Signs and Symptoms of Lymphedema
Lymphedema can develop in any part of the body or limb(s) where lymph nodes or vessels have been removed or damaged. Signs or symptoms of lymphedema include sensations of fullness or heaviness in the limb(s), tightness of the skin, visible swelling, difficulty fitting into clothing or shoes, or changes in the fit of jewelry. Any noticeable symptoms and signs of swelling in the limb or body region, warrant medical attention even if the swelling seems to go away completely.
Lymphedema develops in a progressive manner, from mild to severe, making early identification of the condition important. The stages of lymphedema are:
Stage 0 (Latency)
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 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 to prevent the onset of the condition. Special imaging or other lymphatic technology is required for diagnosis in this stage.
Stage 1 (Spontaneously Reversible)
In this early stage, swelling may or may not be present all the time. Swelling many 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 out treatment for lymphedema management at this early stage to help to prevent the condition from becoming progressively more swollen.
Stage 2 (Spontaneoulsy Irreversible)
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 to reduce limb volume and improve tissue. The treatment will be more intensive and will require more vigilant follow up to maintain the swelling.
Stage 3 (Lymphostatic Elephantiasis)
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 into decrease or loss of 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.