We’re much too quick to judge others and ourselves. Not even those affected always know that portly thighs, saddle bags, or swollen calves aren’t necessarily a result of a poor diet or a lack of exercise.
That means a pathological cause for an arm suddenly swelling up or a corpulent leg will often remain undetected for years and may only be caught by coincidence. Only when diets don’t work, the legs become painful, or circumferences continue to increase will those affected consult a physician. But if treatment is started early, it can effectively counteract the progression of the condition.
In our edema subject area, we’d like to explain the different causes of what is known as ‘edema’ and make you aware of this condition. After all, not everyone who looks like it “is simply fat”!
Lymphedema in the arm following breast cancer
More than five percent of all women are affected by swelling in the arms and hands after cancer surgery as a result of damage to the lymphatic system. This is referred to as lymphedema in the arm or arm lymphedema following breast cancer.
This happens when lymph can no longer be removed as usual, which is the case after radiation treatment or surgery, for example. This fluid causes swelling and increases the risk of infection. The likelihood of arm lymphedema occurring in cases of breast cancer depends on the extent of the procedure: if the lymph node removal is comprehensive, an increase to 20 percent of women affected by the after-effects of breast cancer treatment is to be expected. According to studies, the problem is worsened if the patient is overweight.
Just like the blood system, the lymphatic system runs through the human body with minute and large vessels. These vessels carry what is known as lymph – a usually clear fluid. It acts as a transport medium for waste products that are not directly in the blood stream. It therefore plays an important role in the body’s immune system.The filtration of these waste products takes place in lymph nodes in particular, as does communication with the body’s own immune cells to trigger defense responses. Lymph nodes are always found where lymph vessels meet: especially in the armpit and the knees, as well as the jaw, for example. The large lymph node close to the armpit is therefore often first affected by metastasized cancer cells in cases of breast cancer. That’s why the lymphatic system must be carefully borne in mind during surgery and radiation treatment.
During breast cancer surgery, the sentinel lymph node close to the breast is also removed and checked for cancer, ideally to exclude this possibility. Sometimes, unfortunately, these sentinel lymph nodes are already affected so a number of lymph nodes must be removed to prevent metastasizing of cancer cells. For the lymphatic system, however, this life-saving procedure means a disturbance of the natural flow paths. This can result in irritation in the body.
Right after surgery, swelling occurs quite often and is nothing to worry about to a certain extent. The same applies to swelling in the arms and hands following breast cancer surgery. It often subsides by itself or can be effectively treated using a combination of lymphatic drainage and compression therapy. However, it’s common knowledge that arm lymphedema can develop within the two years following breast cancer treatment. The condition often starts with minor signs:
- clothing and jewelry are suddenly tighter than before
- the arms and hands feel heavy
- swelling can be measured
- mobility is restricted
- pain caused by swelling can be noticed
Initially, when the skin is pushed with a finger, an indentation typical for edema occurs, which disappears again in the early stages of the condition. Elevation and gentle massage of the arm can also provide relief in the beginning. But if the lymphedema in the arm remains untreated, the swelling will change because the tissue hardens. The skin feels taut and starts to hurt. An indentation can no longer be caused with a finger because the skin is under too much tension. Significant restrictions in arm mobility also occur, and elevation now no longer provides relief.
If you notice any of the symptoms mentioned above, speak to the physicians in charge of your breast cancer follow-up treatment to get diagnosed. This can often be based on your symptoms. Imaging technology, such as ultrasound, can confirm the condition. Once the problem has been identified, treatment can be started without delay. It usually includes the following:
- lymphatic drainage
- compression therapy (bandaging and arm sleeves)
- skin care
Best results are achieved when these treatment elements are combined. In addition, keeping an edema diary can help you to find out whether certain foods or alcohol increase your swelling, so you can avoid these. Constantly wearing your compression products is absolutely crucial – in the summer in particular because edema is increased by high temperatures. The longer you wear your compression garments every day, the better the positive effect on your lymphedema.
Additionally, injuries should be prevented as much as possible to minimize the risk of infection. Patients have the best treatment success when they realize that the combination of the different treatment elements will yield the best results, if they commit to the measures specified, and incorporate them in their daily lives. This is the only way to prevent the lymphedema progressing and to reach a permanent state where quality of life is barely or at least not extremely restricted.
In addition to manual lymphatic drainage and the exercises that can also be carried out at home, compression therapy is an important aspect of lymphedema treatment and of breast cancer related follow-up care of the arm. Based on external pressure, compression products specifically custom-made for the individual lymphedema are able to reduce the accumulation of fluid and therefore to prevent the lymphedema progressing.
