Unexplained swelling can often be concerning, as it causes pain, heaviness and can limit your function.
There are several conditions which can cause this unexplained swelling, and they can be treated very effectively with some specialist physiotherapy services now available at Alpha Physiotherapy.
Causes Of Swelling
There are several processes which can cause lymphoedema. These can be classified in to primary lymphoedema and secondary lymphoedema.
Primary lymphoedema means a lymphoedema of unknown cause. It most commonly occurs in the legs, and symptoms can begin at an early age. There are several genetic/familial/hormonal disorders which can also result in lymphoedema, some are included below.
- Milroy’s Disease: Lymphoedema that is present from birth usually involving both legs.
- Conatal Lymphoedema: Present from birth, the child has few or no lymphatic vessels present.
- Lymphoedema Praecox: Lymphoedema that starts in adolescence.
Secondary lymphoedema is one that is caused by a known condition. The most common is after having lymph nodes removed due to cancer, however any surgery can potentially cause lymphoedema. A surgical incision will not only damage body tissue, muscles, and nerves but also lymphatic vessels.
The lymphatic system helps to move fluid around the body. If there is excess protein in the tissue causing swelling, as well as impairment of the lymphatic system, a backlog of fluid will build up in the limb resulting in swelling, pain, heaviness, and loss of function.
The most common causes of secondary lymphoedema are:
- post mastectomy (removal of breast tissue due to cancer) lymphoedema of the arm
- leg lymphoedema caused from removal of pelvic lymph nodes
- radiotherapy for treatment of cancer (lymphoedeam can be in arms, legs, or abdomen)
Symptoms include swelling that begins at the ankle or wrist (foot and hand are normal) and extends up the whole arm or leg. Both sides are affected. Abnormally large legs/bottom or arms in comparison to the rest of the body can also be an indication.
Treatment is similar to that of lymphoedema, however usually a modification of diet is required as well as a supplement to prevent the leakage of fats and proteins from the blood vessels.
Usually the lymphatic system within the body can deal with the increased fluid in the injured body part and over days or weeks, removes the excess fluid and filters it back into the blood stream.
However, sometimes things do not run smoothly. If the lymphatic system is in any way sluggish (due to being unwell or fatigued), or there is a blockage in any lymph nodes (which can happen without a specific cause), then the amount of fluid the lymphatic system can transport will be less than the load of the swelling.
The swelling will therefore persist longer than expected. This can lead to chronic inflammation and fibrosis of the tissue, which can further impair the lymphatic system. This results in a long term swelling of the body part, which may become painful, heavy. and may not function as it used to.
Treatment is similar to that of lymphoedema, however supplements may be required to strengthen damaged blood vessels to prevent leaking of protein into the tissue.
As the body ages the skin becomes more compliant and weaker. This allows more fluid to enter the weak tissue. Fluid in the feet has to fight against gravity to rejoin the blood supply and as the muscles are also weaker in the elderly, there is less force helping the fluid to circulate through the lymphatic system – thus fluid pools in the feet and ankles.
This swelling usually gets worse during the afternoon, but goes down over night. Eventually though, it will turn to chronic inflammation causing fibrosis of the tissue. It may also result in a number of podiatric problems and infections of the feet and toes/toe nails.
This condition is easily managed, in a similar way to that of lymphoedema, however simple measures, such as elevation and exercise can be very effective also.
Treatments For Swelling
Treatment is comprised of a 3 part process:
- Manual lymphatic drainage (lymphoedema massage)
- Prescription of a compression garment
Optimal treatment is intensive and over a 2 week period (5 sessions over 2 weeks). Most people will lose between 1-5 litres of fluid from their arm/leg in this period. After the 2 week period, wearing of a compression garment will prevent the fluid from returning and maintain these results over a long period of time. Most patients can then self-manage their condition, however some maintenance treatment every 3-6 months may be required.
Bandaging can be cumbersome, but it is a necessary step towards recovery from lipoedema or lymphoedema. Treatment is a lot less successful if bandaging is not included in the treatment procedure.
Compression garments are commonly ill fitting and this will often make swelling worse. They should be comfortable, not tight. They should not dig in or cut off circulation. Compression garments need to be prescribed by an experienced practioner, otherwise an ill fitting garment will not be effective, and is not likely to be worn, contributing to the condition.
If you have any further questions regarding a swelling problem or any other condition, please feel free to contact Alpha Physiotherapy and book an appointment on (07) 3279 3871.