Managing Leg Swelling

Introduction

In order to understand lymphoedema you need to know a little bit about the lymphatic system.

The lymphatic system is a network of vessels (tubes) and nodes (glands) that cover the body and drain fluid from the tissues into the blood stream. The lymph vessels collect extra fluid, protein and waste material from the body tissues and transport it through the lymph nodes back into the blood. The lymph nodes filter the fluid of any unwanted material and make special cells that help the body fight infection.

What is lymphoedema?

Lymphoedema is a swelling in the tissues below the skin that occurs when the lymphatic fluid cannot drain away. Lymphoedema can occur in the arm or trunk on the affected side of your body. This can happen if the lymphatic system is damaged or blocked. Similarly, if lymph nodes are removed as part of cancer surgery this can also block the normal drainage pathway. Lymphatic vessels and nodes can also be damaged by cancer and any scarring that follows after surgery or radiotherapy. If lymphoedema fluid is dammed behind the blockage and builds up in the surrounding tissues this can also result in tissue swelling.

Other causes that may interrupt or damage the Lymphatic system include:

• Surgery
• Infection
• Severe injury
• Burns
• A congenital or hereditary abnormality.

NOT ALL LYMPHOEDEMA IS CANCER RELATED

Taking care of your skin

Good skin care plays a vital part in the treatment of swollen or at risk areas. Stretched skin can become dry and cracked and any break or injury to the skin is a potential entry for bacteria which thrive in the warm, protein-rich fluid of the swelling.

Prevention of infection in the skin tissues is of great importance. Not only is an infection unpleasant and painful, but it may also cause the swelling to get worse. Any infection should be treated promptly with a two week course of antibiotics. So if you think you may be developing an infection see your doctor immediately, If you do have an infection, discontinue the use of any hosiery until pain and swelling resolves and stop massage or exercise until it is better.

Some people who suffer repeated infections may be prescribed a small but continuous dose of antibiotics over a long period of time as a preventative treatment.

If infection tends to be a problem, it may be advisable to take an emergency supply of antibiotics with you, especially if you are going on holiday, just in case they are needed. Your doctor or lymphoedema nurse will advise you.

Skin with fungal infection such as athlete’s foot may provide a potential entry site for bacterial infection as well. Therefore such fungal infections should receive prompt treatment.

You may hear the term acute inflammatory episode (AIE) or cellulitis. These are commonly used words which refer to an infection of the skin tissues.

Hints for positioning movement

• Avoid standing for long periods of time as the muscles cannot pump away the fluid. If you do have to stand for a period of time remember to bend and stretch your feet at the ankles and transfer your weight from one leg to the other
• When sitting try to rest with your legs supported with your feet at the same level as your knees. Resting your legs on a sofa may be an idea
• Be careful of vigorous exercise – if you play sport find out how much you can do without causing more problems with swelling or discomfort
• Cycling is often helpful for leg swelling – remember to wear your stocking(s) and make sure the cycling is not too vigorous. A static exercise bicycle set at a low resistance can be used as an alternative
• Swimming is a very useful exercise and will be especially beneficial if you wear your stocking, use an old stocking as the chlorine can damage the fabric

Exercises – see leaflet for diagrams

Exercise is important for helping to drain fluid since muscles help to pump lymph out of the limb. Very vigorous exercise, however, causes an increased blood supply consequently forming more fluid in the tissues. Try to do gentle regular exercise rather than intensive bursts, normally twice a day is ideal. Do the exercises slowly, rhythmically and gently.

Remember to wear your hosiery when you are exercising.

The following exercises are designed to help keep your leg joints mobile and prevent stiffness and to stimulate drainage in the swollen area by working the muscles. Do the exercises one leg at a time (except exercise 4 and 5 when both feet can be used together). Repeat each exercise about 10 times:

1. Tighten your buttock (gluteal) muscles, hold for 3 seconds, then relax.
2. Tighten your thigh (quadriceps) muscles, hold for 3 seconds, then relax.
3. Bend up your leg at hip and knee. Stretch out your leg, then slowly lower back down to rest.
4. Bend and stretch your feet at the ankles, slowly and firmly.
5. Slowly and firmly circle the feet at the ankles, first in one direction, then in the other direction.