The recommended treatment for lymphoedema is a treatment plan called Complex Decongestive Therapy (CDT). It is also known as Decongestive Lymphatic Therapy (DLT).
CDT is not a cure for lymphoedema, but it can help control the symptoms of swelling and pain. Although CDT takes time and effort, it can be used to effectively control your lymphoedema.
Complex Decongestive Therapy (CDT)
There are four components to CDT treatment:
- Manual lymphatic drainage (MLD) is a specialised massage technique designed to stimulate the flow of fluid and reduce swelling.
- Multilayer lymphoedema bandaging (MLLB) uses bandages and compression garments to move fluid out of the affected limb.
- Remedial exercises designed to activate muscles in the limb to improve lymph drainage.
- Skin care is required to prevent infection.
Each of these treatments is described in more detail below.
CDT begins with an intensive phase of therapy, during which you may receive daily treatment for up to six weeks. This is followed by the second phase, known as the maintenance phase. During the maintenance phase, you will be encouraged to take over your own care using simple lymph drainage techniques (MLD administered by either yourself or a carer) and exercise while wearing compression garments.
You will then have regular six-monthly review meetings to check how your treatment is progressing.
Manual lymphatic drainage (MLD)
During manual lymphatic drainage (MLD), your lymphoedema therapist will use special massage techniques to move fluid from the swollen areas into working lymph nodes where it can be drained.
It is important you receive MLD from a trained lymphoedema therapist and not a regular masseur. This is because the technique requires a detailed knowledge of the lymphatic system to be performed correctly.
Your lymphoedema therapist will also teach you a range of massage techniques you can use during the maintenance phase.
MLD can make some existing health conditions worse. For example, it may not be suitable if you currently have cancer, or a history of:
- heart disease – where your heart’s blood supply is blocked or interrupted by a build-up of fatty substances in the blood vessels around your heart
- deep vein thrombosis (DVT) – a blood clot in one of the deep veins in the body
Multilayer lymphoedema bandaging (MLLB)
Unlike the blood circulation system, there is no central pump, such as the heart, to move fluid around the lymphatic system. Instead, the lymphatic system uses the massaging effect of the muscles surrounding the lymph vessels and nodes to move the fluid.
The aim of multilayer lymphoedema bandaging (MLLB) is to support the muscles during exercise and encourage them to move fluid out of the affected limb. MLLB is often used after a session of MLD to prevent fluid accumulating in the limb again.
You will be taught how to correctly apply your own bandages and compression garments so you can continue to use MLLB during the maintenance period.
Remedial exercises
Remedial exercises are designed to strengthen muscles involved in lymph drainage. You will be given an exercise plan tailored to your requirements and ability.
Skin care
Taking good care of your skin is important because it will reduce your risk of developing an infection, such as cellulitis. You should be given a daily routine to follow, where you are required to meticulously clean your skin and check for any cuts, abrasions or signs of infection.
Read information about preventing lymphoedema for more advice about skin care.
Surgery
In some cases, a surgical procedure using liposuction (where a tube is used to suck fat out of tissue) can be used to treat lymphoedema.
Liposuction is used to remove excess fat from the affected limb to help reduce swelling. Once the surgery is complete, you will have to wear a compression garment on the affected limb for at least a year.
The National Institute for Health and Clinical Excellence (NICE) has announced that liposuction for chronic (long-term) lymphoedema is acceptable in terms of clinical safety. However, NICE states there is currently no evidence about its long-term effectiveness or whether there are risks of long-term complications.
Access to liposuction for lymphoedema may be limited depending on what is available from your local primary care trust.
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