Lymphedema is a chronic medical condition characterized by swelling, typically affecting an arm or a leg, though it can manifest in other body parts. It develops when the lymphatic system, a vital network responsible for draining excess fluid and fighting infection, becomes damaged or blocked, leading to a buildup of protein-rich fluid in the tissues that results in a feeling of heaviness and sometimes restricted movement. Compression garments are elastic garments that apply pressure to the affected area, commonly used to manage swelling and support circulation. While these garments are an important part of lymphedema management, some individuals worry their use could inadvertently worsen the condition. This article explores how compression therapy functions and the specific circumstances where compression garments might worsen lymphedema.
How Compression Garments Aid Lymphedema
Compression garments work by applying controlled, graduated pressure to the affected limb, strongest at the extremity and decreasing towards the body’s core. This external pressure provides needed support to the compromised lymphatic vessels, helping to move lymphatic fluid away from the swollen area. The consistent pressure helps reduce fluid leakage from capillaries into tissues and improves lymph reabsorption and transport back into the circulatory system.
The garment, combined with muscle movement during daily activities, creates a massage-like effect that further propels fluid through existing lymphatic pathways. This mechanical assistance prevents fluid re-accumulation, controls swelling, and can soften hardened tissues that sometimes develop with lymphedema. By consistently supporting lymphatic drainage, compression garments help maintain limb size, reduce discomfort, and prevent the progression of lymphedema.
Factors That Can Worsen Lymphedema
While compression garments are beneficial for lymphedema, certain factors can undermine their effectiveness or even worsen the condition. Improper fit and sizing are key concerns. A garment that is too tight can create a tourniquet effect, impeding both lymphatic and venous flow above the compressed area, potentially leading to increased swelling in uncompressed regions or even nerve damage, causing numbness or pain. Conversely, a garment that is too loose will not provide the necessary therapeutic pressure to support fluid movement, making it ineffective for swelling management.
The type of garment and its pressure level are important. Lymphedema often requires specific garment materials and compression strengths. Flat-knit garments, with seams and less elasticity, are recommended for lymphedema. They provide higher, consistent pressure and better contain irregular limb shapes and skin folds than seamless, more elastic circular-knit garments, which might roll or constrict. Using an incorrect pressure level, either too low for the severity of swelling or excessively high, can hinder effective fluid drainage or cause discomfort and skin issues.
Improper application or wearing habits can also lead to complications. Garments that are rolled down, especially at the edges, can create a constrictive band, restricting flow and causing fluid to pool, making swelling worse directly above the rolled area. Wearing garments for extended periods without appropriate breaks, or wearing daytime garments during sleep, can also cause issues unless advised by a therapist, as this can impede circulation or lead to skin breakdown.
Certain underlying medical conditions can make compression therapy unsafe or detrimental without careful medical oversight. For individuals with peripheral arterial disease (PAD), where blood flow to the limbs is already compromised, standard compression could further reduce arterial circulation and lead to tissue damage. Similarly, severe congestive heart failure (CHF) requires cautious use of compression, as increasing fluid return to the heart could worsen cardiac function. Nerve damage, such as diabetic neuropathy, can also increase the risk of skin injury due to reduced sensation, making careful monitoring important.
Finally, skin irritation or infection can be exacerbated by compression garments. The constant pressure and potential for moisture buildup beneath the garment can create an environment conducive to skin breakdown, chafing, or fungal infections. If existing skin issues like wounds or cellulitis are present, compression can trap bacteria, delay healing, or spread infection, requiring temporary removal of compression until the skin condition improves.
Identifying and Addressing Issues
Recognizing signs that a compression garment might be negatively affecting lymphedema is important for timely intervention. Increased swelling, particularly above the garment’s edge, is a strong indicator that fluid is being displaced rather than managed effectively. Other localized swelling or a feeling of increased heaviness in the limb also warrant attention.
Discomfort and pain are common side effects of compression therapy. A garment that feels too tight, causes numbness, tingling, or a pins-and-needles sensation, or leads to changes in skin color, suggests excessive pressure or a tourniquet effect. Skin changes like redness, chafing, or the development of blisters or sores are also important warning signs, indicating friction or moisture buildup. The formation of new skin folds or the deepening of existing ones can also signal that the garment is not providing even compression or that fluid is pooling.
If any of these symptoms appear, it is important to take immediate action. The garment should be removed if it is causing pain, numbness, tingling, or changes in skin color. While minor adjustments might be attempted, such as smoothing out wrinkles or ensuring proper donning, extensive self-adjustment is not recommended. Promptly seeking professional medical advice from a certified lymphedema therapist or healthcare provider is important. They can assess the fit, address any underlying issues, and recommend appropriate changes to the compression therapy plan, ensuring the continued safety and effectiveness of treatment.
Best Practices for Compression Therapy
Ensuring compression therapy is both safe and effective requires adherence to specific practices. Professional consultation is important; a certified lymphedema therapist (CLT) possesses specialized training in lymphedema management, including precise garment measurement and fitting. They assess individual needs and recommend the appropriate garment type and compression level, which is important for good results.
Regular assessment by a healthcare provider or CLT is also necessary. Lymphedema can change over time, and periodic re-evaluation of limb size and shape ensures the garment continues to provide effective and safe compression. Garments themselves lose elasticity and compression strength over time, typically requiring replacement every 4 to 6 months, and a professional can determine when a new garment is needed.
Careful skin care is an ongoing practice to prevent irritation and infection. Daily cleansing with mild, pH-neutral cleansers, followed by thorough drying, especially in skin folds, helps maintain skin integrity. Fragrance-free, hypoallergenic moisturizers should be applied at night after garment removal to keep skin hydrated and supple, reducing friction and dryness.
Patient education is important for long-term management. Understanding how to correctly don and doff garments prevents damage to the garment and skin while ensuring proper fit. Patients should also be taught how to care for their garments through daily washing and air-drying, which maintains their therapeutic properties.
Open communication with the healthcare team is important. Patients should report any changes in symptoms, discomfort, or skin issues promptly. This collaborative approach allows for timely adjustments to the treatment plan, addressing concerns before they escalate and ensuring compression therapy remains a supportive and beneficial component of lymphedema management.