Secondary lymphedema is more common than primary lymphedema and is caused by damage or trauma to the lymphatic system. Causes of damage to the lymph system include:

• Cancer 
• Cancer-related surgery
• Can include surgery to remove lymph nodes or vessels that carry lymph fluid
• Radiation therapy
• Traumatic injury
• Obesity
• Parasitic infection
  • The most common cause of damage to the lymphatic system worldwide, commonly in subtropical areas of Southeast Asia, India, Central America, and Africa
  • Leads to a form of lymphedema called filariasis

When the lymph system is damaged, such as from cancer, surgery, or radiation, lymphedema may not occur right away but may develop years later. Triggers for lymphedema include: 

• Air travel, due to changes in air pressure
• Injury to the affected area 
• Wounds or skin punctures, such as insect bites or injections
• Skin infections on the affected area
• Excessive heat exposure, including sunburn
• Excess load on a limb such as from carrying heavy bags or standing for long periods on a susceptible leg 
• Limb constriction from blood pressure tests, tight clothes, and jewelry

Lymphedema is diagnosed with a physical examination. If an arm or leg is swollen, it may be measured to compare with the other arm or leg. If a swollen arm or leg is 2 cm (about 4/5 of an inch) bigger than the other arm or leg, it is usually considered lymphedema.

Other tests used to confirm the diagnosis of lymphedema or to determine the cause include: 

• Lymphoscintigraphy 
• Computed tomography (CT) scans 
• Magnetic resonance imaging (MRI) 

There is no cure for lymphedema and treatment is aimed at reliving symptoms and reducing swelling or preventing it from getting worse. 

Treatment for lymphedema includes: 

• Exercise to help lymph fluid to drain and to reduce swelling
• Compression sleeves or stockings to help lymph fluid drain out
• Manual lymph drainage is a special type of massage therapy to help push lymph fluid out of the swollen parts of the body
• Pneumatic pump
• Weight loss in patients who are overweight or obese
• Cancer treatment in cases where a tumor is causing lymphedema
• Surgery in severe cases 
  • Liposuction
  • Lymphatico-venous anastomosis (lymphovenous bypass)
  • Vascularized lymph node transfer surgery (lympho-venous transplant)
  • Charles procedure (skin grafts)

Complications of lymphedema include: 

• Increased risk of infection in the swollen area
• Slow wound healing
• Stiff or sore joints in the part of the body affects by lymphedema
• Progressive tissue swelling 
• Psychological problems such as depression, anger, or embarrassment