Lipoedema

Lipoedema

Lipoedema is a disproportionate, symmetrical fatty swelling characterized by pain and bruising existing almost exclusively among women. It may co-exist with lymphoedema and is then called lipo-lymphoedema. It is usually first noticed around puberty, pregnancy or menopause, and there may be a positive family history. It is different from obesity, the fatty deposits are often only found in the legs, and sufferers may have a normal body mass index. It is a chronic, progressive disease that can be well managed with the help of a supportive team and the correct treatment.

Signs and symptoms of lipoedema:

  • Symmetrical abnormal fat deposition on legs, abdomen and less commonly arms. The enlargement of the legs is disproportionate in relation to the upper body
  • Oedema (swelling) is non-pitting. The feet are usually spared, except when lymphoedema co-exists (lipo-lymphoedema)
  • Tenderness, especially of the shins, a tendency to bruise easily, and varicose veins are common
  • Joint hypermobility, demonstrating laxity of ligaments, is often present
  • As the limbs increase in size, joint strain may cause pain and dysfunction, commonly in the hips, knees, ankles and feet

Diagnosis is based upon clinical features, and investigation of co-existing cardiovascular and lymphatic dysfunction is important as this can be treated to optimise outcome and prevent progression.

Autoimmune dysfunction and nutritional deficiencies are also commonly seen with this disorder and should be well managed.

The left-hand picture shows lymphoedema of the left leg, (this can also be bilateral), oedema will always involve the foot. The picture on the right shows true lipoedema, which is always bilateral - the feet are spared


Treatment

The recommended treatment for lipoedema is called Complete Decongestive Therapy (CDT). This is performed by a certified lymphoedema therapist working actively with the patient and aims to manage oedema, improve the health of the limbs and prevent progression of the disorder with well-fitting, carefully selected compression garments.

The components of Complete Decongestive Therapy are:

  • Manual lymphatic drainage therapy
  • Multi-layered compression bandaging if required
  • Skin care
  • Compression garments
  • Rehabilitative exercises to improve lymphatic function, fitness, strength and general health as required
  • Self-management with the ongoing support of the treating Dr, lymphoedema therapist and the rest of the multi-disciplinary team

A healthy diet is important in order to reduce to or maintain a healthy weight. This will help to reduce strain on joints, improve energy levels and may help to correct metabolic dysfunction. Persons with lipoedema often report that they have tried to reduce the size of their limbs unsuccessfully through a low-calorie diet, and can be found to be malnourished or underweight as a result. A dietician may be involved to help with this.