Lymphedema is the name for an observable accumulation of fluid in interstitial spaces (between cells) that is caused by mechanical insufficiency(disturbance) of the lymphatic system.
This results in an incapacity of the lymphatic system to drain a sufficient volume of fluid, leading to a back-up which is referred to as “lymphedema”.

In many cases, minor and/or major lymphatic vessels are disrupted by surgery, injury, radiotherapy or infection.

As a result of the damage to the lymphatic system, the remaining vessels are no longer capable of draining the fluid accumulating in tissue, and lymphedema develops.

The most common cause for secondary lymphedema is cancer surgery involving removal and/or radiotherapy of the lymph nodes.

The probability of edema occurring decreases continually following surgery, provided that the patient takes steps to avoid it. This means that patients absolutely must give the highest priority to preventing lymphedema. Sometimes edema does not occur immediately after cancer treatment, but several months or even years later, despite the necessary precautions being taken; a medical specialist should be consulted in such cases to rule out the growth of any new tumors.

The following pages will provide you with detailed information about the various types of lymphedema and lipedema, as well as the treatment options in each case.

  • Secondary lymphedema of the arm following surgery for breast cancer
  • Secondary lymphedema of the leg following surgery for abdominal cancer
  • Primary lymphedema
  • Phlebo-lymphedema
  • Head lymphedema
  • In many cases, the treatment of breast cancer requires the removal of lymph nodes. This surgical intervention often causes damage to the lymphatic system which compromises its effectiveness in draining fluids.
  • Fluids are no longer drained or are drained insufficiently.
  • Radiotherapy also affects the lymphatic system and its effectiveness. The imbalance between lymphatic load and lymph transport capacity following breast cancer surgery may result in a so-called secondary (=acquired) arm lymphedema. However, there are also cases of such edema – which is rarely painful – occurring in the chest.
  • Lymphedema frequently does not occur immediately after surgery but appears months or sometimes even years later.
  • The most common cause of secondary lymphedema is cancer surgery including removal and/or radiation of lymph nodes. The likelihood of edema formation diminishes as the post-operative period increases. To reduce the chances of developing lymphedema, patients need to follow very specific rules.If, however, a lymphedema does develop, it will require lifelong therapy. The treatment schedule will depend on the course of the disease. If left untreated, lymphedema will progress in most cases and can assume monstrous proportions (elephantiasis).
  • In such cases please consult your doctor so that he/she can make the necessary examinations to exclude the possibility that another tumor has developed.
  • After many years of experience in this area we regret to have to say: “Once an edema, a lifetime of edema.”There is no known cure for lymphedema, but it is possible to manage and control the symptoms through consistent treatment and strict observance of precautionary rules.

In many cases, the treatment of abdominal cancer requires the removal of lymph nodes. This surgical intervention often causes damage to the lymphatic system which compromises its effectiveness in draining fluids.

Fluids and other substances are no longer drained or are drained insufficiently.

Radiotherapy also affects the lymphatic system and its effectiveness. The imbalance between lymphatic load and lymph transport capacity following abdominal cancer surgery may result in a so-called secondary (=acquired) leg lymphedema.

There are rare cases where lymphedema involves the lower abdominal region or the genitals as well. The most common cause of secondary lymphedema is cancer surgery including removal and/or radiation of lymph nodes. The likelihood of edema formation diminishes as the post-operative period increases

To reduce the chances of developing lymphedema, patients need to follow very specific rules.

If, however, a lymphedema does develop, it will require lifelong therapy.

The treatment schedule will depend on the course of the disease. If left untreated, lymphedema will progress in most cases and can assume monstrous proportions (elephantiasis).

Primary lymphedema is an inherited abnormality of the lymphatic system. Its root causes are  lymph vessels are too few or too small, lymph nodes are too few or too small, lymph vessels and/or lymph nodes fail to function properly, or the causes are a combination of the above disorders

The lymphatic system has considerable reserve power, which is why it often takes years until its weakness becomes visible. It may be a simple sunburn which triggers system overload and is the last drop “to make the cup overflow”. As a consequence lymphedema will develop.Primary lymphedema usually begins in the distal leg area, i.e. the toes, in rare cases also in the hands. However, it may also develop in any other area of the body. Alongside the swelling, so typical of lymphedema, skin changes will also occur with progressing disease.

