Stages of Lymphedema

Lymphedema begins to develop deep within the tissues and can progress very slowly. Early changes happen without obvious, noticeable swelling. However, the fluid congestion causes sensations such as tightness, heaviness, or diffuse tingling in the at-risk limb. Despite the normal appearance of the limb, there may be sub-clinical changes occurring that can be measured and identified.

Responding to changes in this early stage can help prevent the onset of the condition. Special imaging or other lymphatic technology is required for diagnosis in this stage.

In this early stage, swelling may or may not be present all the time. Swelling may come and go intermittently. When swelling is present, the skin will “pit,” meaning that the area indents with pressure and holds the indentation. Elevation of the swollen limb provides relief and reduction in the swelling.

It is important to seek treatment for lymphedema management at this early stage to help prevent the condition from becoming progressively more swollen.

In this stage, the tissue now has obvious signs of stagnant swelling that do not go away with elevation. The tissue will be firmer and show signs of less pitting. The tissue consistency change is caused by the formation of fibrosis. Fibrosis is the scarring of the tissue due to the prolonged presence of stagnant lymph.

This marks the beginning of the hardening of the limb and progressively more aggressive swelling. Seeking treatment at this stage will help reduce limb volume and improve tissue. The treatment will be more intensive and will require more vigilant follow-up to maintain the swelling.

At this stage, the tissue becomes very hard (fibrotic) and may begin to develop thickening on the surface of the skin. Excess skin forms on the limb and there is greater potential for open, seeping areas. Due to the high concentration of lymph fluid, the swollen limb(s) becomes an ideal culture medium for bacteria to thrive, and recurrent infections may be common.

Moreover, untreated lymphedema can lead to decreased or lost functioning of the limb(s), skin breakdown, chronic infections, and sometimes irreversible complications. Treatment is still beneficial at this stage and can have a remarkable impact on tissue softening and decongestion of the swelling.

These stages represent the natural progression of lymphedema when the condition is left untreated. At any stage, lymphedema can be treated and the progression halted and, in some instances, reversed. The importance of early identification and early management should be stressed.