Dr. Zatrok's blog
Dr. Zatrok's blog

Dr. Zatrok's blog

Why does the lymph accumulate in lymphedema?

by Dr. Zsolt Zatrok

You have lymphedema. You wear the compression stockings regularly, see your therapist every week for manual lymphatic drainage, but barely see any results …you don’t understand why the swelling doesn’t decrease, and why the lymph production does not just stop. Let me explain it.

Lymphedema is not curable today, meaning it can not be cured permanently despite all the treatment efforts. You should carry on with the treatments to prevent swelling and reduce limb circumference to a level close to normal.

The lymph is formed during each heartbeat, unstoppably as long as your heart beats!

This is absolutely normal. This is the case for all people. Those with a healthy lymphatic system do not develop swelling.

In a lymphatic disease, the collection and transport of lymph is problematic. Therefore, as soon as you stop a treatment, it will start to accumulate immediately. For some people, the accumulation process is slow, while others are less fortunate and their edema returns even within hours.

You should treat it as often as the edema recurring regularity requires.

How is lymph formed?

When your heart beats, it pumps out blood into your arteries, which deliver it all the way to your cells. Cells take up the substances from the blood that they require for their operation, and release waste materials they do not need.

Your veins collect this “used blood” and return it back to your heart. “Along the way”, your blood flows through your liver and kidneys, which filter out the toxins from it, finally with the help of your lungs, your blood gets “mixed” with fresh oxygen. From the lungs, your blood enters your heart again, which pushes it through the arteries into your body again.

Your arteries are strong and your heart is actively pumping your blood into them. However, your veins are “less efficient”. They cannot bring back all the fluid brought by the arteries.  A little fluid stays between the cells (in the interstitial space), in your body after each heartbeat.

This is the “residual” lymph

Your lymphatic vessels are “responsible” for collecting the rest (residual lymphatic fluid). These above-mentioned vessels collect it, the lymph nodes filter out the pathogens from it, and eventually, get them back into your bloodstream.

In a healthy state, your veins and lymphatic vessels together collect (without leaving any residual lymphatic fluid) the amount of blood pumped through the arteries. Thus, by draining the interstitial fluid that collects in tissues, no swelling develops.

When does the lymph begin to accumulate?

Swelling (lymphedema) occurs when your lymphatic vessels do not work properly and cannot perform the “task assigned to them”. After each heartbeat, a little extra fluid remains that stays there. It accumulates slowly, multiplies, and becomes visible over time. It causes tension slowly. If the affected area/limb is very tense, it will cause you pain.

The lymphatic vessels cannot do their job if, on the one hand, they are congenitally poorly developed (you were born ill). But, on the other hand, as more often is the case, the lymphatic vessels may become damaged, destroyed, or occluded in an accident, or even more often times, during medical treatments (surgery, radiation therapy). And if there is no (vascular) channel/not enough channels, through which the lymph could be carried away, it stays in place and multiplies…

We are not yet able to “manufacture” new lymphatic vessels. Once ruined, they cannot be replaced. That is, the affected area/limb will always swell.

The balance may “break” for other reasons, too.

For example, if certain veins are removed or occluded in a limb during varicose vein surgery, then the (remaining) veins will no longer perform their function properly. This happens due to a decreasing venous capacity, thus more tasks will remain on the lymphatic vessels. But they have a certain capacity. In this case, your body cannot drain, collect the lymph and transport back to the heart due to the missing veins. The consequence is the same.

Drastic, surgical eradication of your crooked varicose veins can lead to braking the lymphatic balance and the formation of lymphedema.

What follows from this?

Because lymph production is an unstoppable process, from heartbeat to heartbeat, the development and onset of swelling is only a matter of time.

Luckily, it takes 1-2 days for you to start feeling the tension. Others are not so lucky, because in their bodies, the previous situation recur quickly, even 1-2 hours after stopping the treatment.

You should handle this situation and manage your disease in a way that you take into account the edema recurring time. If it recurs only every two days, it may be enough to treat it every two days. However, if it recurs within 2 hours, you should manage it more often, accordingly.

My advices

The accumulation of lymphedema occurs just as dirty laundry accumulates in the family. Every moment someone comes and throws a used shirt/pants/socks in the laundry. It constantly accumulates. It takes you less effort if you “throw” some of your clothes into the washing machine every day, than if you waited a month and spent an entire day washing a pile of dirty clothes.

From this, you can also understand that regarding the treatment of lymphedema, it is a big mistake to wait too long. Please, do not wait until the affected limb/area becomes tense, sore or the skin over the affected region ruptures, or becomes ulcerated! The longer you let it swell, the harder it will be to “clean it up”!

You are doing it right if you watch yourself carefully. As soon as you feel the edema, treat it by applying a short duration (20-30 minutes) and low pressure (40-60 mmHg) mechanical lymphatic massage. If needed, treat up to 2-3 times a day. This is better than carrying out a long, high-pressure treatment once a week …and a thousand times better than waiting for someone to schedule an appointment for you for a manual lymphatic massage. If your edema recurs in 2-3 hours, 1-2 massages a week is simply a waste of your money. It will not improve your condition in any way in the long run (it may help only for a 1-2 hours time period right after the massage, but no longer).

There will be two consequences if you wait too long between the treatments!

  • The greater the swelling, the harder it is to get rid of it. A single massage session cannot significantly reduce it.
  • The more you let it swell (the higher the pressure/tension), the faster your condition will worsen. Proteins start to deposit in your tissues from the lymph that “sits still in one place” for a long time. In a few years time, the area becomes so firm (fibrotic) as irreversible changes happen. Finally, your lymphedema grows to such a state that the specialists no longer consider it treatable,…only suffering remains which accompanies you. Please, accept my advices, and avoid that state.

Start treating your lymphedema as soon as possible, please, don’t wait years with it. Set the frequency of treatments to the recurring time of your edema. Don’t let it swell too long untill a painful state develops, with a large edema feeling firm due to great tension. You can treat it several times a day. It is much better if you apply more short duration, low pressure treatment sessions, rather than one long session with a high pressure. You can only do so if you own a compression therapy unit yourself! If you have only the simplest 4-chamber device at home, it’s also a thousand times better than not handling the problem at all.

You have one body and the better you treat it, the better you will feel.

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