Navigation

Lymphoedema


Expert reviewer, Natalie Kruger, Physiotherapist
Next review due December 2021

Lymphoedema is the build-up of a fluid called lymph in a part of your body. The main noticeable sign is that the affected body part swells up.

It is most often caused by damage to the lymphatic system. This could be because of an injury, cancer or cancer treatment. However, some people can be born with a tendency to develop it from birth or later in life.

An image showing the lymphatic system

About lymphoedema

Lymphoedema (pronounced lim-fo-dee-mah) usually affects an arm, hand, leg or foot. But it can happen in any part of the body, including the breasts, genitals, torso and chest.

It happens because something goes wrong with the lymphatic system. The lymphatic system is made up of organs, lymphatic vessels and lymph nodes. It plays an important role in fluid balance, and in supporting your immune system and nutrition in the body.

The lymphatic system transports lymph from the body tissues, back into the blood circulation. Lymph carries important proteins, salts and cells around the body, including white blood cells, which help to defend against illness.

Lymphoedema happens when the lymphatic system becomes unable to transport lymph properly. This is either because there is a problem with the lymphatic system itself, or there is simply too much lymph for the body to process. This causes a build-up of lymph, which then collects in the tissues and causes swelling. The waste products contained in the blocked lymph can add to the swelling in surrounding tissues.

Types of lymphoedema

There are two main types of lymphoedema:

  • Primary lymphoedema is the result of problems with how your lymphatic system develops, which may be present from birth or develop later in life. This may run in the family, but in most cases the lymphatic vessels just haven’t developed properly for some reason.
  • Secondary lymphoedema is more common. It is caused by damage to the lymphatic system.

There are a number of reasons why the lymphatic system may become damaged, including:

  • cancer treatment – surgery to remove lymph nodes and radiotherapy that targets the lymph nodes can both increase risk of lymphoedema
  • cancer itself, where enlarged lymph nodes or a tumour blocks the flow of lymph
  • injury to the armpit or groin, which damages the lymphatic system
  • being very overweight (obese)
  • infection (called lymphatic filariasis) – this is not a common problem in the UK, but is common in countries where mosquitoes transmit infections with parasites that cause widespread inflammation

Symptoms of lymphoedema

The following can be symptoms or signs of lymphoedema.

  • You may notice part of your body has become swollen. This may or may not be painless.
  • Jewellery, clothes or shoes may start to feel tight.
  • The affected part of the body might feel heavy or weak and may ache.
  • Skin over the affected area can thicken and may become rough.
  • If your hand or foot is swollen, you may notice that you can’t pinch the skin on your fingers or toes.
  • You may also have something called ‘pitting oedema’. When you press the swollen area, the flesh doesn’t spring back. A small hollow or ‘pit’ remains that gradually disappears.

In very advanced lymphoedema, you may have:

  • increasing hardening of the area, as the tissues become stiffened (fibrosed)
  • non-pitting oedema – because the swollen tissues are hard, you no longer get pitting when you press on them
  • breaking down of the skin, with fluid leaking onto the surface

The skin in the swollen area will have more waste products and less oxygen because the usual lymph circulation isn’t taking place. This can make it more likely that an infection will develop within the affected area, which is called cellulitis. Cellulitis requires quick medical attention, and often a prescription of antibiotics. See our section on Managing your risk of lymphoedema below for more information.

Diagnosing lymphoedema

Lymphoedema needs to be diagnosed correctly in order to make sure that the right type of treatment is given.

Your doctor or health professional may suspect lymphoedema based on your symptoms, the appearance of the affected area and your medical history.

Physical checks and medical history

Your doctor will examine you, and ask about your medical history. If you have primary lymphoedema, they may also check to see if you have other signs of a genetic disorder. If you have secondary lymphoedema, it may be related to another medical condition, an injury or medical treatment that you’ve had in the past, or being very overweight (obese).

Measuring volume

Your doctor or health professional will measure around the affected area to check whether it’s enlarged. If it’s an arm or leg that’s affected, they may compare it to the other side.

Your doctor or health professional might compare measurements over time, to check whether the swelling is increasing. This is commonly done using an infra-red light called perometry, or with a tape measure. They will also check your skin and how well you can move the affected body part.

Other scans and tests

Your doctor or health professional may sometimes arrange other scans and tests to investigate and confirm the diagnosis. These could include the following.

  • A lymphoscintogram (pronounced lim-fo-sin-toe-gram) is a very accurate way of diagnosing lymphoedema. First, you have a very small radioactive injection (much too small to be harmful). Then you have scans, 45 minutes and two hours later. The scan shows all your lymph nodes but where lymph isn’t flowing properly, they won’t show up.
  • Other imaging scans can sometimes help with the diagnosis by detecting extra fluid in tissues. These can include an ultrasound, magnetic resonance imaging (MRI) or computerised tomography (CT) scan.
  • Bioimpedence testing is a way of measuring the water content of the body with a small electrical current.
  • Your doctor may arrange genetic testing if you are thought to have primary lymphoedema.

