LEG SWELLING AND LYMPHEDEMA

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Swelling in the legs is usually caused by fluid buildup under the skin, known as edema. Swelling of the legs can also be caused by trauma, blood clots, deep vein thrombosis, primary or acquired lymphatic disease, infection, or illness. Standing or sitting for a long time can cause leg swelling. 

Leg swelling can also be caused or contributed by venous and other lymphatic problems. When leg veins can't pump blood back into the heart as efficiently as they should, that's called venous insufficiency. Associated varicose veins are a sign of venous insufficiency, but they can also be just cosmetic. A blockage in the lymphatic system, known as lymphedema, or fat deposition underneath the skin, known as lipedema, can also cause leg swelling. Leg swelling can also be caused by kidney, liver, and heart problems. 

Medications can cause leg swelling, an often-underestimated cause. Discuss all your medications with your doctor. These are some examples:

1. Amlodipine (Norvasc) used to lower blood pressure,
2. Gabapentin (Neurontin) and Pregabalin (Lyrica) are used to treat nerve pain,
3. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin, Advil) and naproxen (Aleve),
4. Some oral contraceptive pills that contain estrogens (which also increase the risk of blood clots)
5. Steroid medications like prednisone may increase salt retention,
6. Pioglitazone (Actos) and rosiglitazone (Avandia) are used to treat diabetes.

Identifying the cause of recent onset or worsening leg swelling is important because some causes like organ failure and blood clots can be life-threatening. There aren't always associated symptoms like chest pain or shortness of breath, so patients shouldn't self-diagnose, but rather see a doctor.

There are certain things that can help people with uncomplicated mild to moderate chronic edema, such as lifting their legs above their hearts when they are lying down. While traveling or working, make sure you exercise regularly and move around frequently to assist your legs in pumping fluid back to your heart. One of the most important things to do is to lose weight if you have excess weight and to consume less salt. Wear graduated support hose to help your veins pump more efficiently, and avoid tight clothing. 

Lymphedema is swelling in a body part caused by inefficient fluid drainage by the lymphatic system, most commonly in the arms or legs. In the lymphatic system, fluid leaks from capillaries and is absorbed by lymphatic channels and lymph nodes, which act as filters to stop infections. Lymphedema happens when the lymphatic system is damaged or ineffective and can't remove fluid. There are a lot of reasons why people develop lymphedema, including genetic abnormalities (primary lymphedema), surgery, radiation therapies, infections, obesity, heart/liver/kidney problems, and chronic venous disease (phlebolymphedema). 

Symptoms of leg lymphedema include ankle and foot swelling, heaviness, and fatigue, starting in the morning and getting worse as the day goes on. It's hard to figure out the causative agent at the beginning of the disease, (Stage 1) as initially it responds to leg elevations and compression stockings. Skin cracks and blisters make it susceptible to infections as the condition progresses (Stage 2). In the most advanced cases (Stage 3) compression can’t reduce swelling and the skin becomes hard and irregular.

First, the doctor will ask you about your symptoms and about your medical history. We'lll also do a physical exam and order blood work. To check out the leg veins, an ultrasound is usually ordered. A heart ultrasound is sometimes ordered if you're having heart failure symptoms. To assess the blood vessels in your abdomen and pelvis, the doctor might order a CT scan or MRI. Finally, a lymphoscintigraphy may be ordered in select cases, where dye is injected into the foot to see the lymphatic system.

Lymphedema is often a chronic disease that needs lifelong attention. The first thing a health care provider does when you're diagnosed with lymphedema is treat the symptoms. Compression stockings can help, either elastic or stiff. For more advanced cases, Velcro wraps, or multilayer bandaging are needed. Another thing that helps treat lymphedema is massage therapy, which is done by a certified lymphedema therapist (CLT) and continued at home by the patient. Another at-home treatment is pneumatic compression, called a lymphedema pump, which is attached to leg sleeves that inflate sequentially providing gentle active compression of the lymphatic system. Skin needs to be moisturized, clean, and protected from cuts, abrasions, and sunburns. Exercise, leg elevation, and not standing still or sitting for long periods are also important. Treatment for lymphedema depends on the patient's acceptance and compliance with the prescribed treatments. Medication to reduce swelling can sometimes be helpful. Although surgery is rarely done for lymphedema, select cases can be treated with liposuction or microsurgery of lymphatic vessels and channels by surgeons who specialize in these procedures.