What is a normal lymphatic system like?                                                              

The lymphatic system is similar to the blood system and has just as many vessels - but they contain lymph, which is clear and so cannot be seen (unless a suitable dye is injected). The lymphatics differ from the blood system in that the blood continually circulates through each part of the body while the lymph just drains from each part. Lymphatics drain away the excess protein and water which continually escape from the blood in small amounts, plus some substances made in the tissues, and any foreign substances which enter them. Lymphatics start, in almost every tissue, as many tiny vessels which gradually join together into bigger ones. What else happens?

Lymph is pumped into and along these vessels by the movements of adjacent muscles and by the contractions of the walls of the larger lymphatics. This pumping is aided by many valves inside the vessels. Finally the lymphatic system empties into the blood (largely in the lower neck). On its way along the lymphatics, the lymph is filtered in the lymph nodes (lymph glands). These remove foreign matter (e.g. bacteria) and start any necessary immune reactions.

What does the normal lymphatic system do?

The lymphatics help to remove the excess fluid and protein which enters the tissues from damaged blood vessels, in any inflammation (e.g. after a burn, or other injury). If they cannot remove it all, the part swells (oedema, edema). However, this swelling is usually only temporary, because the tissues heal and the blood vessels no longer leak excessively.

In an acute injury, e.g. a sprained ankle, the lymphatics are essentially normal. Although there is initial swelling, this is gradually removed over days to weeks. The overload is only temporary although, depending on the severity of the injury, some fibrosis will occur. This may remain for months or even permanently.  Both the venous and lymphatic systems have the job of removing waste substances. The veins cannot do this alone because large molecules such as proteins cannot fit into the veins and must be removed by the lymph vessels.

What is lymphoedema?

Lymphoedema is the accumulation of excessive amounts of protein-rich fluid resulting in swelling of one or more regions of the body. Lymphoedema is a gradually progressing condition. It causes swelling and occurs when the body’s lymphatic transport capacity becomes permanently overloaded. This is due to a mechanical failure of the lymphatic system and occurs when the demand for lymphatic drainage exceeds the capacity of the lymphatic circulation. The condition usually affects the limb(s) although it may also involve the trunk, breast, head and neck or genital area.

What are the signs of lymphoedema?

Can include the following:

·         Swelling of all or part of the arm

·         Swelling in the hands and fingers

·         Swelling in the breast/chest or armpit region

·         Feelings of heaviness, pain, aching, tightness or ‘bursting’ in the arm or the hand

·         Skin changes, feeling more sensitive to touch

·         Difficulty putting on clothing, with the sleeves feeling tight.

Sometimes swelling associated with lymphoedema is often aggravated by heat, at the end of the day, with overuse, with sustained positions and prolonged inactivity. 

What are the different types of lymphoedema?

1.      Primary lymphoedema: develops from a birth abnormality within the lymphatic system.  Can occur from birth, or develop in teenage years, or in later adulthood.

2.    Secondary lymphoedema: develops following radiation therapy or following axillary clearance and lymph node removal.  Can also occur from scarring to the lymphatic vessels from surgery/injury.