Lymphoedema treatment and management
This sections discusses ways to manage and treat lymphoedema.
Learn more about:
- The aim of treatment
- Skin care
- Massage therapy
- Compression therapy
- Types of compression therapy
- Complex lymphoedema therapy (CLT)
- Laser treatment
- Lymph taping
- Caring for affected area
- Recognising and managing infections
- Help paying for treatment
The aim of treatment
The aim of treatment is to help 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, make movement easier and more comfortable, and improve your wellbeing.
A lymphoedema practitioner will work with you to develop a treatment plan based on the severity of swelling (the stage) and any other health conditions you may have.
Mild lymphoedema (stages 0–1) is usually managed with skin care, exercise and compression therapy. Massage therapy may also be used for stage 1 lymphoedema. Moderate or severe lymphoedema (stages 2–3) usually needs complex lymphoedema therapy (CLT). Less commonly, you may have laser treatment, lymph taping and surgery.
Any physical activity – such as walking and/or strength (resistance) training – can help reduce the severity of lymphoedema. Water-based exercise can be helpful as it provides support and compression.
Aim for about 150 minutes of moderate exercise each week. Exercise may need to be modified if certain movements make symptoms worse. If you usually wear a compression garment, you should also wear it while exercising. A lymphoedema practitioner, exercise physiologist or physiotherapist can design an exercise program for you.
Manual lymphatic drainage (MLD) – This is a specialised type of massage to the affected area that moves fluid towards lymph nodes that are draining normally. It must be performed by a lymphoedema practitioner.
Simple lymphatic drainage (SLD) – This is a simplified form of MLD, which your lymphoedema practitioner may teach you or a carer to do daily.
Research into how well MLD and SLD work in lymphoedema is ongoing.
Compression therapy involves applying different levels of pressure to the affected area. Bandages and wraps and compression garments are most commonly used in compression therapy. Intermittent pneumatic compression (below) may also be used. Compression can reduce and contain swelling, and soften thickened tissue.
Compression needs to be used on an ongoing basis; if stopped, the swelling will usually return.
Who can have compression therapy? – Not everyone with lymphoedema can have compression therapy. It can be dangerous for people with a range of conditions, such as uncontrolled congestive heart controlled high blood pressure.
Intermittent pneumatic compression (often called a pump) – A compression pump may be used for people who find it difficult to move around or to perform SLD. This machine inflates and deflates a plastic garment placed around the affected area to stimulate lymphatic fluid. You may need to have MLD or SLD before using the pump.
The pump can be used at home but it’s important that a trained practitioner shows you how to use the pump and adjust the pressure to your needs. You can buy or hire a pump to use at home.
Only wear a garment if it is recommended by your lymphoedema practitioner or doctor; poorly-fitting garments can make lymphoedema worse. Your lymphoedema practitioner will show you how to put on and take off the garment, and recommend aids and techniques if you find this difficult.
Types of compression therapy
Compression bandages and wraps
- used to get the fluid moving, remove the fluid and reduce swelling
- applied by a trained lymphoedema practitioner
- often used in intensive treatment (called CLT)
- uses non-elastic bandages or wraps and secured with Velcro
- changed regularly as the swelling reduces
- may need to be worn day and night (24 hours); your lymphoedema practitioner will advise you
- used to maintain improvements
- fitted by a lymphoedema practitioner to ensure correct fit and pressure gradient
- 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
- may be used as a standalone treatment, but often used as a part of CLT
- 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), shorts with padding (genitals), scrotal supports (genitals), or head and neck garment
- available in different skin tones
- ask your lymphoedema practitioner whether you should wear a garment during travel
For people with moderate-to-severe lymphoedema, CLT can be used to help control the symptoms.
It is done in 2 phases: 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 manage the lymphoedema yourself, or with the help of a partner or carer.
During the maintenance phase, you will continue to look after your skin and exercise regularly. You will also continue to wear the compression garments prescribed by your practitioner to help maintain the improvements made in the treatment phase.
Low-level laser therapy (called photobiomodulation or PBM) may be used to target cells in the lymphatic system. This treatment 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 infrared light beams to the affected area. You will not feel any heat during the procedure.
There is some evidence that laser treatment works well when used with lymphatic drainage and compression therapy. Research is still continuing into this treatment.
Some early research suggests that a special, elasticised tape (called kinesiology tape) can help lymph fluid drain from the affected area.
The tape is different from strapping tape and is applied by a lymphoedema practitioner. They will tell you whether lymph taping may be helpful for you.
Caring for the affected area
If possible, you should:
- keep cool in summer as the heat may make swelling worse – have cold showers, stay indoors during the hottest part of the day, avoid sunburn, and drink plenty of water
- wear clothing and jewellery that fits well and doesn’t put pressure on the affected area
- tell health professionals that you have lymphoedema (or are at risk of lymphoedema) before having blood taken, injections, blood pressure monitoring or other procedures – it may be safe to use the affected arm, but your health professional will discuss this with you.
