Lymphoedema is chronic swelling of a limb or region caused by impaired drainage of lymph fluid, not by too much water in the body. The lymphatic system is a network of fine vessels that collects fluid and protein from the tissues and returns it to the blood through lymph nodes. If that network is damaged, or its nodes are removed, fluid accumulates in the tissue and over time the skin becomes thickened and fibrous. The commonest secondary causes are removal of lymph nodes or radiotherapy during cancer treatment, repeated skin infections, and injury; a minority of cases are congenital and appear at a young age. Diagnosis begins with clinical examination and repeated measurement of limb circumference, and conditions that mimic it are excluded: deep vein thrombosis, chronic venous insufficiency, heart failure, kidney, liver and thyroid disease, and tumours pressing on vessels. Assessing arterial supply is essential before any compression is prescribed, because external compression harms a limb with poor arterial flow. The mainstay of treatment is not a drug but complete decongestive therapy: specialised manual lymphatic drainage, then multilayer bandaging which, once the volume improves, is replaced by properly fitted compression garments, combined with movement exercises and meticulous skin care to avoid infection. In selected cases surgery is considered: joining a lymphatic vessel to a vein, transferring lymph nodes, or reducing the bulk of fibrotic tissue. The limits are clear. Lymphoedema is usually a condition that is managed rather than fully cured, and compression is a permanent part of that management, not a course that ends. Diuretics are not a treatment for it — a widespread myth that causes dehydration and salt disturbance without helping the limb. What suits your case is decided by clinical examination, not by reading.
Procedure steps
- 1
Diagnosis and excluding other causes
The doctor asks how the swelling began and progressed and about any previous surgery, radiotherapy or skin infections, and examines the skin for pitting and thickening. Tests and studies are requested to exclude venous thrombosis, heart failure and kidney, liver and thyroid disease, and arterial perfusion is measured before compression is even considered.
- 2
Measurement and building the treatment plan
Limb circumference is measured at defined points, compared with the other side and recorded as a baseline for progress, with imaging where needed. A written plan is agreed: the number of drainage sessions, the type of bandaging, the dates for re-measurement, and specific exercises that fit your work and daily routine.
- 3
Manual lymphatic drainage
A trained therapist uses gentle, superficial strokes in a defined sequence, starting in healthy regions to open drainage pathways before moving fluid out of the swollen limb. This is not vigorous massage; forceful pressure damages the delicate lymphatic vessels rather than helping them, and sessions are built up gradually.
- 4
Multilayer bandaging then compression garments
The limb is wrapped in graded layers that hold on to the volume reduction achieved between sessions, and the technique is taught to those who can manage it at home. Once the volume stabilises you are measured for a compression stocking or sleeve at a strength the doctor specifies, and it is replaced whenever it loses elasticity, because a loose garment does nothing.
- 5
Follow-up, skin care and the surgical option
Measurements are followed and the plan adjusted, and you are taught daily skin care to prevent the recurrent infections that make lymphoedema worse. If swelling remains resistant despite full adherence, a selected surgical option is discussed — lymphovenous anastomosis, lymph node transfer or tissue reduction — with its benefits and its limits explained honestly.
Before the procedure
Bring your full medical records, especially details and dates of any cancer surgery, lymph node removal or radiotherapy, since these explain the swelling in most cases. Write down when the swelling began and whether it eases overnight, and record how many episodes of skin infection you have had and when. Bring a complete list of your medicines, and say if you are taking diuretics — they are not a treatment for lymphoedema, and you should not stop them on your own either. Wear clothing that allows the whole limb to be examined and bring any compression stockings or sleeves you already use. Do not shave the limb with a razor beforehand, do not apply perfumed creams, do not massage the limb forcefully, and tell the team about any cut, redness or fever before a session.
After the procedure
Wear your compression garment every day in the manner and for the duration prescribed, put it on in the morning before swelling builds up, and replace it once it loses elasticity. Care for the skin daily: unperfumed moisturiser, avoid cuts and scratches, never shave irritated skin with a razor, and wear gloves for housework and gardening. Avoid blood samples, blood-pressure cuffs and injections on the affected limb. Move the limb with gentle daily exercises and elevate it while resting. Keep to a healthy weight, and do not rely on diuretics, which are not a treatment for lymphoedema. Seek care immediately if: **the limb becomes red, hot and painful with fever or shivering** (possible spreading skin infection needing urgent treatment) · **a leg suddenly becomes painful, swollen and warm** (possible deep vein thrombosis — do not massage the leg and do not wait for an appointment) · **chest pain or breathlessness follows a leg clot** (possible pulmonary embolism — emergency now) · the limb enlarges unusually fast, becomes numb or weak, breaks down or leaks fluid, or the skin changes in texture or colour.
Expected duration
A drainage and bandaging session usually takes forty to sixty minutes and is repeated several times a week during the intensive phase, which commonly lasts two to four weeks depending on response. You then move to long-term management with compression garments and exercise, with periodic reviews for re-measurement.
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