Treatment of Leg Lymphedema

Compression therapy

Compression stockings are made of fabric that puts a controlled amount of pressure on different parts of the leg to help move fluid and keep it from building up. Some patients may need to have these stockings custom-made for a correct fit. Bandaging (wrapping) can be an alternative. Wearing a compression stocking during exercise may help prevent more swelling in an affected limb. 

Exercise

Both light exercise and aerobic exercise help the lymph vessels move lymph out of the affected leg and decrease swelling. Exercises shouldn't be strenuous or tire you but should focus on gentle contraction of the muscles in your leg. A certified lymphedema therapist can teach you exercises that may help.

Leg and skin care

The goal of leg and skin care is to prevent infections: 

• Keep legs always clean.
• Use cream or lotion to keep the skin moist.
• Treat small cuts or breaks in the skin with an antibacterial ointment.
• Avoid needle sticks of any type into the affected leg (ask to have blood drawn from the other arm)
• Wear sunscreen and shoes when outdoors.
• Cut toenails straight across
• Keep the limb with lymphedema elevated as much as possible. Put it on a pillow when in bed.
• Do not cross legs while sitting.
• Change sitting position every 30 minutes.

Compression device

Compression devices are pumps connected to a sleeve that wraps around the leg and applies pressure on and off. The sleeve is inflated and deflated on a timed cycle. This pumping action may help move fluid through lymph vessels and veins and keep fluid from building up in the leg. Compression devices may be helpful when added to combined therapy. The use of these devices should be supervised by a trained professional because too much pressure can damage lymph vessels near the surface of the skin.

The device is usually used at night. If your doctor recommends it, you’d better try it first before buying it.

Massage therapy

Massage therapy for lymphedema should begin with someone specially trained in treating lymphedema. In this type of massage, the soft tissues of the body are lightly rubbed, tapped, and stroked. It is a very light touch, almost like a brushing. Massage may help move lymph out of the swollen leg. Patients can be taught to do this type of massage therapy themselves.

When done correctly, massage therapy does not cause medical problems. Massage should not be done on any of the following: 

• Open wounds, bruises, or areas of broken skin.
• Deep vein thrombosis (blood clot in a vein).
• Sensitive soft tissue where the skin was treated with radiation therapy.

Weight loss

In patients who are overweight, lymphedema may improve with weight loss.

Combined therapy

Combined physical therapy is a program of massage, bandaging, exercises, and skin care managed by a trained therapist. At the beginning of the program, the therapist gives many treatments over a short time to decrease most of the swelling in the limb with lymphedema. Then the patient continues the program at home to keep the swelling down. Combined therapy is also called complex decongestive therapy.

Drug therapy

Lymphedema is not usually treated with drugs. Antibiotics may be used to treat and prevent infections. Other types of drugs, such as diuretics or anticoagulants (blood thinners), are usually not helpful and may make the lymphedema worse. Diuretics may alleviate symptoms temporarily, but they should generally be avoided. Check with your doctor.

Surgery

Lymphedema is rarely treated with surgery.