The recommended treatment for lymphoedema is decongestive lymphatic therapy (DLT).
DLT isn't a cure for lymphoedema, but it can help control the symptoms. Although it takes time and effort, the treatment can be used to bring lymphoedema under control.
Decongestive lymphatic therapy (DLT)
There are four components to DLT:
- compression bandages – to complement exercise by moving fluid out of the affected limb and minimise further build-up
- skin care – to keep the skin in good condition and reduce the chances of infection
- exercises – to use muscles in the affected limb to improve lymph drainage
- specialised massage techniques – known as manual lymphatic drainage (MLD); this stimulates the flow of fluid in the lymphatic system and reduces swelling
Each of these components is described in more detail below.
DLT is an intensive phase of therapy, during which you may receive daily treatment for several weeks to help reduce the volume of the affected body part.
This is followed by a second phase called the maintenance phase. You'll be encouraged to take over your care using simple self-massage techniques, wearing compression garments, and continuing to exercise.
This treatment phase aims to maintain the reduced size of the affected body part.
You'll have reviews every few months to check how your treatment is progressing.
Compression bandages and garments
Unlike blood circulation, the lymphatic system has no central pump, such as the heart, to move fluid to the lymph glands.
Instead, it uses the massaging effect of surrounding muscles to move the fluid. This is why exercise is important.
Compression bandages or garments, such as sleeves, gloves, stockings or tights, fitted over affected limbs act as a counterforce to muscles.
This stimulates more effective lymph drainage. The combination of exercise and compression encourages the fluid to move out of the affected limb.
Compression garments may also be applied after a massage session to prevent fluid accumulating in the limb again.
Velcro wraps may be used instead of bandages or compression garments. These are easier to apply yourself.
You'll be taught how to correctly apply compression garments or Velcro wraps so you can continue using them during the maintenance period.
It's important to take good care of your skin to reduce your risk of developing an infection, such as cellulitis.
See preventing lymphoedema for more skin care advice.
Movement and exercises
Your lymphoedema care team will help devise an exercise and movement plan designed to strengthen and stimulate the muscles involved in lymph drainage.
They'll also help you lose weight if you're overweight. Your exercise plan will be tailored to your requirements and ability.
Your plan may involve specific limb exercises, as well as gentle activities that involve the whole body, such as swimming, cycling and walking.
To begin with, you may receive specialised massages called manual lymphatic drainage (MLD) – usually carried out by a specialist therapist – to move fluid from the swollen areas into working lymph nodes, where it can be drained.
Your lymphoedema therapist will also teach you a range of simpler massage techniques that you or your carer can use during the maintenance phase of treatment to help keep the swelling down. These self-massage techniques are known as simple lymphatic drainage (SLD).
In a small number of cases, surgery may be used to treat lymphoedema. There are three main types of surgery that may be useful for the condition:
- removal of sections of excess skin and underlying tissue (debulking)
- removal of fat from the affected limb (liposuction)
- restoration of the flow of fluid around the affected section of the lymphatic system – for example, by connecting the lymphatic system to nearby blood vessels (lymphaticovenular anastomosis)
These treatments may help reduce the size of areas of the body affected by lymphoedema, but some are still being evaluated – particularly lymphaticovenular anastomosis – and aren't in widespread use.
The accumulation of fat is a significant feature of lymphoedema swelling. Liposuction is where a thin tube is inserted through small cuts (incisions) in the skin to suck fat out of tissue.
It can be used to remove excess fat from an affected limb to help reduce its size.
After surgery, you'll have to wear a compression garment on the affected limb day and night for at least a year to help keep the swelling down.
The National Institute for Health and Care Excellence (NICE) states liposuction for long-term (chronic) lymphoedema appears to be safe, and may be effective in the short term.
However, there isn't enough evidence of its long-term effectiveness and safety.
Access to liposuction for lymphoedema may be limited, depending on what's available from your local clinical commissioning group (CCG).