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Lower Body Lymphedema
Francine Manuel, RPT
Just as lymphedema of the upper extremities can become a complication after post surgical removal of breast cancer, lymphedema of the lower extremities can be a debilitating condition with several cancers. Prostate, lung, liver, lymphomas, ovarian, and abdominal cancers can cause swelling of the legs. The swelling can come from any compression or surgical removal of the lymph nodes in the lower body. It can also come secondarily to production of fluid into the abdomen (ascites) which spreads into the legs. When under treatment for any cancer, if your protein levels fall into lower levels, fluid will leak into your whole body including legs.
Refer to the article on upper extremity edema for treatment Introduction and Treatments for Lymphedema. Many of the same precautions exist with any edematous extremity. When you first notice swelling in your legs, you need to act to reverse it. Once you let the legs blow up to large size, it is harder to reverse the process. Often medication is needed to help eliminate water. This must be discussed with your doctor. The use of elastic stockings with at least 30 mm hg pressure is the first step. If the edema is only at the ankles and feet, then you only need stocking to the knee. Any medical supply store can help fit the stockings. You should read the package and measure your ankle,calf and the length from the knee to the heel so that you are sure that they fit you correctly. These measurements are usually listed on the box. If the edema goes up to the knee or past, you will need thigh high stockings. You must keep pulling these up as the stocking fall down with wear during the day. The stockings are all hard to apply. You need someone with strong hands. Sometimes it helps to wear rubber gloves to get a better grip on the stockings. There are also leotards for edema that goes above the thigh. When you apply these stockings, they should be perfectly smooth. If you leave wrinkles, it will become painful underneath or you can cut the circulation in that spot. The stockings should be worn through the day from when you first get up. You do not sleep with them on. At night you remove the elastic hose and elevate your legs on pillows in the bed. Try to get them above your heart. You can wrap legs with elastic wraps.
This is difficult to do correctly. The wraps should be on a diagonal. If you go in straight circles, you could end up with a turnicate like constriction of the leg and make the edema worse. If you develop numbness in your toes or coldness, that means that you have wrapped it too tightly. You should totally remove it and apply it again.
For men, often the edema will go up into the scrotum. You should also elevate your penis at night to try to empty the water back in to the abdomen. Wearing a jock strap helps support the heavy and often painful scrotal sack when you are up and about.
When the edema is not responding, you can use the external pump devices. The devices can be turned up to 60mm hg alternating pressure for the legs. You must stay on for 3-4 hours with the involved extremity or extremities elevated during the treatment. These devices can be rented from a medical supply house. They are usually covered by insurances. After pumping you must then wear the elastic stockings until bed time. You pump daily for 2-3 weeks to get the severe edema under control. You can also go to outpatient physical therapy or edema clinics for treatments.
When you are sitting you need to elevate your legs during the day or lie down at intervals with the legs elevated on pillows. Do not wear tight shoes as any kind of constriction only adds to the edema above or below the constriction. You must also be very careful not to cut yourself or open the skin. You must immediately see an MD if you have a weeping sore. It will take careful treatment to heal it without infection developing. Sometimes antibiotics are necessary.
Exercises like pumping your feet up and down, leg kicks, going up and down on your toes in standing will help decrease edema. A regular exercise program of walking, exercise with light weights or any kind of movement activity is also helpful. In some instances, decreasing your salt intake becomes necessary.
Massage of the legs is also helpful in reducing the edema. You elevate your legs during the massage. THe person rubbing should only rub in the direction toward your heart. You start at the toes and push gently, but firmly up the leg all the way into the groin. This is done for 15 to 20 minutes on each leg.
Other precautions are to be careful with heat or ice on severely swollen legs. That includes your shower or bath water. Bathe legs with regular soaps and rinse well. If you develop athlete's foot, be sure to treat it with one of the common sprays or powders. Be careful cutting your toenail. Get treatment for ingrown toe nails. The problems are more complex when severe edema is involved.
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