The accumulation of fluid in the tissues is called lymphedema, and it is a chronic disease that reduces the quality of life and can lead to permanent structural deterioration on the body if not treated.

What is lymphedema?

Lymphedema occurs as a result of deterioration in the lymphatic system, which is one of the important building blocks of the body's defense system, due to the accumulation of excess fluid in the tissues and the inability of this accumulated fluid to be properly drained by the lymphatic vessels. Lymphedema is a disorder of the lymphatic system and is mostly manifested by the accumulation and swelling of lymph that cannot be drained under the skin.

What is the Lymph System? How does it work?

The Lymph System is the most basic defense system that maintains the body's resistance and is responsible for clearing excess fluid, large molecules and particles between cells and transferring them to the lymphatic vessels and vein system.

The lymphatic system forms lymph nodes, lymph vessels, tonsils, spleen and thymus glands, also known as nodules, and the main function of the lymphatic system is to keep the fluid balance of the tissues in normal norm, therefore it is vital for the body.

The flow of lymph fluid takes place thanks to the lymph vessels on the skin, and with the contraction and relaxation of the vessels depending on each pulse beat, the lymph fluid is systematically transferred between the cells, thus keeping the fluid balance under control.

How Does Lymphedema Occur?

The lymph system is the most important part of the body's defense system, and its main task is to keep the fluid accumulated between the cells at an equal level and to carry it back to the lymphatic vessels and the venous system. In this dynamic cycle of the lymph system, deformations occur in the valves of the lymphatic vessels in some cases, and as a result of the deformation, the transported fluid escapes and accumulates under the skin, causing that region to swell. This swelling that occurs under the skin is called lymphedema, and in cases where it cannot be treated, it creates permanent damage on the body.

What are the types of lymphedema?

Lymphedema is a chronic disease caused by the accumulation of fluid in the subcutaneous tissues as a result of deformations in the transfer of tissue fluid between cells and is considered in three different types.

What is Primary (Congenital) Lymphedema?

Primary lymphedema is a congenital type of lymphedema that occurs as a result of insufficient development of lymphatic vessels in the womb. It occurs when the body is triggered and puts an excessive load on the lymphatic system, especially in cases such as traumatic syndromes, pregnancy, exposure to severe infections. Primary lymphedema can also be seen during puberty.

What is Secondary Lymphedema?

In secondary lymphedema type, it is seen with structural or functional deterioration on lymphatic vessels or lymph nodes as a result of external intervention of the properly functioning lymph system. It is a common type of lymphedema and mostly occurs after surgical interventions and radiotherapy sessions applied due to cancer treatment.
Secondary lymphedema type does not occur as a result of every surgical intervention, but since surgical interventions can directly damage the lymphatic system, it is likely to be seen after surgical interventions. Breast surgery, arm or leg surgery, radiation therapy after breast surgery, and post-operative inflammatory processes are triggering factors for secondary lymphedema, as they will directly affect the working principle of lymph nodes.

While secondary lymphedema is frequently seen during the treatment of cancer disease, diseases that threaten the structural integrity of the body such as infection or trauma are also among the causes of secondary lymphedema. In addition, secondary lymphedema can be seen in patients as a result of diseases such as vein diseases, varicose veins, sedentary life, snake bites, insect stings and sudden external attacks.

Damage or obstruction in the lymphatic system due to a specific cause, such as infection or trauma, eliminates the transport of lymph fluid in the lymphatic vessels and causes lymphedema. In these patients, there is usually no known lymphatic problem.
Secondary lymphedema is mainly caused by lymphatic trauma, infection, and attack of cancer cells. In addition, venous disease, varicose veins, sedentary life, snake bites, insect bites and voluntary interventions (application of tourniquet on the arm/leg, shaking the leg down) may cause secondary lymphedema.
The two most important causes of trauma that damages the lymphatic system are damage during surgery and radiation therapy (radiotherapy). Removal of lymph nodes during surgery (operative removal of inguinal or armpit lymph nodes) is one of the most common causes of lymphedema.

What Are the Symptoms of Lymphedema?

Lymphedema is the accumulation of fluid under the skin as a result of problems in intercellular fluid transfer, and this accumulation causes swelling in different parts of the body. For this reason, swelling in certain parts of the body is among the most prominent lymphedema symptoms.
Lymphedema is generally seen on the upper sides of the hands and feet and causes an increase in the arm and leg. Early diagnosis and diagnosis of lymphedema is vital for the course of the treatment of the disease, and its main symptoms are listed below.

Major Lymphedema Symptoms;

1. Swelling in certain parts of the body and limitation of movement in the joints seen on these areas
2. Sensation disorders and joint stiffness in the hands and feet
3. Pain in the armpits and groin areas
4. Body infections with recurrent attacks
5. Squeezing shoes and rings
6. Swelling and thickening or cracking of the skin in the wrists
7. Elephant leg appearance, milky thickening of the feet from the ankles

What Are the Stages of Lymphedema?

Lymphedema firstly manifests itself in swelling and pain in certain parts of the body, and standing in this position for a while by raising the legs regularly provides improvement in lymphedema disorders. For this reason, early diagnosis and diagnosis of lymphedema is of vital importance and in cases where it cannot be diagnosed early, it follows its development with the following stages.