Products like VenoTrain curaflow are made to measure and can perfectly shape the affected body parts. During movement, the fine knitted fabric exerts a consistently high pressure, thus massaging the tissue under the skin. This is how the compression stocking on the arm ensures increased lymph flow and noticeable relief.
When choosing the appropriate arm sleeve, comfort plays a crucial role because it has to be worn practically all the time. That’s why the comfort of VenoTrain curaflow compression products is based on their particular design: the arm sleeve features an anatomically contoured elbow with an extra soft bending zone, and the gloves have been made without bothersome finger seams. Thanks to its high microfiber content, the material is particularly soft and breathable. Even after a long time being worn, it still feels pleasant on the skin. That’s essential because compression products can only help if they’re being worn! They give patients back their quality of life if they suffer from an arm lymphedema after breast cancer.
On hot days or after long periods of standing, as well as after a lengthy day sitting at a desk, the first signs of weak veins manifest in many adults. Swollen ankles are an undeniable indication of water in the legs. It may start with slight swelling but can then develop into a full-blown problem if not treated – vein weakness intensifies, resulting in edema, or more precisely, a venous edema. Serious long-term consequences can arise, such as inflammation or open wounds, which is why counteraction should be taken as early as possible.
What is commonly called “water” is actually tissue fluid that is designed to be removed via blood and lymph. If venous transport is impaired, i.e. when the heart pumps more blood into the leg than the veins can remove, lymphatic fluid will accumulate. This is when the ankles and lower legs start to swell. Additionally, the blood pools in the legs and feet, with the result that veins widen so that the venous valves can no longer close properly. Because of this additional reflux, veins can even bulge. The venous blood vessels in the lower legs are particularly affected by this. This condition is referred to as congestive edema or venous edema.
But why do some people suffer from impaired venous transport while others don’t? There are many indications that the cause is largely based on congenital predisposition. The firmness of the connective tissue around the venous blood vessels and the function of the valves have different compositions in different individuals, which is why the veins succumb earlier in some people than in others. Additionally, a lack of exercise and obesity are also risk factors.
The extensive circulatory system transports blood into the furthest parts of the extremities. After all, oxygen and nutrients are needed everywhere. Blood low in oxygen is sent back to the heart via the venous blood vessels. When blood supplies the toes, it has a long way to go: the journey down to the toes is not a problem, thanks to the heart beat and gravity. But the opposite direction is not so easy. While the circulatory system does create a type of push-pull effect, gravity still has to be overcome. This is what the venous valves help with. They make sure that the blood cannot flow back. This is particularly important if the leg muscles don’t support the work of the veins with movement. That’s why extended periods of sitting or standing are often a reason for “water in the legs”.
Initially, slight swelling occurs when it’s hot or after a lot of standing or sitting. The legs feel heavy, the skin becomes taut, and an indentation can be made when the skin is pushed with a finger. Simple elevation alleviates pain and reduces swelling. But if the problems appear regularly, the veins will change under the strain and spider veins will form initially, later on varicose veins. If left untreated, these changed blood vessels pose an increasing risk to health:
- an increased risk of thrombosis
- a risk of skin changes in the lower leg region as well as infections caused by constant swelling of the tissue
- insufficient nutrient supply to the skin owing to the edema can result in even small wounds no longer closing, therefore leading to venous leg ulcers
These serious long-term effects highlight one thing: weak veins, also known as CVI (chronic venous insufficiency), is a condition that must be taken seriously and not be ignored or left untreated. In addition to your general practitioner, your specialist for venous disorders (phlebologist) is your contact partner for comprehensive explanations about the different treatment options which are used depending on the severity of the impaired venous drainage.
- Compression therapy: supporting the natural pumping action between muscles and skin via external pressure
- Physiotherapy/exercise: regular sporting activities with targeted exercises for the legs activate and strengthen the muscle pump
- Surgery: removal of damaged veins or varicose veins, if the condition has progressed
- Medication: plant-based products for external and internal strengthening of the veins
Many of the treatment options mentioned can easily be combined. Medication can alleviate accompanying symptoms and support the effects of compression therapy. Adding exercise also boosts the impact.
If there’s a tendency toward swollen ankles, water in the legs, or venous edema, phlebologists recommend daily wearing of compression stockings, such as VenoTrain compression stockings, as a preventive measure. These medical aids exert additional external pressure, thus supporting the muscle pump during movement in its function to improve venous blood flow. During long periods of sitting or standing, external compression also has a positive effect on the removal of the edema fluid, and prevents major swelling of the legs. VenoTrain compression stockings with mild and moderate compression, such as the VenoTrain micro or VenoTrain soft, provide the leg veins with noticeable relief in all situations if there is a tendency toward developing edema and during the initial stages of vein weakness. If the vein weakness has already progressed, VenoTrain compression stockings with powerful compression will be a better choice. The VenoTrain impuls stocking provides support even with minor muscle movement, therefore granting noticeable relief to the leg veins. The soft microfiber material makes VenoTrain compression stockings particularly comfortable, breathable, and easy to care for.
