Lymphedema

An edema is a visual and palpable accumulation of fluid in the tissue. Edemas may occur anywhere on the body. According to their composition we distinguish between two types of edema:

Low-protein edema

These are by far the most common edemas, however, not considered a disease (no diagnosis!), but symptoms of an underlying disease. Triggers for a low-protein edema could either be organic weaknesses (heart, liver, kidney, etc.) or allergies, drugs, inflammations, metabolic diseases, malnutrition (famine edema), vascular diseases or various other causes.

Low-protein edemas can be flushed out with diuretics (“water pills”). The actual treatment of low-protein edemas, however, means treating the underlying disease that has caused the edema.

 

Protein-rich edema = Lymphedema

The lymphedema is not the symptom of a disease, but rather a diagnosis and therefore a "real" disease. A lymphedema is caused by the "mechanical insufficiency" of lymphatic vessels, a condition where the lymphatic system is not (or no longer) able to remove the “lymph-obligatory load“ from the tissue (liquid, protein, metabolites, cell components, etc.) and return it to the blood circulatory system. A lymphedema may occur on limbs, on the head and neck area, on the body or on the genitals.

A lymphedema is a chronic disease which worsens over the years ("progression"), if not treated properly. Only recently lymphedema can be cured in certain cases by transplanting autologous lymphatic vessels ("autologous transplantation"), however, a lymphedema usually requires a lifelong treatment. Only this way its progression can be slowed down or stopped. With the appropriate treatment the edema can be lead to a better condition, ideally even to stage 0 (see below). At this stage the limited transporting capacity of the lymphatic system can be diagnosed, however, without any clinical findings.

Should the treatment, however, be discontinued, the edema will inevitably increase which may lead to repeated ("recurrent") infections, such as the dreaded erysipelas. Those additionally damage the lymphatic vessels and lead to a vicious circle of exacerbation of the edema-erysipelas-exacerbation of the edema-erysipelas... followed by numerous secondary diseases which may affect the physical functionality up to a total disability.

The primary lymphedema develops when the mechanical insufficiency of the lymphatic system is caused by a congenital ("primary") abnormality of the lymphatic vessels or lymph nodes. About one third of all lymphedemas in our latitudes are primary edemas. Very rarely they already manifest from birth. Most frequently they occur at a growth spurt, during puberty, pregnancy, or due to other triggering factors (inflammation, injuries, etc.).

We are talking about a secondary lymphedema, if the mechanical insufficiency of the lymphatic system is caused by an "acquired" damage, or by the loss of lymphatic vessels or lymph nodes. In our latitudes the main causes are mostly surgeries and irradiations in the scope of a cancer therapy, injuries of all kind or inflammations, however, also a high-grade obesity (adiposis) or constriction by self-mutilation (due to the desire of retiring or mental disorder) or tumors (also benign!) could be responsible for the occurrence. Widespread in the tropics is the so-called lymphatic filiariasis; transmitted by insects that cause nematodes which lead to a damage of the lymphatic system and result in gigantic lymphedemas ("elephantiasis"). More than 120 million (!) people worldwide are affected by this form of the disease.

The malignant (malign) lymphedema is the most severe form of a lymphedema. When talking about malignant lymphedemas we must distinguish between those which have been caused by metastases in the lymph nodes, and those which were originally benign lymphedemas, subsequently became malicious and significantly worsened due to metastasis.

Important note: For each lymphedema that has not already been manifest since birth, thus only occurs later, the diagnosis "benign" can only be confirmed by excluding a malicious form.


Depending on the level of severity the edema is divided into four stages:


Lymphedema stage 0
There is a primary or secondary defect on the lymph vessels and/or nodes, however, not yet an edema. Although their transporting capacity is limited they can still completely drain the lymph-obligatory load and therewith prevent the development of an edema.

Lymphedema stage 1
The edema usually emerges in the afternoon or evening and disappears, once the effected limb is elevated or when the patient lies down. The edema has a soft consistency and can easily be indented.

Lymphedema stage 2
Neither elevation nor rest make the lymphedema disappear. It already shows indurations (fibroisis); therefore the skin is firm, dense and can hardly be indented.

Lymphedema stage 3
Besides the massive swelling there are significant skin alterations, such as papillomatosis, cysts, fistulae, lymphoceles and indurations which may reach gigantic proportions ("elephantiasis").


Zur Behandlung des Lymphödems is the Complete Decongestive Physiotherapy (CPT) which can be complemented by expanded measures, if necessary. Lympho-Opt focusses on the treatment of the following lymphedemas:

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Infos (pdf)
Primary lymphedema Stage 1

Primary lymphedema
Stage I

Primary lymphedema Stage 3

Primary lymphedema
Stage III

Secondary lymphedema Stage 1

Secondary lymphedema
Stage I

Secondary lymphedema Stage 3

Secondary lymphedema
Stage III

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