The skin in the edema area gradually thickens and coarsens.
If these changes occur at the base of the second toe, we talk of a “positive Stemmer’s sign”.

Skin changes in lymphedema

The skin in the affected parts of the body frequently shows the typical changes associated with primary lymphedema:

  • Wart-like lesions (papillomatosis)
  • Excessive growth of horny tissue of the skin (hyperkeratosis)
  • Lymph vesicles
  • Fistula (the name given to an abnormal duct or passageway that links two cavities in the body, frequently opening through the skin)

These skin changes worsen with the duration and severity of edema. This is why lymphedema must be treated as early as possible to prevent such changes from developing.

Too late a therapy may result in these changes no longer being fully reversible. Primary lymphedema is a chronic disease which cannot be cured, but it can be very well managed by therapy.

Possible causes of venous insufficiency include: a genetic predisposition to varicose veins thrombosis (or “post-thrombotic syndrome”)

The function of veins is to return blood to the heart. In other words, they pump blood “uphill”.

In order to avoid too much pressure building up, the veins in the legs in particular have special valves, spaced every 0.5 to 1cm apart, that prevent the blood from flowing backwards.
In the case of varicose veins, these valves no longer close properly. The pressure in the veins increases, particularly in the calves, since this section of the legs is farthest from the heart.

Long-term strain on the lymphatic system is considered to be the cause of phlebo-lymphedema. A greater volume of fluid from the blood vessels is forced (filtered) into tissue as a result of increased pressure in the veins. This excess tissue fluid is referred to by physicians as edema.

Patients suffer from congestion and swelling, particularly in the limbs. When the legs are propped up, the body reabsorbs the excess tissue fluid, draining it to the vessels once again. This means that in the morning, after getting up, the legs are not usually swollen any longer.

However, if much bodily waste is retained in the tissue, propping up the legs is no longer a sufficient remedy. The tissue hardens and phlebo-lymphedema develops.

Therapy Symptoms caused by varicose veins (i.e. heavy legs, tingling sensation, cramps) and/or associated edema can be most effectively treated by wearing compression stockings.

Stockings extending to the knee are usually sufficient. In order to achieve the best results, it is necessary to wear the stockings consistently; patients should especially keep them on under warm conditions. Even so, many patients do not wear their compression stockings when temperatures are particularly high.

We recommend to freeze a dry towel in the freezer and apply the cold towel on the legs.

If the skin has already some pathological changes, the lymphvessel system is damaged too. In this case we the most effective therapy is the socalled “complete decongestive therapy” which consists of Manual lymphdrainage, bandaging, skincare and exercises.

A lymphedema(swelling) of the face usually occurs as a consequence of cancer surgery involving the neck or face. Very often, lymph nodes are removed and treated by radiotherapy in the course of surgery for larynx, tongue or thyroid cancer.

In all cases, the lymphatic system’s ability to drain fluid is reduced as a result. Lymphedema occurs, appearing as a swelling in the cheek or below the jawbone (mandible).

The same procedures are used the world over for treating secondary arm and leg lymphedema, and training in these methods is provided by a variety of institutions.

Yet the treatment of head lymphedema depends entirely on where the incisions took place during surgery, as well as on the number of lymph nodes removed and the frequency and intensity of radiotherapy. Additionally, a major factor determining the success of therapy is whether surgery or radiotherapy was performed on only one side or on both.

Patients often complain of difficulties in swallowing and speaking. Dryness of the mouth is another symptom, as the salivary glands have often been affected as well.

The associated psychological stress is considerable since, unlike the arm or leg, the face cannot be concealed.

Medical literature documents that roughly one woman out of five will develop arm lymphedema within three years of breast cancer surgery and post-operative radiation therapy. Similar data are known for lymphedema of the legs following abdominal surgery.

Early intensive treatment of edema, as well as prophylaxis and health promotion, are the key services of the Indo-Lymph clinic

The Dr. Vodder Method of Manual Lymph Drainage or Lymphatic Massage is successfully applied at our Center. This special massage technique uses circular and spiral shaped movements. The strokes involve gentle skin-to-skin contact resulting in the skin being moved over the underlying tissue: the Dr. Vodder Method of MLD works with the skin and not on the skin.

