Q&A: Lymphedema

In A Tight Spot

Question: I am a 45 year-old woman who suffers from lymphedema. I have tried wearing compression stockings to bed but I can’t sleep well because of the tightness in my legs. Can such stockings really help to reduce the swelling?

Answer: Lymphedema is a condition characterised by chronic swelling of the limbs due to the lymph vessels being blocked. The swelling is primarily caused by an accumulation of lymphatic fluid, and also by increased fat deposition and growth in the muscle mass (known as muscle hypertrophy) of the limbs. Severe obstruction to the lymphatic flow will cause a backflow of lymphatic fluid towards the skin (known as dermal backflow).

The severity of lymphedema and dermal backflow can be assessed using imaging techniques such as lymphoscintigraphy and indocyanine green lymphography.

The initial treatment of chronic lymphedema involves specialised therapy (complex decongestive therapy) that is administered by a physiotherapist or occupational therapist who has been specially trained. This treatment involves lymphatic massage and compression bandaging. Once the limbs’ swelling has been reduced, maintenance therapy is administered using compression stockings.

To ensure a proper fit with the appropriate compression pressure, ask your therapist or specialist (plastic surgeon) to prescribe you a pair of custom-made compression stockings. For best results, these should be worn throughout the day except when in the shower.

The tightness felt during sleep (when wearing compression stockings) can be relieved by supporting a swollen limb on two or more pillows to elevate it above the level of the heart. Doing so encourages lymphatic fluid to flow back to the torso. If the tightness persists or worsens despite elevation, it could mean the size of the compression stockings is not right, or that the lymphedema has worsened. Visit your specialist for a reassessment of your condition.