Treatment for lymphoedema

The aim of lymphoedema treatment is to reduce swelling, improve the condition of your skin and improve your overall movement and comfort. You may have a combination of different treatments, under the guidance of a qualified lymphoedema therapist or practitioner.

Complete decongestive therapy (CDT)

Complete decongestive therapy (CDT) is generally considered to be the most effective way to treat moderate or severe lymphoedema. CDT is divided into two parts or ‘phases’:

  • an intensive or ‘decongestive’ phase, aimed at reducing swelling
  • a maintenance or ‘self-management’ phase, where you care for yourself and maintain the improvements

CDT consists of the following treatments.

Skin care

It is important to take care of your skin because you are more likely to develop infections from any skin damage. Caring for your skin can also help to prevent the skin changes (thickening and roughening) that lymphoedema can cause. Your lymphoedema therapist will teach you how to look after your skin.

Manual lymphatic drainage (MLD)

This is a form of specialist, light massage that can help to move lymph around the body. When combined with compression, it may help to reduce swelling in mild-to-moderate lymphoedema. Ask your lymphoedema therapist whether it would be helpful for you.

Multi-layer bandaging

Multi-layer bandaging is very effective at reducing swelling. Your lymphoedema therapist may do it every day over a period of several weeks, depending on the severity of the swelling. Once the swelling has gone down enough, you may move on to wearing a single layer compression garment. You might continue to self-bandage at home, as guided by your lymphoedema therapist.

Exercise

Exercise is a very important part of managing lymphoedema. The normal tensing and flexing of muscles as you move is what helps lymph to move around the body. Exercising will also help you to maintain a healthy weight, which is another important part of managing lymphoedema.

Your lymphoedema therapist will advise you on what is best for you, and give you specific exercises to do daily.

Education

Your lymphoedema therapist will teach you how to manage your symptoms independently in order to prevent the lymphoedema from getting worse. You can find some tips in the ‘Managing your risk of lymphoedema’ section below.

Compression

Compression is very important to reduce and keep down the collection of fluid. The type of compression that you use depends on how advanced your lymphoedema is, and factors specific to you, such as how easily you are able to apply and remove it, and what you find is the most comfortable to wear. You may have the affected area bandaged with multiple layers (this is part of complete decongestive therapy – see above). Or you may wear a specially fitted elastic sleeve or stocking, called a compression garment.

Compression garment

You usually wear your compression garment during the day, putting it on as soon as you get up and removing it at night. But you may have to wear it at night as well, if your lymphoedema specialist has recommended doing this. A compression garment may be a sleeve, stocking, bra, or something else depending on where the swelling is. Your therapist will advise you on how to wear your compression garment, and how to care for the type of garment that you have.

Compression garments need to be fitted by a qualified healthcare professional, or lymphoedema specialist. It’s very important that you are measured accurately and that it fits properly. Once the swelling is under control, the fit should be reassessed every six to 12 months by your lymphoedema therapist.

Pneumatic compression

Your therapist may suggest pneumatic compression. This is a machine that inflates a sleeve or stocking with air, starting at the hand or foot and moving up the arm or leg. It is quite tight but goes up and down in cycles. You wear this for a set time each day and have your compression garment on at all other times during the day.

Surgery

Your doctor or health professional may suggest surgery in order to help with managing your symptoms in the long term. However, there are risks to surgery and it needs to be done together with complete decongestive therapy (CDT – see above). In most cases, surgery doesn’t stop you needing compression garments or to take other steps to look after yourself. Surgery options for lymphoedema can include liposuction.

Managing your risk of lymphoedema

Whether you are at risk of lymphoedema or already have a confirmed diagnosis, there are steps you can take yourself.

Keep in contact with your medical team

Attend check-ups with your doctor or therapist as advised. Between check-ups, you should let them know about any changes in parts of your body that are affected or at risk. This could be, for example, increased swelling or changes to the feel of the body part that’s affected or at risk.

Keep to a healthy body weight and exercise

Keeping your weight at a healthy level is really important for preventing or managing lymphoedema. A key part of doing this is to exercise regularly. If you have questions about what diet or type of exercise would be best for you, speak with your doctor or lymphoedema specialist.

Be aware of cellulitis

When your lymphatic system isn’t working well, it can mean you have a higher risk of developing an infection called cellulitis. Symptoms can include redness, a feeling of warmth, pain or flu-like symptoms. If you already have lymphoedema, cellulitis can make it worse. If you don’t, but are at risk of lymphoedema, cellulitis may cause it. Keep the signs in mind and call 111 or see a doctor as soon as possible if you think you may have the infection.