Latent Lymphedema Stage – Stage 0

The first stage in lymphedema is the latent lymphedema stage, and although there is a problem in the transport of lymphatic fluid, swelling and edema are not seen on the body. Early diagnosis of the patient at this stage makes it possible to cure lymphedema in a short time with regular massage, exercise and bandage treatment.

Lymphedema Stage II – Stage 1

In the second stage of lymphedema, with the accumulation of lymphatic fluid, edema formation begins on the body and it is recommended that the patient regularly raise the arm and leg, and these movements aim to permanently treat lymphedema.

Third Stage of Lymphedema – Stage 2

In the third stage of lymphedema, swelling and edema are seen on the body with the accumulation of lymph fluid, and in this stage, the discomfort cannot be treated with one's own routine exercises. The patient must be seen by a specialist physiotherapist.

Stage Four Lymphedema – Stage 3

This stage of lymphedema is the most severe stage of the disease, the ankles of the legs swell and thicken upwards, taking the shape defined as elephant leg in medical language. The skin thickens in the area or areas of discomfort, begins to dry and crack. This stage is the most important stage to be considered in lymphedema, and it is vital for the patient to start the treatment under the control of specialist doctors and physiotherapists in order to prevent the chronic course of the disease.

How Is Lymphedema Diagnosed?

Lymphedema is generally diagnosed by seeing a specialist doctor or physiotherapist as a result of swelling in the arms and legs. In the diagnosis and diagnosis of lymphedema, the patient's history is first listened to, and the patient's history of trauma, chronic infection or surgical operation on the breast is investigated.

The diagnosis of lymphedema can be determined by ultrasound imaging, as well as other imaging devices can be used for accurate diagnosis and diagnosis. It is important for the early diagnosis and treatment of lymphedema that especially patients with a history of breast cancer and its treatment should see a specialist physiotherapist in parallel with the treatment.

Is Lymphedema Common After Cancer Treatment?

Lymphedema occurs as a result of structural and functional deformation of the lymph vessels and lymph nodes in the lymph system, either congenitally or caused by external interventions. Especially in cancer surgeries, while the malignant mass on the body is surgically removed, lymph nodes are also removed, or rays targeting cancer cells during radiotherapy treatment also damage the lymph nodes and nodules.
For this reason, the risk of lymphedema disease after cancer surgery is high, and regular controls and examinations by specialist doctors are vital for the diagnosis and early diagnosis of lymphedema of patients receiving cancer treatment.

What are Lymphedema Treatment Methods?

Depending on the condition of the deformation on the lymph vessels and lymph nodes, it is possible to treat lymphedema. Lymphedema is a chronic disease and early diagnosis and diagnosis of the disease is of great importance for successful treatment.

There are different physiotherapy methods applied for lymphedema treatment, which vary according to the type and course of the disease, and it is vital that these therapy treatments are carried out under the control of expert physiotherapists.

What is Manual Lymph Drainage?

Manual lymph drainage, manual therapy treatment As a part of the lymphatic system, the deformed area should be handled manually. With the manual lymph drainage treatment technique, it is aimed to ensure the reflow of the blocked fluid on the lymphatic vessels by manually pressing the problem area. Manual lymph drainage is a frequently used method in the treatment of lymphedema and it is very important to perform it under the control of specialist physiotherapists.

What is Compression Bandaging Technique?

Compression bandaging technique is a lymphedema treatment technique applied under the control of physiotherapists in terms of the course of manual lymph drainage treatment. In the compression bandaging technique, short-stretch and inelastic bandaging is applied on the problematic area of ​​the body to protect the healthy functioning of the activated lymph system after manual lymph drainage. With this bandaging, it is aimed to prevent the re-accumulation of lymph fluids by applying pressure on the deformed area of ​​the lymph system.

In addition to the compression bandaging technique, considering the relapse of the disease at the end of the treatment, compression stockings suitable for the body type are recommended to the patient and are an important part of the treatment process of lymphedema. It is vital that compression stockings are given under the control of expert physiotherapists.

What is Skin Care in Lymphedema Treatment?

As a result of lymphedema, the skin of the problematic area starts to dry, thicken or form a skin layer called elephant skin. In order to prevent skin discomfort on the edematous area, moisturizers with a Ph value of 5.5 are given to the patient for regular use during the treatment phase and it is recommended to use these moisturizers until the treatment is successful.

Why Exercise in the Treatment of Lymphedema?

An inactive body structure is also considered among the causes of lymphedema. Since the flow rate of the lymph fluid is dependent on the intermittent external pressure provided by the skeletal muscles, the correct exercise program to assist fluid drainage is of great importance in the treatment of lymphedema.
The exercise program to be applied in the treatment of lymphedema must be given by specialist physiotherapists, and in order for the treatment to be successful, bandages or stockings should be used during the exercise and weight training should be avoided.

Lymphedema treatment includes a series of physiotherapy sessions applied in a synchronous manner. Regular medical exercises applied together with manual therapy not only helps the lymphatic system to function in a healthy way, but also creates an increase in body resistance to protect the body against future threats. Physiotherapy treatments must be performed by specialist physiotherapists. Otherwise, permanent damage may occur on the body that cannot be treated.