Patient information from BMJ

Lymphoedema: what treatments are available?

Last published:Dec 09, 2021

The lymphatic system is part of the body’s defence against infection. But if you have lymphoedema, a build-up of fluid in the lymphatic system causes swelling, usually in the arms or legs.

There is no cure for lymphoedema, but there are treatments that can help to control it. You can use our information to talk with your doctor about the best treatments for you.

What treatments are available?

The lymphatic system is spread all over your body. For example, you might have heard of lymph nodes, which are small glands that clean lymph as it passes through them.

Lymphoedema happens when fluid can’t move easily around the lymphatic system. This causes parts of the body, usually the arms or legs, to swell (the word oedema means swelling).

For more information about the causes and symptoms of lymphoedema, see our leaflet: Lymphoedema: what is it?

There is no cure for lymphoedema, but treatments can help to relieve the symptoms.

Your doctor will understand that these treatments can often be time consuming, uncomfortable, and hard to stick to. But it’s important to do the best you can, and to tell your doctor if you are having any difficulties or feeling discouraged about your treatment.

Skin care

One of the most important things that people with lymphoedema need to do is to take care of the skin on the parts of the body where there is swelling.

It’s easy for skin on a swollen area to break, and even small cuts can lead to infection. Skin infections such as cellulitis are a common problem for people with lymphoedema.

About one-third of people with lymphoedema have a cellulitis infection at least once a year. Some infections are serious enough to need hospital treatment. And some people who have a lot of problems with cellulitis take antibiotics regularly to help prevent it.

Your doctor should advise you about good skin care. This can include things like:

• regular moisturising to help prevent dry, broken skin

• regular washing to help prevent the build-up of germs and funguses on the skin

• wearing protective clothing while outside: for example, wearing trousers rather than shorts or skirts, to prevent accidental scratches, and

• avoiding walking barefoot.

Treatments to help reduce swelling

Static compression

An important treatment for lymphoedema is called static compression. It involves wearing special sleeves and stockings that look a bit like bandages. You wear these under your normal clothes. These can be loosened and tightened as needed.

These garments work by gently compressing (squeezing) swollen limbs so that fluid can’t build up and cause more swelling.

Compression garments can feel bulky and uncomfortable and it can take time to get used to using them. But they are an important and effective part of treatment for lymphoedema. If you have difficulty with them, talk to your doctor.

Elevation

This treatment is meant to help lymph to drain from swollen limbs and stop more fluid from pooling there. As the name suggests, it involves raising a swollen limb above the level of the rest of your body for a period of time.

For example, you might prop your arm up on cushions so that your hand is higher than your wrist and your elbow is higher than your shoulder.

The results with elevation are a bit mixed. Some people find that elevation works well, but some people find that it doesn’t help much. As with other treatments for lymphoedema, trying them will help you to find which ones work best for you.

Exercise

People with lymphoedema are encouraged to exercise as much as possible. Exercise helps to strengthen the muscles that help to drain lymph and reduce swelling.

You can discuss exercise with your doctor and come up with a plan that works best for you. It’s always easier to stick to exercise if it’s something that you enjoy.

Combined massage and bandaging

You might be able to have treatment that involves massage followed by compression bandaging. This can help to drain fluid from the lymphatic system.

As with other treatments, it works better for some people than for others. It can also be time consuming, and it means attending regular appointments for massage. But some people value this interaction with medical staff.

Intermittent pneumatic compression

The name makes this treatment sound complicated, but it’s really just massage done by a machine.

You wear special padded sleeves or stockings on the limbs that need massage. They look a bit like parts of a space suit.

These sleeves and stockings are connected to a machine that controls them. When switched on, they massage your limbs just as a person would do, helping to drain fluid from your limbs.

Some people prefer this treatment over massage by a therapist, because it means they can have it at home.

Psychosocial support

It’s no surprise that lymphoedema can have a negative effect on people’s quality of life. Things like time-consuming treatments, bulky garments, problems with movement, and your feelings about how you look can all get you down.

So it’s important to make the most of what your doctor might call psychosocial support. This sounds like a fancy term. But it just means any help that you get with your mental and social well being.

This help can come from many places, including:

• professionals, including therapists

• friends

• family, and

• support groups. For example, in the UK, lymphoedema.org provides information and support to people with the condition and their families.

Keeping to a healthy weight

Being overweight can make lymphoedema worse. It can make treatments less helpful. So it’s important to pay attention to your weight.

You can talk with the medical staff treating you about how to keep to a healthy weight, and about how to lose weight if you need to.

This might involve some changes to your diet, and doing more exercise. People who are very overweight (obese) might need more treatment to lose weight. For example, your doctor might talk with you about the possibility of weight-loss surgery.

Antibiotics for filariasis

In some countries, mainly in South America, lymphoedema can be caused by a parasitic infection called filariasis, which is spread by mosquitoes.

If you have filariasis, you will need special antibiotics to get rid of the infection. But this is not common outside of South America.

Surgery

Surgery is not suitable for everyone with lymphoedema, but it can help some people. Even if you have surgery, you will still need to keep up your compression therapy for the rest of your life.

There are two main types of surgery for lymphoedema. These are:

• procedures to remove excess tissue, such as fat that can build up around the lymphatic system. For example, one procedure for removing excess tissue in people with lymphoedema is liposuction. You might have heard of this procedure as a type of cosmetic surgery. It involves using suction to remove body fat. Fat can build up more than usual in limbs affected by lymphoedema.

• surgery to create new connections in the lymphatic system that help to drain away fluid.

All types of surgery have risks. And, while some people find that surgery helps them, it can sometimes make things worse, or lead to other problems.

If you discuss surgery with your doctor, he or she should explain all the possible benefits and risks. 

What to expect in the future?

There is no cure for lymphoedema, but treatments can help reduce the swelling and the chance of cellulitis. However, while your doctor will stress how important it is to keep up with your treatments, it can sometimes be hard to stay motivated.

For example, there might be times when you feel on top of things and your symptoms improve; but there will probably also be tough times when you find it hard to stay positive. It can be easy to become depressed and anxious.

So it’s important to make the most of psychosocial support.

Your doctor will want to check on you at least once or twice a year, depending on how severe your symptoms are, and on whether you have problems with cellulitis.

He or she will monitor your progress and give you help and advice on treatments, and how to avoid complications such as infections.

Your doctor should explain to you that lymphoedema can sometimes develop into a serious type of cancer called lymphangiosarcoma. But this is very rare. It happens to about 1 in every 200 people with lymphoedema.