How is lymphedema treated?
With early diagnosis, treatment and learning to take charge of your health, you can control lymphedema and lower your risk of it getting worse. In fact, with the help of a therapist, swelling can be halted and may even be reversed.
The best treatment is decongestive lymphatic therapy from a certified lymphedema therapist. It includes:
- Compression therapy to reduce and contain swelling
- Lymphatic drainage (a special type of gentle massage) to improve lymph flow, direct fluid to other drainage pathways, and unblock or soften hard tissue
- Skin care education to avoid infection
- Exercises to promote lymphatic function and flow
Your treatment plan will depend on your stage of lymphedema, degree of swelling and phase of treatment.
Intensive phase: the goal is to reduce swelling with compression bandaging, lymphatic drainage, good skin care and exercise. The lymphedema therapist is very involved during this phase.
Maintenance phase: the goal is to keep your condition stable with a compression garment and ongoing skin care, regular exercise and self-massage for lymphatic drainage. During this phase you will take charge of your care and will learn which options work best for you.
It takes a team to manage lymphedema: you, a certified lymphedema therapist, medical doctors, nurses, exercise trainers, social workers and people who care for you. Together, the team will develop a treatment plan that adapts when needed and helps you enjoy life.
Compression therapy uses special bandages and garments to reduce and control swelling. The type of compression therapy you need depends on whether the swelling is mild, moderate or severe.
- Mild swelling may be controlled with a compression garment only
- Stable swelling may require bandaging (often only at night) to maintain reduction and daily wear of a compression garment
- Moderate to severe swelling requires intensive treatment (2-5 times per week) with compression bandaging to reduce the swelling, to the point where you can wear a compression garment
There are two approaches to compression bandaging, to help reduce swelling:
- One approach is to apply bandages daily; they can be washed, hung to dry and reused
- The other is a two-layer cohesive bandage that is applied once or twice a week; it can be left on for several days but cannot be reused
Different types of garment are used to keep swelling under control:
- Compression sleeves, stockings or gauntlets with varying compression levels are made for lymphedema in different parts of the body
- Different garments for day and night wear
- Range of colours and styles, in circular or flat knit
- Ready-made and custom-made garments are available from pharmacies and stores that specialize in compression wear
- Garments must be replaced regularly for proper fit and compression level
- Garments are prescribed by a medical doctor, based on advice from your certified lymphedema therapist
- Whether you need ready-made or custom-made garments, go to a qualified garment fitter for proper measurement and fitting
Lymphatic Drainage is a special type of gentle massage that promotes lymph flow, aids relaxation, reduces pain and helps improve mobility. It is a technique that requires special training and can only be given by a certified lymphedema therapist. With this technique, the therapist’s hands make gentle movements on your skin in a certain direction. This movement helps lymph fluid move from just below the surface of your skin to bigger lymphatic vessels deep in your body. During the intensive phase of treatment, your lymphedema therapist may perform lymphatic drainage prior to applying compression bandages.
Your therapist may also treat you with other manual techniques to soften hardened (fibrotic) tissue. These techniques can help to treat tissue damaged by radiation or hardened by tissue swelling.
Measures to monitor lymphedema
Your lymphedema therapist will measure the affected limb/area to calculate its volume. There is no standard method, but measurements are taken in the same place(s) each time to show if swelling has increased, been stable or reduced. Your therapist may teach you and/or family members how to take your own measurements to monitor your condition.
As part of your treatment plan, your lymphedema therapist will also provide you with lymphatic drainage massage and other manual therapies and educate you about the importance of taking charge yourself to manage your lymphedema.
Other Treatment Options
Some hospitals and private clinics may use a pneumatic compression pump to treat lymphedema of the arm or leg. The affected limb is put into an inflatable sleeve with many sections and remains in the device for one to two hours. The pump compresses each section in turn, usually moving from the hand or foot to the trunk of the body. Trained staff set the correct level of pressure to reduce swelling and monitor the device. Compression bandaging or a garment must also be used after the pump to help control the swelling.
Low-level laser therapyis used by some therapists as part of the treatment plan for lymphedema, especially when there’s a significant amount of thick, hard scar tissue under the skin (known as fibrosis). However, more evidence from research studies is needed to make definite recommendations about the best use of laser therapy.
Some lymphedema therapists may use Kinesio taping applications in combination with compression bandaging to try and accelerate edema reduction time. Its effectiveness hasn’t been widely studied and patients are cautioned to seek trained therapists who have been taught the proper techniques and can help determine whether Kinesio taping is right for them.
Lymphedema surgery is not standard treatment yet and is not readily available in Canada. It is used to treat severe swelling that has not responded to lymphatic drainage or compression therapy. After surgery, the treatment plan must include decongestive lymphatic therapy. The person will also need to wear compression bandaging or garments at all times, for the rest of their life.
There is no medication to treat or cure lymphedema at this time and research on natural supplements is limited. If you’re considering a new supplement, check with a health professional first for advice.
Lymphedema is not the same as water retention. It is treated differently and diuretics are not recommended. However, if you take diuretics for another condition (e.g. high blood pressure or heart disease), keep taking them and speak to a health professional about your options.
Hope for the future
Research is helping us better understand lymphedema. Advances in diagnostic imaging, surgical techniques, possible drugs, and our ability to predict lymphedema, give us hope that how we detect, treat and manage it in the future will improve greatly.