In most cases, lymphoedema can be managed with CLT, but surgery may be an option for some people when lymphoedema doesn’t respond to other treatments or you are not satisfied with standard treatment. Special types of surgery can be used before the lymphatic system becomes badly affected and the tissues have changed a lot. Ask your GP or surgeon if surgery may be a option for you.
To work out whether surgery is the right option for you, your treatment team will consider the extent of the swelling, how often you get infections, and your general health. It is best to have surgery for lymphoedema in a specialist centre.
As with all surgery, there are risks involved. These include scarring, nerve damage, blood clots, infection, loss of mobility in the affected area, 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 can remove fat from under the skin of the affected area and the limb will look smaller. It should only be considered when CLT cannot reduce the swelling.
Liposuction will not cure lymphoedema, but it can make it easier to wear normal clothes and be active.
Liposuction can also reduce the risk of infection. After liposuction, it’s essential to continue wearing a compression garment 24 hours a day or as advised.
Lymphovenous anastomosis (LVA) – This uses microsurgery to repair or create a new pathway for the lymph fluid to drain out of the area to a small vein or another lymph vessel that is working well. This technique appears to work better for people with early-stage lymphoedema. Further research on the long-term effectiveness of this type of surgery is needed.
Lymph node transfer (LNT) – This involves moving healthy lymph nodes from an unaffected area of the body to the affected limb. More research is needed to work out whether this technique is effective in the long term.
Recognising and managing infections
|who is at risk||People with, or at risk of, lymphoedema are at higher risk of getting a serious skin infection known as cellulitis.|
|how an infection starts||If lymph fluid can’t drain properly, bacteria can multiply and an infection may start in the affected area or sometimes more generally in the body. The high amount of protein in lymph fluid also makes it a place where bacteria is more likely to grow.|
|signs of cellulitis||Redness, painful swelling, warm skin, fever, and feeling generally unwell. It may help to mark the red area with a soft marker and check for spreading.|
|when to start treatment||See your doctor immediately, as you may need antibiotics. Treating symptoms early will help the recovery from cellulitis. Having one episode of cellulitis increases the risk of further infections.|
|taking antibiotics||It’s important to follow your doctor’s instructions when taking antibiotics – you may need to take antibiotics for longer periods of time if cellulitis develops in an area affected by, or at risk of, lymphoedema. If you have developed cellulitis several times, your doctor may give you an antibiotic prescription to keep on hand, so you can start on antibiotics as soon as you notice symptoms. For more information, visit lymphoedema.org.au.|
There is no proven drug treatment for lymphoedema and some medicines may make it worse. There is little evidence to support taking naturopathic medicines or supplements such as selenium to help reduce lymphoedema symptoms. Talk to your doctor before taking any supplements or medicines to ensure they are not harmful.
Treatment for lymphoedema – including seeing lymphoedema practitioners and buying compression garments – can be expensive. There are options to help with these costs:
- If your GP refers you to a lymphoedema practitioner as part of a chronic disease management plan, you may be eligible for a Medicare rebate for up to 5 visits a year.
- Compression garment subsidy schemes are run by all state and territory governments. There are also some federal subsidies through the Department of Veterans’ Affairs. These schemes cover some, or all, of the cost of compression garments. People with permanent and significant disability may be eligible for support through the National Disability Insurance Scheme. For more information, visit the Australasian Lymphology Association.
- If you have private health insurance, check with your provider whether your policy covers lymphoedema therapy and compression garments.
A/Prof Louise Koelmeyer, Director, Australian Lymphoedema Education, Research and Treatment (ALERT) Program, and Associate Professor, Macquarie University, NSW; Prof John Boyages AM, Founding Director and Honorary Professor at the ALERT Program, Macquarie University, NSW; Dr Nicola Fearn, Occupational Therapist and Accredited Lymphoedema Therapist, The Lymphoedema Clinic Wollongong, and Senior Research Officer, St Vincent’s Hospital Sydney, NSW; Jennifer Gilbert, Clinical Nurse Consultant – Lymphoedema, Icon Cancer Centre, Chermside, QLD; Megan Howard, Senior Physiotherapist and Lymphoedema Physiotherapist, Peter MacCallum Cancer Centre, VIC; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Dr Amanda Pigott, Clinical Specialist Occupational Therapy, Princess Alexandra Hospital, QLD; Prof Neil Piller, Director, Lymphoedema Clinical Research Unit, College of Medicine and Public Health, Flinders University, SA, and Patron, Lymphoedema Association of Australia; Ashlynne Pointon, Consumer; Dr Cathie Poliness, Breast Surgeon, Peter MacCallum Cancer Centre, VIC; Tara Redemski, Senior Physiotherapist – Cancer and Blood Disorders, Gold Coast University Hospital, QLD.
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