It increases and decreases pressure, this change in pressure creating the necessary pumping effect. The direction of the increase of pressure lies in the direction of the lymph flow.

The technique is generally applied to dry skin. If the skin does not move in certain areas (e.g. due to scars, ulcer margins, firm edemas), or if the skin is very dry or rough, some oil may be applied.

In addition to Manual Lymph Drainage, another important pillar of lymphedema treatment is correct and consistent bandaging. (Compression) bandaging supports the positive effect of MLD.
Bandaging increases both lymph and venous return, and also serves to soften fibroses. Fibroses are changes in skin texture frequently associated with lymphedema. The proteins accumulated in the tissue cause the tissue to harden.

Compression stockings
Wearing compression stockings is indispensable for maintaining the positive effects of Dr. Vodder’s MLD. These stockings are given to patients for post-therapy use.

If patients wear their custom-made stockings on a daily basis, the success of their residential stay (edema volume reduction) will be maintained over a long period of time, during which venous and lymphatic return are stimulated and missing tissue pressure is substituted and compensated.

The Manual Lymph Drainage results in a marked reduction of edema. To maintain this result or improve it further, the therapist bandages the affected limb(s). Any movement with the bandaged limb will reduce edema volume for the following reasons:

  • a) In addition to the “pressure” of the bandages moving the extremity creates a strong compression with the muscels. All vessels (veins and lymphvessels)who are in between bandage and muscles will be drained by this force.This leads to an quicker bloodstream and improves a better backflow of the lymphatic system.
  • b) Needing more oxygene the arterial bloodstream will be raised automatically by an higher muscleacitivy. Close to the arteries a lot of lymphvessels are situated.The higher pulsation of the arteries has an stimulating effect on the lymphatic system. That’s why we have a better drainage of the deep lymph vessel system.

Which exercises are best suited for lymphedema patients?

The optimum decongestive exercise for the lower extremities is climbing stairs. We also recommend activities such as cycling, Nordic walking, hiking and walking.

Activities such as cleaning, cooking and washing will involve considerable use of the arm muscles. If your daily routine involves engaging in these activities, it is important to know that straining or overusing muscles may lead to inflammation and/or worsening of your edema.

The part of your body affected by lymphedema is more vulnerable to infection of the build-up of fluid within the tissues.

Any cuts on your skin can allow bacteria to enter your body and may quickly develop into an infection Thus, it is important to take good care of your skin to reduce your risk of developing an infection.

Currently, there is no cure or permanent remedy for lymphedema. The Transport Capacity in the damaged lymph vessels cannot be restored to its original level.

Although the swelling may recede somewhat during the night in some early stages, lymphedema is a progressive condition. Regardless of genesis, lymphedema, in most cases, will gradually progress through its stages if left untreated.

There are 4 stages of lymphedema

Stage 0: Subclinical stage
You may notice a heavy feeling in the affected area but not see any physical changes.

Stage 1: Reversible stage
The limb becomes enlarged or swollen.

Swelling improves at night and worsens during the day.

Elevating your limb helps temporarily reduce swelling.

If you push your finger on the affected area, it leaves an indentation.

Stage 2: Spontaneously irreversible stage
Pitting subsides, and the skin takes on a sponge-like appearance.

The swelling no longer changes from morning to night, and elevation does not help. This problem happens because the swelling is no longer from fliud, but from the formation of scar tissue.

Stage 3: Lymphostatic Elephantiasis
The skin is dry and flaky.

Fluid-filled blisters may form, which can increase the chance of infection.

The swollen, heavy limb may become difficult to move, affecting normal function and activities.


Where possible please bring your recent medical records (dating back the last three months)

  • The most recent oncologic findings (for cancer patients)
  • Recent blood chemistry including CRP and electrolytes (dating back no more than three weeks)
  • Recent cardiology findings (dating back no more than three months) for patients with known cardiac problems
  • Also bring your most recent compression stockings. (if you are wearing any)
  • Your shoes will need to be two to three sizes larger than normal to accommodate any bandaging.
  • Bring a loose fitting training suit that you feel comfortable in.

The extent and number of daily therapy sessions will be arranged in consultation with our therapist. You will receive at least one hour of Complete De-Congestive Therapy(CDT) per day as individual therapy. The daily minimum of therapy time is one hour from Monday to Saturday.