“Lymphoedema is not just swelling — it is a chronic condition that affects every aspect of a person’s life. Early diagnosis and the right treatment plan can make an enormous difference.”
Written by Dr Rahul Agarwal, Consultant Vascular & Endovascular Surgeon
CARE Hospitals, Banjara Hills, Hyderabad
Lymphoedema is a form of chronic swelling caused by a damaged or blocked lymphatic system — the network of vessels that drains excess fluid from the body’s tissues back into the bloodstream. Unlike the swelling from heart failure or kidney disease, lymphoedema does not respond to diuretics. It tends to worsen over time if untreated and can lead to recurrent infections, skin changes, and significant disability.
🦠 Types of Lymphoedema
Primary Lymphoedema
Caused by congenital abnormalities of the lymphatic system. Can present at birth (Milroy’s disease), at puberty (lymphoedema praecox), or later in life. Less common than secondary lymphoedema.
Secondary Lymphoedema
Caused by damage to the lymphatic system from an external cause. The most common causes worldwide include filariasis (a parasitic infection common in tropical countries including parts of India), cancer treatment (surgery removing lymph nodes, radiation therapy), trauma, and infection.
🦥 Symptoms
- Progressive swelling of the arm or leg that does not resolve overnight
- A heavy, aching sensation in the limb
- Skin that feels tight and may thicken or harden (fibrosis)
- Recurrent episodes of cellulitis (skin infection) in the swollen limb
- Difficulty fitting clothes or shoes on the affected limb
🔬 Diagnosis
Diagnosis is clinical in most cases — based on the history and examination. Where the cause is uncertain, investigations include duplex ultrasound (to exclude venous disease), lymphoscintigraphy (nuclear medicine imaging of lymph flow), and MRI lymphangiography for complex cases.
💉 Treatment
Lymphoedema is a chronic condition managed rather than cured. The mainstay of treatment is complex decongestive therapy (CDT) — a combination of:
- Manual lymphatic drainage — Specialised massage to stimulate lymph flow
- Compression bandaging and garments — To prevent fluid re-accumulation
- Skin care — To prevent cellulitis, which can worsen lymphoedema significantly
- Exercise — Promotes lymph flow through muscle pump activity
In selected patients, surgical options including vascularised lymph node transfer and lymphaticovenous anastomosis (connecting lymph vessels to veins) are emerging as effective treatments in specialised centres. For filarial lymphoedema, antiparasitic treatment (diethylcarbamazine) combined with physiotherapy is the standard of care.
❓ Frequently Asked Questions
Is lymphoedema the same as water retention or oedema?
No. Water retention (oedema) from heart, liver, or kidney disease responds to diuretics. Lymphoedema is a protein-rich fluid accumulation that does not respond to diuretics. Treating lymphoedema with diuretics alone is ineffective and can lead to skin changes and fibrosis.
Can lymphoedema be cured?
For most patients, lymphoedema is a condition that is managed rather than cured. However, with early diagnosis and consistent compression therapy, the swelling can be reduced substantially and quality of life maintained. In early-stage lymphoedema, surgical lymphatic procedures can sometimes produce remarkable improvement.
💡 Key Insight: Lymphoedema is significantly underdiagnosed and undertreated in India. Patients spend years being told their leg swelling is “normal” or given diuretics that make no difference. If your leg has been swelling for months and nothing is helping, ask for a vascular surgery review.
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About the Author 🧑🏻⚕️
Dr Rahul Agarwal is a Consultant Vascular & Endovascular Surgeon at CARE Hospitals, Banjara Hills, Hyderabad.