Lymphedema is a symptom indicating inadequate lymph circulation. The essence of lymph circulation is the drainage of fluid formed between cells and tissues. Lymph is the medium that establishes communication between blood and cells, as most capillaries and most cells are not in direct proximity. This tissue fluid (lymph) ensures the necessary connection for metabolism and cell nutrition. The production of lymph fluid is determined by physical factors, namely, the pressure conditions prevailing in the capillaries and the interstitial space of tissues. The pressure in the arterial part is high enough to direct fluid flow outward, allowing the necessary nutrients for cells to exit the bloodstream). On the venous side, the pressure is lower, so the fluid containing metabolic products released by cells flows in the opposite direction, inward, back into the bloodstream. However, venous capillaries are only able to transport a portion of this fluid, so the rest is drained by the lymphatic vessels. Under normal circumstances, lymph formation and lymphatic drainage are balanced.
In addition to the lymphatic vessels, lymph nodes also play an important role in this process. Lymph nodes are round or elongated organs located along the course of the lymphatic vessels. They produce lymphocytes (lymphocytes), which contribute to the body’s immune defense. There are about 600-700 of them scattered throughout the body. They are found in larger numbers in various body creases (armpits, groin, knees), as well as in the neck and intestines. They are generally 2-3 mm in diameter, but under pathological conditions, they can significantly increase in size, becoming palpable by hand, for example, in the neck due to tonsillitis.
Lymph nodes are important “filter stations”; within them, lymph flows more slowly, allowing lymphocytes produced in the lymph nodes to accumulate, which engulf foreign bodies entering them, such as bacteria, dust particles, etc. Thus, lymph nodes are important barriers to potential infections; however, in certain cases, they can also be sources of infection or dissemination, in cases of various inflammations and tumors, when surgical removal may be necessary.
Lymphedema means the accumulation of fluid, typically high in protein content, in the interstitial space between cells, which should be drained from the tissues by the lymphatic vessels. This tissue fluid should return to the venous circulation, but due to insufficient lymphatic circulation, pathological circulatory conditions develop, and one of the spectacular symptoms of this is limb swelling, also known as edema.
Primary lymphedema develops when the components of the lymphatic system are congenitally unsuitable for draining fluid from the tissues. Symptoms of this can occur at birth or a few months after birth, and it is characteristic of young adulthood, typically appearing after puberty, or in late adulthood, after the age of 35. In this case, the inadequately developed but highly adaptable lymphatic system can fulfill its function for a certain period, but due to increased demands, such as pregnancy or obesity, its capacity becomes exhausted, and it cannot drain lymphatic fluid. The symptoms always begin in the more distant parts of the limbs, typically starting on the feet. Primary lymphedema affects 70-90% of women.
The cause of secondary lymphedema can be diverse; damage to the lymphatic vessels and/or lymph nodes (e.g., accidents, surgical interventions) results in the inability of the lymphatic system to perform its function. In cases of cancerous diseases, the tumor forms metastases or occupies the lymph nodes, thus slowing down or halting the transmission of lymphatic fluid through the lymph nodes, resulting in edema formation in the area from which the lymphatic vessels would transport fluid to those lymph nodes. Various surgical interventions that can damage lymph nodes or lymphatic vessels can also lead to edema; typically, after varicose vein surgeries, symptoms of lymphedema often accompany chronic venous insufficiency.
Initially, it is difficult to detect lymphedema, and it can take months or even years for the symptoms to become clinically evident. It is sometimes considered a consequence of obesity, something one must “live with.” Indeed, lymphedema can be associated with obesity problems, as increased adipose tissue also imposes a greater burden on lymphatic circulation, and if edematous symptoms occur in such cases, it is an important signal from the body that the increased weight has strained circulation, and the problem needs to be addressed. It is common for forced diuresis with high-dose diuretics to be recommended in such cases; however, if these remain ineffective or if edematous conditions worsen, it is advisable to seek specialized medical care, such as a hospital specializing in lymphedema.
In the early stages, the “variability” of edema is a very characteristic symptom. At this stage, edema develops under load, in warm weather, usually in the evening, with swelling of the ankles, feet, and calves. At this stage, the edema retains the imprint under pressure, and more prolonged indentation can be seen along the socks, stockings, trousers, or bra line. At this stage, swelling still subsides after rest, after night sleep. This spontaneous regression, followed by recurrence, in the absence of any other disease causing edema, is a warning sign of lymphedema, from which further stages develop, when the lymphatic system is unable to perform its function well even at rest, and the edema does not disappear after rest.
In the later stages, edema no longer retains the imprint. By this time, in the absence of treatment, fluid cannot be removed mechanically due to various reasons, so chronic inflammation develops in this area, fibrous tissue and blood vessel proliferation occur, and the hand or foot swells like a stump. It is more difficult to fold the skin on them than on an edema-free area. Another characteristic symptom is that the fingers become sausage-like thickened. At sites of constant movement (toes and fingers, ankles, wrists), movements push out the fluid, and deep wrinkles form, reminiscent of wrinkles seen on the limbs of infants. Untreated lymphedema, due to stagnant, inflamed lymphatic fluid, can lead to serious bacterial infections, which in the most severe cases can even open up to the skin surface, such as erysipelas. Neglected lymphedema can progress to the so-called elephantiasis stage, so named because the leg swells and distorts to the extent that it resembles an elephant’s leg.
According to the WHO, chronic lymphedema is a condition that leads to permanent health damage if left untreated. Therefore, it is very important to recognize the symptoms and seek medical help in time!
If chronic lymphedema is diagnosed in someone, a so-called complex decongestive therapy is applied in treatment, which is a combination of physiotherapeutic procedures, dermatological and compression treatments (performed with elastic bandages) carried out by trained therapists. Compression stockings and bandages are essential elements of lymphedema treatment. Their daily use is essential for maintaining chronic edema. The use of these should be taught by specialists from lymphedema clinics tailored to the specific problem,
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