LYMPHOEDEMA TREATMENT

Early diagnosis and conservative treatment is the key to controlling lymphoedema as well as possible. The prescribing of water tablets for lymphoedema is not beneficial and should be a thing of the past. A patient presenting with long-term swelling, no matter how minimal, should be referred by the GP to a clinic. An initial assessment may include various tests following which it may be decided, particularly if moderate to severe lymphoedema is diagnosed, for the patient to undergo two to three weeks of intensive daily treatment comprising of the following main elements:

1. Manual lymphatic drainage (MLD)
2. Skin care
3. Bandaging
4. Exercise

1. Manual Lymphatic Drainage (MLD)
This is a specialised light massage. The aim of MLD is to stimulate the lymph system to work more efficiently thereby removing excess protein waste and fluids from the skin tissues. This encourages drainage away from the swollen area. Areas of skin tissue which have become hard and thickened – fibrosis - can be softened and reduced over time.

2. Skin care
The skin of the swollen area is checked for any redness or cuts which could be an indication of infection. The skin is then cleansed and moisturised. Bland emollients should always be used such as soap substitutes, e.g. aqueous cream and moisturisers preferably in the form of ointment.

3. Compression Bandaging or Multi-Layer Bandaging
Compression bandaging is the use of short-stretch bandages to contain the swollen limb and encourage lymph and venous flow thereby reducing swelling. During intensive treatment these bandages are re-applied daily with under-padding which helps to re-shape the limb.
Towards the end of the intensive treatment, the limb will be measured for a compression garment. Once fitted, the compression garment must be worn on a daily basis to maintain the reduction in swelling.

4. Exercise
With lymphoedema it is always important to take regular exercise. The patient may have some physiotherapy and will be given exercises to carry out daily. Depending on the facilities available there may be some gym work.

Maintenance Programme
To maintain the reduction in swelling and encourage further reduction, the patient needs to comply with a maintenance programme following the intensive treatment. A daily self-care regime is for all patients including those with mild symptoms who have been prescribed compression garments without initial intensive treatment.

1. Skin care
2. Simple lymphatic drainage (SLD)
3. Wearing compression garments
4. Exercise and walking

1. Skin care
Daily moisturising of the affected area is essential.

2. Simple Lymphatic Drainage (SLD)
Many patients are now taught SLD. This is a modified form of MLD which can be done daily by the patient. Periodic MLD by a therapist, however, is still beneficial.

3. Wearing Compression Garments
The patient will be given at least double the required number of garments to cover wearing and washing. The effective lifespan of such garments can vary and should be checked and replaced between four and six months.

4. Exercise and Walking
This is essential but always done whilst wearing compression garments. The patient will have been given exercises to do on a daily basis as well. Hydrotherapy and swimming are also very beneficial.

Patient’s compliance
One of the important factors in the management of lymphoedema is the patient’s compliance in life style, healthy eating and adherence to the daily regime to keep swelling under control as best as possible. Body weight can become a problem, particularly if there is impaired mobility, but there should be every endeavour to keep it within normal limits.