Look after your skin and the area affected

You should aim to avoid putting extra strain on your lymphatic system. That means taking steps to avoid infection by keeping your skin clean and well moisturised, and avoiding damaging it.

  • Take care cutting your nails and don’t cut your cuticles. Consider having your nails cut professionally.
  • Wear insect repellent to avoid insect bites.
  • Wear gloves when gardening and doing housework or DIY.
  • Wear sun protection so you don’t get sunburnt.
  • If you do get a cut or graze, clean and dry it well and apply antiseptic ointment.

There are other steps that you can take to care for your lymphatic system.
  • Avoid constraining or squeezing the affected body part too much. For example, don’t wear jewellery or clothing that is too tight, as this blocks the flow of lymph.
  • Try not to sit or stand for a long time without moving or changing position.
  • Avoid prolonged periods in extreme cold or heat (for example, hot tubs or saunas).
  • Avoid injections, blood pressure or blood tests taken on an at-risk arm if it’s possible to do so.
  • If you’re due to have surgery, let your surgeon know you have lymphoedema or are at risk.

Living with lymphoedema

It is very normal to feel upset and sometimes angry about having lymphoedema. If your lymphoedema is a result of past cancer treatment, it may also be a reminder of a difficult time in your life.

Talking to other people with experience of coping with lymphoedema may help. You can swap ideas on ways of coping and they are more likely to understand if it makes you feel down at times.

Ask your therapist or see our 'Other helpful websites' section below for more information about support groups for lymphoedema.


About our health information

At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. That’s why our content is produced to the highest quality standards. Look out for the quality marks on our pages below. You can find out more about these organisations and their standards on The Information Standard and HON Code websites.

Information standard logo  This website is certified by Health On the Net Foundation. Click to verify.

Learn more about our editorial team and principles >

Related information

  • Sources

    • Lymphatic system. Encyclopaedia Britannica. www.britannica.com, revised November 2017
    • Lymphedema. Medscape. emedicine.medscape.com, last updated June 2018
    • Lymphoedema. BMJ Best Practice. bestpractice.bmj.com, last updated April 2018
    • The diagnosis and treatment of peripheral lymphoedema. International Society of Lymphology. Lymphol 2016; 49:170–84
    • Reducing the risk of upper limb lymphoedema. Royal College of Nursing. www.lymphoedema.org, published September 2011
    • Lymphedema Clinical Presentation. Medscape. emedicine.medscape.com, last updated June 2018
    • L-Dex U400 for lymphoedema after breast cancer treatment. National Institute of Health and Clinical Excellence. www.nice.org.uk, last updated July 2017
    • Early and locally advanced breast cancer: diagnosis and management. National Institute for Health and Clinical Excellence. www.nice.org.uk, published July 2018
    • Standards of practice for lymphoedema services. British Lymphology Society. thebls.com, last updated July 2016
    • Lymphedema Treatment & Management. Medscape. emedicine.medscape.com, last updated June 2018
    • Best practice for the management of lymphoedema. International Consensus. The Lymphoedema Framework. www.woundsinternational.com, published 2006
    • Comerota AJ, Aziz F. The case for intermittent pneumatic compression. J Lymphoedema 2009; 4(2):57–64
    • Your questions answered. Lymphoedema Support Network. www.lymphoedema.org, last updated April 2017
    • Manheimer E, McNeely M, Howell DM, et al. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database of Systematic Reviews, 2015, 5. Art. No.: CD003475. DOI: 10.1002/14651858.CD003475.pub2
    • Skin. Oxford Handbook of Geriatric Medicine. 3rd ed. Oxford Medicine Online. oxfordmedicine.com, published February 2018
    • Bracha J, Tamar J. Using exercise classes to reduce arm lymphoedema. J Lymphoedema 2010; 5(1):46–57
    • Lowering your risk of lymphoedema. Cancer Research UK. www.cancerresearchuk.org, last updated June 2017
    • Skin care for lymphoedema. Macmillan Cancer Support. www.macmillan.org.uk, last updated July 2016
    • Information for patients at risk of lymphoedema undergoing anaesthesia and surgery. Royal College of Anaesthetists. www.rcoa.ac.uk, published 2018
    • Lymphoedema. Breast Cancer Care. www.breastcancercare.org.uk, last updated July 2016
    • National Lymphedema Network. Position Statement of the National Lymphedema Network: Lyphedema Risk Reduction Practices, last revised May 2012
    • Lymphoedema Framework. Best practice for the management of lymphoedema: international consensus, published 2006
  • Reviewed by Graham Pembrey, Lead Editor, Bupa UK Health Content Team, December 2018.
    Expert reviewer Natalie Kruger, Physiotherapist
    Next review due December 2021



Has our health information helped you?

We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short survey will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.

ajax-loader