What is edema?
Edema is the abnormal collection of fluid in tissues from leaking capillaries. Many different conditions or diseases can cause edema to occur. It can be from sitting or standing in one position too long which due to gravity and increased pressures in the veins inhibit blood return to the heart. Eating too much salt will cause the body to retain fluid to dilute the salt back to a normal level. Some hormones, particularly estrogen can result in fluid retention during monthly menstrual cycles and pregnancy. Heart disease may decrease the ability of the heart to contract effectively resulting in congestion in the venous system. Kidney disease can decrease the body’s ability to eliminate excess fluids. Liver disease can decrease the body’s ability to filter and excrete wastes resulting in fluid retention to dilute the waste levels in the blood to acceptable levels. Vascular disease or abnormal blood vessel walls may allow fluids to leak into the tissues. Medications that can result in swelling include medications used to treat hypertension, non-steroidal anti-inflammatories, steroids, estrogen and a class of diabetes medications called thiazolidinediones. Obesity can also cause edema because it increases the amount of work it takes for the body to return the blood to the heart.
Edema generally effects both sides of the body evenly and is usually first noticed in the feet and legs. Symptoms of edema include obvious swelling, puffiness, stretched or shiny skin, and skin that dimples when pressed (pits). Complications that can happen if the edema is not treated and starts to happen on a regular basis includes difficulty walking, itchy skin, stretch marks, increased chance of skin infections, skin layers start to turn to scar (fibrosis), decreased circulation, decreased ability to stretch in the walls of the arteries and veins, joints and muscles become more stiff, and increased risk of skin ulceration.
Treatment of edema is generally aimed at fixing whatever is causing it if possible. Compression hose or stockings, 20 to 30 mmHg should be worn daily to help control the symptoms. Diuretics, or fluid pills, generally work for the treatment of generalized edema but are only recommended after failure of conservative measures such as weight loss, exercise and compression.
What is lymphedema?
Lymphedema is edema that results in the failure of the lymphatic system to move lymphatic fluid through its vessels to the lymph nodes to be filtered and ultimately eliminated through urine. Lymphedema can be primary or secondary. Primary lymphedema is actually very rare and is most often caused from congenital disorders which are inherited disorders where the lymph system does not form right or work right.
Most lymphedema is secondary lymphedema and can come from many different causes. Surgery and radiation therapy are the most common causes for secondary lymphedema. Surgeries can disrupt the flow of lymph fluid through the vessels or lymph nodes. Radiation therapy for the treatment of cancer can damage lymph nodes and decrease their ability to function. Physical obstruction of lymph flow from tumors can result in the inability of the body to get rid of extra fluid. Infections, getting older, being overweight and having rheumatoid or psoriatic arthritis can damage lymph vessels and lymph nodes turning them hard and like scar tissue that doesn’t work as well and can make lymphedema worse.
Symptoms of lymphedema include heaviness, tightness, aching, restricted range of motion, and swelling. It generally does not cause severe pain and the skin color and temperature is generally normal. Natural folds in the skin look deeper and often you cannot pinch and pick up any skin on the fingers or toes when it is true lymphedema.
Secondary lymphedema often times is often only involving one arm or leg if it is from surgery or radiation but can be on both sides if it comes from other causes. It also can come from untreated regular edema when the body just can’t keep up with the need to get rid of the extra fluids.
Treatment of lymphedema is generally life-long once diagnosed. Manual lymphatic drainage that is done by a Physical or Occupational Therapist in combination with compression garments or stockings, 20 to 30 mmHg is first line treatment. Lymphedema is generally reversible if diagnosed early and treatment is started and continued for life. There are special pumps made that patients can use at home to help massage the fluid out of the tissue but most are used after evaluation by a therapist. Compression garments or stockings that are 20 to 30 mmHg should be worn daily for the rest of their life. Once tissues and skin starts to turn into fiber or scar like changes occur, the lymphedema is generally not reversible but reducible. Skin care is essential for any patient with edema or lymphedema no matter what the cause is because of the high risk of infection and sores.
Untreated lymphedema will increase the chance of infections, scar or fibrosis formation in tissues and skin, non-cancerous skin growths, skin cysts (collection of skin fluids in a small sacs), fistulas (where areas of the body grow together abnormally) and thick, scaly skin. In rare cases, patients can develop a rare form of cancer called a lymphangiosarcoma which can be fatal.
Anyone that has swelling regardless of the cause should be evaluated by a medical provider. Compression therapy should be prescribed and used daily. Please refer back to our previous article on compression therapy for more information or feel free to contact us if you have questions.