Treatment and management

For most people, CLT helps control the symptoms of lymphoedema. It includes a treatment phase and a maintenance phase. During the treatment phase, a lymphoedema practitioner provides a combination of regular skin care, exercises, manual lymphatic drainage (MLD), and compression bandaging. It may take a few days or up to several weeks to reduce the swelling and then you will be fitted with a compression garment. You will also be taught how to take over the management of your lymphoedema.

During the maintenance phase, you continue to look after your skin and exercise regularly. Wearing the compression garments prescribed by your
practitioner will help maintain the improvements made in the treatment phase. It is recommended that you see your lymphoedema practitioner every 6–12 months for regular reviews, but this may vary depending on your circumstances.

CLT consists of the following strategies:

Skin care – It is important to keep your skin in good condition to prevent infections.

Exercise – Regular physical activity such as walking and/or resistance training can reduce the severity and symptoms of lymphoedema by  encouraging the lymph fluid to move around the body. It can also help you stay a healthy weight. Flexibility exercises can help maintain your mobility. Resistance exercise can improve your strength plus reduce lymphoedema symptoms. Your lymphoedema practitioner may develop an exercise program for you.

Download our booklet ‘Exercise for People Living with Cancer’

Download our poster ‘Arm & shoulder exercises after surgery’

Manual lymphatic drainage (MLD) – This is a specialised type of massage that is performed by a trained lymphoedema practitioner. Mild pressure
is applied to the skin around the affected area to move fluid towards lymph nodes that are draining normally. The technique used during MLD will be
different for each person depending on the location of the swelling and stage of lymphoedema.

Simple lymphatic drainage (SLD) – This is a simplified form of MLD, which your lymphoedema practitioner may teach you or a carer to do daily.

Although massage therapies are commonly part of CLT, the effect of MLD on the quality of life of people with lymphoedema is unclear. Research to prove the effectiveness of MLD and SLD is ongoing.

Compression therapy involves applying graduated pressure to the affected area to reduce swelling, contain swelling and soften any thickened tissue.

There are different ways to apply compression. Bandages and wraps are used to stimulate the lymph fluid, remove the fluid and reduce swelling.
Compression garments are used to maintain improvements. Compression can also be applied by intermittent pneumatic compression.

Compression for the treatment of lymphoedema needs to be used on an ongoing basis: if stopped, the swelling will usually return.

A compression garment needs to be fitted by a trained lymphoedema practitioner. This will ensure you have the right pressure and good pressure
gradient. Using a poorly fitted compression bandage or garment can make lymphoedema worse. It may cause swelling in other parts of the body, discomfort and further damage to the lymphatic system.

Intermittent pneumatic compression (often called a pump) – This machine inflates and deflates a plastic garment placed around the affected area
to stimulate lymphatic fluid. It’s recommended you have MLD or SLD before using the pump.

The pump can be used at home but it’s important a trained practitioner shows you how to use the pump and adjust the pressure to your needs.
Depending on the type of pump used, you either sit or lie down while wearing the pump.

A compression pump may be used for people who are unable to wear a compression garment.

Compression therapy is not suitable for everyone with lymphoedema. It can be dangerous for people with a range of conditions, for example, uncontrolled congestive heart failure or uncontrolled high blood pressure. These conditions need to be under control before you start compression therapy.

Compression bandages/wraps

• applied by a trained lymphoedema practitioner
• uses inelastic (short-stretch) bandages or wraps
• changed regularly as the swelling reduces; how often they need changing will depend on the type of bandaging and how quickly the swelling reduces
• worn day and night (24 hours)

Compression garments

• self-applied (you put them on yourself)
• worn during the day as soon as possible after getting up; you may wear a lighter garment at night
• can be off-the-shelf or custom-made
• may be a stocking (leg), sleeve (arm), glove/gauntlet (hand), bra/singlet/vest (breast or chest), leotard (trunk), bike shorts with padding, or scrotal
  supports (genitals)
• available in different skin tones, sizes and grades of pressure
• garments must be professionally fitted to ensure the pressure and fit are correct
• handwash garment daily according to the manufacturer’s instructions – this will help it last longer and maintain its compression
• you will need at least two sets: one to wear and one to wash
• replace garment regularly (every 6 months or as required); you need to remeasure for a new garment if your body weight changes or the size of the affected area changes
• may need to wear a cotton liner between the compression garment and your skin
• may need to use with additional padding material to increase or spread the local pressure
• ask your lymphoedema practitioner whether you should wear a garment during airplane travel

Tips

• Only wear a garment if recommended by your doctor or lymphoedema practitioner.
• Your lymphoedema practitioner will show you how to put on and take off the garment. They may also recommend aids and techniques to use if you find getting your garments on and off difficult.

This treatment uses low-level laser to target cells in the lymphatic system. This may reduce the volume of lymph fluid in the affected area, any thickening of the skin and any pain. Your lymphoedema practitioner will use a handheld device or a larger scanner to apply infra-red light beams to the
affected area. You will not feel any heat.

There is some evidence that laser treatment works well when used with lymphatic drainage and compression therapy. Research is still continuing to find the treatment that works best.

Some early research suggests that a special tape called kinesio tape can help lymph fluid drain from the affected area to working nodes. The tape is different from strapping tape, and your lymphoedema practitioner will tell you whether this could be part of your management plan.

Most people are able to manage lymphoedema with CLT, but surgery may be an option when lymphoedema doesn’t respond to other treatments or you are not satisfied with standard treatment. To work out whether surgery is right for you, your specialist will consider the extent of the swelling, how often you get infections, and your general health.

It is becoming common to have surgery before the lymphatic system becomes badly affected and the tissues have changed a lot. Speak to your GP or
surgeon about this option.

As with all surgery, there are significant risks involved. These include scarring, nerve damage, blood clots, infection, loss of mobility, further damage to the lymphatic system, and continuing lymphoedema. Most people still need to wear a compression garment after surgery.

Examples of surgery for lymphoedema include:

Liposuction – In some people, the lymphoedema fluid changes into fatty tissue, but CLT doesn’t reduce the fat. Liposuction removes fat from under
the skin of the affected area but the limb will look smaller. It should only be an option when CLT cannot reduce the swelling. Liposuction can reduce
swelling in the long term and the size of the affected area can be maintained when combined with compression therapy. This treatment is not a cure
for lymphoedema – it’s essential to continue wearing a compression garment.

Lymphatic reconstruction (anastomosis) – This uses microsurgery to repair or create a new pathway for the lymph fluid to drain out of the area. This
technique appears to work better for people with early-stage lymphoedema. Further research on the long-term impact on people who have undergone this surgery is needed.

Tissue transfer – This involves transferring healthy lymph nodes from an unaffected area of the body to the affected limb. Further research is required into whether this technique is effective in the long term.

There is no proven drug treatment for lymphoedema. Although diuretics (water pills) help remove fluid from the body when it’s caused by heart or blood pressure problems, they don’t work well for lymphoedema as lymph fluids are generally protein rich. Once the diuretic is stopped the fluid usually returns to the area affected by lymphoedema.

There is little evidence to support taking naturopathic medicines or supplements such as selenium to help reduce the symptoms of lymphoedema. High doses of selenium can be harmful. Talk to your doctor before taking any supplements or medicines to ensure they are not harmful and don’t interact with any other medicines you are taking.