Lymphedema is the buildup of fluid called lymph in the tissues under your skin when something blocks its normal flow. This causes swelling, most commonly in an arm or leg.
Lymph normally does an important job for your body. It carries foreign material and bacteria away from your skin and body tissues, and it circulates infection-fighting cells that are part of your immune system.
Lymph flows slowly through the network of vessels called your lymphatic system. Lymph flow stops at points along the way to be filtered through lymph nodes. Lymph nodes are small bean-shaped organs that are part of your immune system.
Lymph is formed from the fluid that surrounds cells in the body. It makes its way into very small lymphatic vessels. After traveling through these small vessels, lymph drains into deeper, wider lymph channels that run through the body. Eventually, lymph fluid returns to the blood.
Lymphedema occurs when there is inadequate lymph drainage from the body, usually from a blockage in a lymph channel. Lymphatic fluid builds up underneath the skin and causes swelling. Most commonly lymphedema affects the arms or legs.
Swelling from lymphedema can look similar to the more common edema caused by leakage from tiny blood vessels under the skin.
In most cases of lymphedema, the lymphatic system has been injured so that the flow of lymph is blocked either temporarily or permanently. This is called secondary lymphedema. Common causes include:
When lymphedema occurs without any known injury or infection, it is called primary lymphedema. Doctors diagnose three types of primary lymphedema according to when symptoms first appear:
All three types of primary lymphedema are probably related to the abnormal development of lymph channels before birth. The difference is when in life they first cause swelling of the legs or arms.
Lymphedema causes swelling with a feeling of heaviness, tightness or fullness, usually in an arm or leg. In most cases, only one arm or leg is affected. Swelling in the leg usually begins at the foot, and then moves up if it worsens to include the ankle, calf and knee. Additional symptoms can include:
Lymphedema can make it easier to develop a skin infection. Signs of infection include fever, pain, heat and redness. If lymphedema becomes chronic (long lasting), the skin in the affected area often becomes thickened and hard.
Your doctor will ask you whether you have had any surgery, radiation treatments, or infections in the affected area. The doctor may ask if you have ever had a blood clot. If a child has lymphedema, the doctor will ask if anyone in your family had leg swelling starting at a young age. This may indicate an inherited disorder.
Your doctor will examine the swollen area and press on the affected skin to look for a fingertip indentation (pitting). The skin will be indented in people with the much more common type of edema caused by leaky blood vessels. Pitting does not happen when you press on skin if you have lymphedema.
Your doctor may measure the circumference of the affected arm or leg to determine how swollen it is compared to the other one. The doctor will look for signs of infection, including fever, redness, warmth and tenderness.
Usually, no specific testing is necessary to diagnose lymphedema. But tests may be ordered if the diagnosis is not clear or there is no obvious cause for your condition:
How long lymphedema lasts depends on its cause. If lymphedema develops immediately after surgery, it can clear up within one week as the swelling goes down and the arm or leg is elevated to allow better drainage. If surgery or radiation therapy produced long-term damage to the lymphatic system, lymphedema can become a long-term or recurring problem.
After breast cancer or prostate cancer surgery, your doctor or physical therapist may advise that you do specific exercises once you have fully recovered from the surgery. Using your muscles can encourage the flow of lymph through small channels.
After breast surgery, you are less likely to develop lymphedema if you can avoid having injections, intravenous (IV) lines, or blood drawn in the arm on the side of the surgery. Also, be sure to get prompt treatment if you think you may have a skin infection on the side of your surgery.
Other ways to help decrease the risk of secondary lymphedema include:
The basic treatment for lymphedema includes:
If lymphedema affects your legs, avoid wearing socks with tight bands across the top. Avoid standing for long periods. If you work on your feet or at a desk all day, your doctor may prescribe special compression stockings for you to wear throughout the day. Your doctor may suggest that you follow a protein-rich, low-salt diet and that you lose weight if you are obese.
For people with more severe lymphedema, doctors prescribe inflatable sleeves that can be worn around the arm or leg, called pneumatic compression devices. These sleeves are attached to a machine that alternately fills and deflates them with air, and they can be used at home to help reduce limb swelling. An alternative to air-filled sleeves is to wrap the limb with a non-elastic bandage, and adjust the bandage each time the swelling decreases.
A very helpful treatment is a type of massage therapy called manual lymph drainage. Massage should not be done if you have cancer in the limb. People with lymphedema are more prone to infection in the affected arm or leg. If your doctor suspects you have an infection, you will need to take antibiotics by mouth or into a vein (intravenously).
Make an appointment with your doctor if you develop symptoms of lymphedema in an arm or leg.
You should call your doctor the same day if you have symptoms that could be from an infection:
It isn't always easy to predict whether edema will last. Most of the time, treatments can improve lymphedema symptoms.
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