Lymphoedema - Treating lymphoedema

The recommended treatment for lymphoedema is decongestive lymphatic therapy (DLT).

DLT is not a cure for lymphoedema, but it can help control the symptoms. Although it takes time and effort, the treatment can be used to effectively control your lymphoedema.

Decongestive lymphatic therapy (DLT)

There are four components to DLT:

• compression bandages and garments – to move fluid out of the affected limb and minimise further build-up
• skin care – to keep the skin in good condition and reduce the chances of infection
• exercises – to use muscles in the affected limb to improve lymph drainage
• specialised massage techniques – known as manual lymphatic drainage (MLD) – to stimulate the flow of fluid in the lymphatic system and reduce swelling

Each of these components is described in more detail below.

DLT usually begins with an intensive phase of therapy, during which you may receive daily treatment for several weeks to help reduce the volume of the affected body part.

This is followed by the second phase, known as the maintenance phase. During this, you will be encouraged to take over your own care by carrying out simple self-massage techniques, wearing compression garments and continuing to exercise. This phase of treatment aims to maintain the reduced size of the affected body part.

You may then have reviews every few months to check how your treatment is progressing.

Compression bandages and garments

Unlike the blood circulation system, there is no central pump, such as the heart, to move fluid around the lymphatic system. Instead, the lymphatic system uses the massaging effect of surrounding muscles to move the fluid.

If you have lymphoedema, you will have special bandages or garments (such as sleeves, gloves, stockings or tights) fitted over any affected limbs. These will support the affected muscles during exercise and encourage them to move fluid out of the affected limb.

These may also be applied after a session of MLD, to prevent fluid accumulating in the limb again. This use of compression bandages and garments is known as multilayer lymphoedema bandaging.

Velcro wraps may be used instead of bandages and have the advantage that the person with lymphoedema can apply them themselves.

You will be taught how to correctly apply your own bandages and compression garments, so you can continue to use them during the maintenance period.

Skin care

Taking good care of your skin is important, because it will reduce your risk of developing an infection, such as cellulitis.

Read our page on preventing lymphoedema for more skin care advice.

Movement and exercises

Your lymphoedema care team will help devise an exercise and movement plan designed to strengthen and stimulate the muscles involved in lymph drainage. They will also help you to lose weight, if you are overweight. This will be tailored to your requirements and ability.

Your plan may involve specific limb exercises, as well as gentle activities that involve the whole body, such as swimming, cycling and walking.

Massage

To begin with, you may receive specialised massages called manual lymphatic drainage (MLD) – usually carried out by a specialist therapist – to move fluid from the swollen areas into working lymph nodes, where it can be drained.

Your lymphoedema therapist will also teach you a range of simpler massage techniques that you or your carer can use during the maintenance phase of treatment, to help keep the swelling down. These self-massage techniques are known as simple lymphatic drainage (SLD).

Surgery

In a small number of cases, surgery may be considered to treat lymphoedema. There are three main types of surgery that may be useful for the condition:

• the removal of sections of excess skin and underlying tissue (debulking)
• the removal of fat from the affected limb (liposuction) – see below
• the restoration of the flow of fluid around the affected section of the lymphatic system – for example, by connecting the lymphatic system to nearby blood vessels (lymphaticovenular anastomosis)

These treatments may help to reduce the size of areas of the body affected by lymphoedema, but some are still experimental – particularly lymphaticovenular anastomosis – and are not in widespread use.

Liposuction

Liposuction is where a thin tube is inserted through small incisions in the skin to suck fat out of tissue. It can be used to remove excess fat from an affected limb to help reduce its size.

Once the surgery is complete, you will have to wear a compression garment on the affected limb day and night for at least a year to help keep the swelling down.

The National Institute for Health and Care Excellence (NICE) states that liposuction for chronic (long-term) lymphoedema appears to be safe, and may be effective in the short term. However, NICE says there is not enough evidence of its long-term effectiveness and safety.

Access to liposuction for lymphoedema may be limited, depending on what is available from your local NHS Clinical Commissioning Group (CCG).