Lymphedema presents itself as swelling of a body part, most often in the extremities but is not excluded from the trunk region, face, abdomen or genital area. Lymphedema occurs as a result of accumulated protein-rich fluid in the superficial tissues; once it becomes evident, treatment becomes a lifelong endeavor for that individual.
There are two classifications of lymphedema: primary and secondary. Primary lymphedema is caused by congenital malformations of the lymphatic system and may be present at birth or develop later in life. Primary lymphedema usually affects the lower extremities more often than the upper extremities. Secondary lymphedema is more common and can be caused by: trauma, post-surgery, radiation therapy for cancer, lymph node removal, infection to the lymphatic system and also venous insufficiency can be culprits for the onset of lymphedema. Opposite of the primary classification, secondary lymphedema is more often found in the upper extremities.
There are three stages to the presentation of lymphedema. The early stage, stage 1, presents as an edematous extremity in which elevation and decongestive exercises may reduce the size of the limb. Stage 2, lymphostatic fibrosis, is more involved and the protein-rich fluid causes a hardening of the affected tissues and increases the volume of the swollen extremity. Otherwise known as elephantiasis, stage 3 will present if no treatment is provided over time to allow the fluid to harden even further.
Treatment unfortunately requires a lifelong commitment to self-awareness and continual education on the individuals behalf. Since there is no cure, the goal of therapy is to reduce swelling to a minimal amount and to educate the patient how to maintain the reduction. For the majority of patients, this is provided through complete decongestive therapy, CDT. With manual lymph drainage, MLD, the patient will experience a gentle manual massage-like treatment to move and re-rout the fluid for removal. Compression therapy is applied after MLD with short-stretch bandages to assist the damaged lymphatic vessels in that the bandages provide the extra push the fluid needs to continue moving out of the affected extremity. Decongestive exercises are then supervised and completed by the patient to aid the movement of the fluid while wearing the bandages to increase the effect. Education regarding skincare and hygiene are reviewed to prevent fungal infections.
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