Lymphoedema treatment and management

Lymphoedema requires lifelong self-care and management. It is important to find a treatment that you can incorporate into your lifestyle and maintain in the long term. If you feel overburdened by your treatment schedule, talk to your lymphoedema practitioner. They may be able to suggest some changes to make it more manageable for you.

The focus of treatment is to improve the flow of lymph fluid through the affected area. This will help reduce swelling and improve the health of the swollen tissue. Reducing the swelling will lower your risk of infection, improve your wellbeing and make movement easier.

In the early stages of lymphoedema, treatment may focus on exercise and elevation. Some people will be advised to wear a compression stocking or sleeve. Other people with more advanced lymphoedema will require complex lymphoedema therapy.

Other ways to manage lymphoedema include manual lymphatic drainage, compression therapy, laser treatment and surgery.

It is important that you consult a lymphoedema professional who can tailor a treatment plan for you based on the location and stage of the lymphoedema and any other health conditions you may have.

Learn more about:


Complex lymphoedema therapy

This is the standard treatment used for chronic lymphoedema. The majority of people will respond well to CLT. It aims to reduce symptoms such as swelling, improve the condition of the skin, prevent infections and improve quality of life.

CLT consists of a treatment phase and a maintenance phase. During the treatment phase, a lymphoedema practitioner will provide a combination of regular skin care, manual lymphatic drainage (MLD), exercises and compression bandaging to reduce the swelling. This phase may last for only a few days or up to several weeks.

Once the swelling has been reduced you will enter the maintenance phase. Your lymphoedema practitioner will teach you how to care for your skin, how to perform self-massage known as simple lymphatic drainage (SLD), and how to do some suitable exercises. Wearing the compression garments prescribed by your practitioner will ensure that the gains made in the treatment phase are maintained. It is recommended that you see your lymphoedema practitioner for regular reviews every 6–12 months. 


Components of complex lymphoedema therapy

Skin care

It is very important to care for your skin to prevent infections. You should regularly look over your skin for cuts and scratches, redness, dryness, and signs of bacterial or fungal infections. Make sure to dry your skin thoroughly after washing to help prevent fungal infections. Apply a moisturiser every day to help protect your skin – dry skin can lead to small skin tears and infections. See How to prevent and/or manage lymphoedema for more tips on looking after your skin.

Manual lymphatic drainage (MLD)

This specialised type of massage is performed by a trained lymphoedema practitioner. It involves applying light pressure to the skin around the swollen area to stimulate the lymph vessels and improve the flow of lymph fluid. 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)

Your lymphoedema practitioner may teach you a simplified form of MLD, which you may be advised to do daily.

Sequential intermittent pneumatic compression

This device applies pressure by using a compression pump to inflate and deflate a plastic garment placed around the affected area. It is given alongside MLD or SLD. The device can be used as a home treatment under the guidance of a trained professional to ensure you apply the correct amount of pressure for your situation.

Exercise

Regular physical activity such as walking can reduce the severity and symptoms of lymphoedema by encouraging the lymph fluid to move around the body. Flexibility exercises can help with maintaining your mobility. Your lymphoedema practitioner may develop a program of exercise tailored to your particular situation and abilities. For more information, see Exercise for People Living with Cancer or Exercises after breast surgery.

Compression therapy

Compression therapy involves applying pressure to the area to help control the swelling associated with lymphoedema. It can help prevent the redevelopment of lymph swelling in the affected area and soften any thickened tissue. Pressure can be applied using compression bandages or compression garments. It can also be applied by a compression pump.

Compression is a long-term treatment: if stopped, the swelling will return. If you find it difficult to take your garments on and off, talk to your lymphoedema practitioner about what aids are available to help you. Some people find rubber gloves helpful.

If compression therapy is done incorrectly, it can cause swelling in other parts of the body, pain and further damage to the lymphatic system. It is important that you talk to your lymphoedema practitioner about appropriate therapies for you.

Compression therapy is not suitable for all people 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 stabilised before starting compression therapy.

Compression bandages Compression garments
  • used to stimulate the lymph flow and remove the fluid (decongestive)
  • applied by a trained lymphoedema practitioner
  • uses inelastic (short-stretch) bandages that have a massaging effect
  • 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)
  • used to keep the fluid from returning
  • self-applied (you put them on yourself)
  • worn during the day; you may wear lighter compression garments at night
  • can be ready-to-wear or custom-made
  • garments must be professionally fitted to ensure the pressure and fit is correct
  • need daily washing so you will need at least two sets; one to wear and one to wash
  • need to be replaced regularly (every 3–6 months)
  • may be a stocking (leg), sleeve (arm), glove/gauntlet (hand), bra/singlet/vest (breast or chest), leotard (trunk), bike shorts with padding (genitals)
  • may need a cotton liner between the compression garment and your skin
  • may need to use with additional padding material to increase the pressure

 


Subsidies for compression garments

Compression garments can be expensive. For information about available subsidy schemes visit the Australasian Lymphology Association. If you have private health insurance, check with your provider whether you are entitled to a rebate on compression garments.


Laser treatment

Low-level laser therapy may reduce the volume of lymph fluid in the affected area, any thickening of the skin and any pain. Your lymphoedema practitioner will apply infrared light beams to the affected area using a hand-held device or a larger scanner. You will not feel any heat. There is some evidence that this therapy is effective when used alongside lymphatic drainage and compression therapy. Research is still ongoing into the most effective treatment regimen.


Surgery

Most people will be able to manage their lymphoedema with CLT. Surgery may be an option in some cases when lymphoedema doesn’t respond to other treatments. Your doctor will consider a range of factors when assessing your suitability for surgery, including the extent of the swelling, how often you get infections and your general health.

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. 

People having any of the following procedures will still need to wear compression garments after surgery.

Liposuction

This involves the removal of fat from under the skin of the affected area. It should only be undertaken when CLT cannot reduce the swelling. Liposuction can reduce swelling in the long term when combined with compression therapy after surgery.

Lymphatic reconstruction (anastomosis)

This involves microsurgery to repair or create new lymphatic pathways to drain the fluid. This technique appears to be more effective in the early stages of lymphoedema, but additional research is needed into the effectiveness of this treatment.

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.

Read more about surgery for lymphoedema

Medicines

There is no proven drug treatment for lymphoedema. Although diuretics help remove fluid from the body, they do not remove lymph fluid and can cause dehydration. Your doctor may prescribe you diuretics for other conditions such as high blood pressure, but they are not recommended for 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 about any supplements or medicines to ensure they don’t interact with any other medicines you are taking and are not harmful.


This information was last reviewed in June 2017
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