Lymphedema Explained: Symptoms, Causes, and Treatment Options
What is Lymphedema
Understanding the Lymphatic System and Fluid Retention
The lymphatic system plays a crucial role in maintaining fluid balance, immune function, and circulation. When lymphatic vessels are damaged or blocked, fluid accumulates in the tissues, leading to swelling, discomfort, and skin changes.
Types of Lymphedema: Primary vs. Secondary
Primary Lymphedema – Inherited condition where the lymphatic system does not develop properly, leading to fluid retention.
Secondary Lymphedema – More common and occurs when lymphatic drainage is disrupted due to surgery, cancer treatment, infection, or trauma.
Difference between edema and lymphedema
Cause: Lymphedema occurs due to a malfunctioning or damaged lymphatic system, leading to protein-rich fluid buildup, whereas edema results from fluid leakage from blood vessels, often caused by underlying medical conditions or external factors.
Fluid Composition: Lymphedema fluid contains high protein levels, which can increase the risk of infections, while edema fluid is typically low in protein.
Location and Symmetry: Lymphedema commonly affects one limb or specific areas asymmetrically, whereas edema is often symmetrical, appearing in both limbs or throughout the body. However both conditions can effect both limbs or present in one limb only.
Causes and Risk Factors of Lymphedema
The impact of lymphatic damage on welling
Lymph fluid usually circulates through lymphatic vessels and drains into the bloodstream, but when lymph nodes or vessels are damaged, this process is disrupted, causing fluid accumulation and chronic swelling.
Causes of lymphedema
Primary lymphedema
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Congenital Lymphedema (Milroy’s Disease), Present at birth or develops within the first year of life.
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Lymphedema Praecox (Meige’s Disease), Develops during puberty or before the age of 35.
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Lymphedema Tarda, Develops after the age of 35.
Secondary Lymphedema
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Surgery - Lymph node removal (e.g., during cancer surgery such as breast cancer, melanoma, or gynaecological cancer procedures).​
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Cancer and Tumour - Tumours can press on lymphatic vessels, blocking normal drainage. Lymphoma (cancer of the lymphatic system) can directly affect lymph nodes and vessels.
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Radiation Therapy - Radiation treatment for cancer can scar and damage lymphatic vessels, reducing their ability to drain fluid.
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Chronic Venous Insufficiency and varicose veins - Long-term venous hypertension can overwhelm the lymphatic system, leading to phlebolymphedema. Varicose veins and deep vein thrombosis (DVT) can contribute to poor lymphatic function.
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Infections and Inflammatory Conditions - Cellulitis or repeated skin infections can cause lymphatic scarring and dysfunction. Filariasis (parasitic infection), common in tropical regions, can lead to severe lymphedema (elephantiasis).
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Trauma and Injury - Severe burns, fractures, or soft tissue injuries can damage lymphatic vessels. Chronic pressure or compression on lymphatic structures (e.g., from tight clothing, prolonged immobility).
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Obesity - Excess fat tissue can place pressure on lymphatic vessels, impairing normal drainage. Obesity-related chronic inflammation may contribute to lymphatic dysfunction.
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Cardiovascular and Systemic Conditions - Heart failure, kidney disease, or liver disease may contribute to fluid retention and secondary lymphedema. Autoimmune diseases (e.g., rheumatoid arthritis, lupus) can cause lymphatic dysfunction.
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Post-Surgical or Radiation-Induced Scarring - Scarring from previous surgeries or chronic inflammation can block lymphatic drainage pathways.​
Signs Symptoms of Lymphedema
Common signs and symptoms of lymphedema
Swelling – Gradual or sudden swelling in the arms, legs, hands, feet, or other affected areas, often worsening throughout the day.
Heaviness and Tightness – A feeling of fullness, tightness, or heaviness in the swollen limb, making movement uncomfortable.
Reduced Range of Motion – Stiffness or difficulty moving the affected limb, hand, or foot due to swelling and skin thickening.
Skin Changes – Thickened, tight, or hardened skin (fibrosis). Discolouration or a shiny appearance. Skin may take on an "orange peel" texture in later stages.
Pain or Discomfort – Mild aching, tingling, or numbness in the swollen area. Burning sensations or muscle cramps in some cases.
Increased Risk of Infections – Frequent skin infections (cellulitis) due to fluid buildup and poor circulation. Skin may feel warm, red, or tender, indicating inflammation or infection.
Skin Ulcers (Advanced Stages) – Poor wound healing due to persistent swelling and lymphatic dysfunction. Increased risk of developing chronic venous or lymphatic ulcers.
When to seek medical attention
If you notice persistent swelling, changes in skin texture, pain, or signs of infection, it is important to seek medical attention. Early diagnosis and treatment can help prevent complications and improve long-term management.
Diagnosis of Lymphedema
Clinical Examination and Medical History
A thorough physical examination and review of medical history help determine the extent of swelling, skin changes, and risk factors for lymphedema.
Imaging Tests to Assess Lymphatic Function
Doppler Ultrasound – To rule out venous insufficiency or blood clots.
Lymphoscintigraphy – A specialised imaging technique that tracks lymphatic flow.
MRI or CT Scans – May be used in cases where obstructions or abnormal lymphatic structures need further evaluation.
Lymphedema treatment
Compression Therapy and Manual Lymphatic Drainage (MLD)
Compression garments or bandages help improve lymph flow and prevent swelling from worsening. Manual lymphatic drainage (MLD) is a specialised massage technique that encourages the movement of lymph fluid.
Exercise and Lifestyle Adjustments
Gentle movement, stretching, and low-impact activities (e.g., swimming, yoga, walking) help improve circulation. Weight management and a balanced diet reduce pressure on the lymphatic system and promote overall vascular health.
Surgical Interventions
surgical treatments include liposuction for lymphedema, which removes excess fibrotic tissue and lymphatic bypass or lymph node transfer, which aims to restore lymphatic drainage and function.
Living with lymphedema
Skin care and infection prevention
Keep the skin moisturised to prevent cracks and infections. Avoid cuts, burns, or insect bites, as lymphedema increases the risk of skin infections like cellulitis.
Habits to Reduce Swelling
Wear compression garments as prescribed to support lymphatic function. Elevate the affected limb to reduce swelling and discomfort. Stay hydrated and maintain a healthy diet to promote circulation
Advanced Lymphedema Management for Improved Quality of Life in Dubai
Lymphedema requires a comprehensive approach to prevent progression and improve quality of life. With early diagnosis and personalised treatment, symptoms such as swelling, discomfort, and restricted movement can be effectively managed. If you are experiencing persistent limb swelling, seeking expert care in Dr Soroush Sohrabi's clinics can provide long-term relief and improve daily comfort.