Embarrassing Illnesses

Complex Decongestive Therapy (CDT)

The recommended treatment for lymphoedema is a treatment plan known as Complex Decongestive Therapy (CDT).

CDT is made up of four components, which will be described in greater detail below. The components are:

• manual lymphatic drainage (MLD) - a specialised massage technique designed to stimulate the flow of fluid and reduce swelling,
• multilayer lymphoedema bandaging (MLLB) - MLLB makes use of bandages and compression garments to move the fluid out of the affected limb,
• remedial exercises - designed to strengthen the muscle in the limb in order to improve lymph circulation, and
• skin care - which is required to prevent infection.

CDT begins with an intensive phase of therapy, during which you will receive daily treatment and training for up to six weeks. This is followed by the second phase known as the maintenance phase. During the maintenance phase you will be encouraged to then take over your own care, using the techniques you have learned during the intensive phase of therapy. You should then have regular six monthly review meetings to check how your treatment is progressing.

Manual lymphatic drainage (MLD)

During manual lymphatic drainage, the lymphoedema therapist will use special massage techniques in order to move fluid into working lymph nodes so it can then be drained.

It is important that you receive MLD from a trained lymphoedema therapist, and not a regular masseur, as the technique requires a detailed knowledge of the lymphatic system in order to perform it correctly.

Your lymphoedema therapist will also teach you a range of massage techniques that you can use during the maintenance phase.

You may not be suitable for MLD if you have a history of heart disease, deep vein thrombosis or kidney disease, as the treatment could make those conditions worse.

Multilayer lymphoedema bandaging (MLLB)

Unlike the blood circulation system, there is no central pump, such as the heart, to move fluid around the lymphatic system. Instead, the lymphatic system makes use of the muscles surrounding the lymph vessels and nodes to move the fluid.

So the goal of multilayer lymphoedema bandaging (MLLB) is to use bandages and compression garments to support the muscles and encourage them to move fluid out of the affected limb. MLLB is also used after a session of MLD in order to prevent fluid re-accumulating in the limb.

You will also be taught how to correctly apply your own bandages and compression garments so you can continue to use MLLB during the maintenance period.

Remedial exercises

Remedial exercises are designed to strengthen the muscles involved in lymph circulation. You will be given your own personalised exercise plan that will be tailored for your requirements and ability.

Skin care

Taking very good care of your skin is important as it will reduce the risks of you developing a skin infection such as cellulitis. You should be given a daily routine to follow, where you are required to meticulously clean your skin and check for any cuts, abrasions or signs of infection. For more advice on skin care see the 'prevention' section.

Surgery

Until recently, surgery was not recommended for lymphoedema as it had disappointing results when compared with non-surgical treatment.

But a new technique is now available that has proved successful in treating lymphoedema. It involves using liposuction (where a tube is used to suck fat out of tissue) to remove excess fat from the affected limb which can then reduce the swelling. Once the surgery is complete you will have to wear a compression garment on the affected limb for at least one year,

The National Institute for Health and Clinical Excellence has judged the procedure to be acceptable in terms of clinical safety. But it has said that patients should be aware that there is yet no evidence about its long-term effectiveness or whether there are risks of long-term complications.

As it is a new technique, access to liposuction for chronic lymphoedema may be limited, depending on your local Primary Care Trust.