By Jill Buterbaugh, RN, MSN, CRNP, FNP-BC
What is venous insufficiency?
Venous insufficiency is also known as venous reflux disease or varicose vein disease. It is a disease that is effected by many other systems in the body but the end result is that there is difficulty in getting blood returned to the heart from the extremities. This produces congestion and high pressures in the veins that can lead to swelling, pain, varicose veins and skin changes.
What is lymphedema?
Lymphedema is also known as lymphatic obstruction. It is a condition of fluid retention and tissue swelling due to the failure of the lymphatic system to filter the excess fluid back into the blood stream to be eliminated by the kidneys. Lymphedema can be primary (inherited) or secondary (obtained). Lymphedema from venous insufficiency is a form of secondary lymphedema.
What’s the connection?
While the conditions are not the same. One can definitely effect the other. When the veins become over congested and dilated, the vein walls begin to leak fluids into the tissues where it is not supposed to be. One way the body manages that is to rely on the lymphatic system to filter the fluid back into the blood stream so the kidneys can eliminate it. So if the lymphatic system can’t keep up with the overflow fluid from the leaking veins, lymphedema will result. Venous insufficiency can be made worse by untreated lymphedema. Lymphedema will increase the pressures in the tissues that can cause a physical barrier which makes it harder for the body to get the blood returned to the heart.
What else can cause swelling?
Not all swelling is from the venous or lymphatic systems. It is important to have a thorough physical examination to make sure there isn’t heart, kidney, or liver disease which can be very serious if they causing swelling. Another culprit that causes swelling is cancer so it is very important to be evaluated before blaming the venous or lymphatic system for the problem. Obesity can result in physical obstruction to lymphatic and venous flow as well as a decrease in activity. Exercise is important to the boy to keep the lymphatic and venous systems working correctly. Underlying diseases need to be well managed before the symptom of swelling can be treated.
Is swelling treated differently depending on the cause?
As long as there are no other identifiable causes and any underlying diseases are treated, the first treatment for swelling from any cause is compression therapy. In venous insufficiency disease, research has proven that it generally takes compression of 20 to 30 mmHg to decompress superficial veins and force blood into the deeper system to be returned to the heart. Increasing exercise also promotes venous return.
In lymphedema, depending on the severity, compression garments may be first line treatment but often times a few weeks of lymphedema drainage therapy may be necessary to help control it before starting compression. If the lymphedema appears more chronic, pumps may be prescribed. A lymphedema pump is a garment that you put on and it massages the fluid through the lymphatic system to be more effectively removed. Often these therapies are used in combination together in order to manage the symptoms.
Edema that comes from systemic illnesses like heart, kidney or liver disease may require drugs known as diuretics or more commonly “fluid pills” to control the symptoms as well as dietary modifications. Diuretics generally do not help swelling that is coming from lymphatic system disease or venous insufficiency disease. When obesity is present, a diet and exercise program is recommended for weight loss and to increase blood return to the heart and fluid elimination.
If you are concerned about your own symptoms or condition, please call us to schedule an appointment today 814-515-9919!