Lipedema in the thighs is also known as saddle bag syndrome.
Edema FAQs: Frequently Asked Questions
Depending on your diagnosis, different compression stockings are used. An impaired lymphatic system affects individual body shapes in various ways. That’s why compression stockings should be custom-made. VenoTrain curaflow products are custom-made for each individual and are available in a variety of compression classes. The general rule is that lymphedema is almost exclusively treated with flat knit products and venous edema with circular knit products, using the compression class specified by the physician based on the severity of the edema. Your medical retail experts will then advise you on material and size of the right product based on these specifications.
Do I need a prescription for compression stockings if I suffer from edema? Will the health insurance company pay?
Strictly speaking, you can get compression stockings without a prescription from your physician. In this case, you will bear the full costs yourself.
Custom-made compression stockings used for lymphedema, lipedema, or venous edema, should be prescribed by a medical specialist. Based on the prescription, a medical supply retailer can provide a quote. The health insurance company often bears the full costs, you merely have to pay the prescription charge. With the relevant medical prescription, you can get new compression stockings twice a year, in exceptional circumstances even more often.
As a general rule, compression stockings should be worn every day, for the whole day. They promote lymph flow, thus preventing the edema progressing. They also alleviate pain and improve mobility.
Wearing compression garments should not be painful. Talk to your physician or medical supply retailer if you feel uncomfortable and ask them to check whether there may be other causes for your pain and whether you need to be refitted for stockings.
You should take your stockings off at night because your body is in a horizontal position for a long time and the vessels don’t need to constantly fight gravity. Compression stockings are most effective during movement!
Compression stockings are worn close to the skin and exert therapeutic pressure. Dust particles, skin bacteria, and skin cells therefore accumulate in the stockings by the end of the day. If these are not removed, the effectiveness of the compression stockings may be compromised. You should therefore wash them every day. It’s best to clean them by hand or in a washing machine at 30 degrees Celsius using a mild detergent. Don’t use fabric softener. Leave the compression stockings to air-dry (rather than using a tumble drier or radiator) to protect the fibers and preserve the effectiveness of the stocking for as long as possible.
Compression stockings must lie right on the skin to provide you with maximum effectiveness. So the skin doesn’t become irritated, make sure the stocking is made of soft, skin-friendly material when you choose the appropriate model. This helps the skin to dispel moisture and it can “breathe” at the same time.
Custom-made compression stockings for lymphedema or lipedema are usually flat knit products. The flat knit is joined with a seam whose properties also have a huge impact on wearing comfort. Flat and soft seams prevent pressure points and chafing.
The general rule is that skin care is essential because the underlying disorder affects the condition of the skin. Wearing the medical compression stockings is necessary but it does subject the skin to particular strain. Special skin care products that can also be used before putting on the stockings can soothe your skin. When you take off your stockings, skin care is like a spa treatment for your skin, helping to prevent dryness.
Depending on how much the edema has progressed, the body’s tissue needs more or less external support. Thanks to its design, the (compression) pressure exerted by the compression stocking on the leg and therefore the tissue under the skin as well as the veins and lymph vessels in it is divided into compression classes (Ccl.). Ccl 1 stands for gentle compression, for example being used during the initial stages of chronic venous insufficiency. Ccl 4 is the most powerful compression class which is rarely used, for example when treating highly advanced stages of lymphedema.
Lymphedema can be divided into several stages, depending on progression and severity of the condition.
- Stage 0: damage to the lymphatic system without visible edema
- Stage 1: soft swelling that can be indented and subsides when elevated
- Stage 2: hard swelling, possibly accompanied by pain and/or restrictions in movement
- Stage 3: a significant increase in edema circumference, sometimes with extreme dimensions
The stages are used as an indication for how high the pressure (compression) and therefore the compression class should be. Your treating physician can tell you which class is right for you.
Unfortunately, chronic edema is often identified as a serious condition quite late. So if you suspect you might have it, don’t hesitate but get examined. In addition to your general practitioner, you should consult a specialist, for example a specialist in internal medicine, a vascular specialist, a phlebologist, or a lymphologist. These medical experts have the required technical equipment and specialist knowledge to identify the cause of the edema and diagnose you. You can then discuss subsequent treatment together.