The Causes & Treatments For Swelling

Lymphoedema is a disorder which results in swelling. The pathological process causing this condition is excessive protein in the body tissue. Fluid molecules follow the concentration of protein. If there is excess protein in the body tissue, then fluid will leak out of the blood vessels into the tissue, causing it to swell up. This can also lead to chronic inflammation and the development of fibrotic tissue (Casley-Smith, 1987).

There are several processes which can cause lymphoedema. These can be classified in to primary lymphoedema and secondary lymphoedema.

Primary 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

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)

Lipoedema is a condition in which excess amounts of fat are deposited in either the arms or the legs. It usually begins in adolescence or post menopause.

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.

After an acute injury or a surgical procedure, there is damage to body tissue which results in leaking of protein in the interstitial fluid, and a release of inflammatory cells causing swelling and inflammation.

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.

In the younger population, swollen feet and ankles may be due to one of the causes previously discussed – primary lymphoedema or lipoedema. Swollen feet and ankles are a common complaint in the elderly population, however the cause is quite different.

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.

A process known as Complex Physical Therapy (CPT) is very effective to treat lymphoedema and other forms of swelling. It is a specialist area of physiotherapy, which is now available at Alpha Physiotherapy.

Treatment is comprised of a 3 part process:

• Manual lymphatic drainage (lymphoedema massage)
• Bandaging
• 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.

This is a gentle massage technique which helps to unblock lymph nodes, and clear fluid away from swollen areas. Patients can learn to self-massage so that they may manage their condition at home.

Bandaging prevents fluid from flowing back into a limb after it has been cleared with Manual Lymphatic Drainage. The bandaging is applied with a gradient, so that there is high pressure around the foot/hand and a lower pressure around the thigh/arm. Fluid moves from high pressure areas to low pressure areas, so this helps to move the fluid from the foot/hand back up to the lymph nodes in the arm pit or groin.

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 a long term way to manage lipoedema and lymhoedema. They provide a gradient compression to help aid lymphatic flow and prevent fluid from pooling in the problem limb. Compression garments should be full length, to aid return of fluid to the lymph nodes in either the groin or the arm pit. This means for legs, compression garments should not stop at the knee, but go up to the thigh/groin.

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 your system is feeling sluggish and you suffer from fatigue, you may benefit from some manual lymphatic drainage. This helps the lymphatic system return fluid into the blood stream. It also cleanses and filters out the impurities, detoxifying your system. Flushing of the system in this way can help reduce bloating and increase energy levels.