Compression/Lymphedema
Compression
Compression is often times needed when an individual is experiencing a retention of fluids in their upper and/or lower body. Once a diagnosis has been made from a qualified clinician then specific actions can be taken to get the situation under control. There are several factors that can play into the need for compression. Based on diagnosis, there are several treatment options available.
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Venous Insufficiency
When the body is working correctly, arteries bring oxygen-rich blood from your heart to the rest of your body and veins return oxygen-poor blood back to your heart. Leg muscles are contracting as the blood moves back to the heart. If your leg veins cannot pump enough blood back to your heart you have chronic venous insufficiency (CVI). Insufficiencies such as valve complications and disrupted amounts of pressure and blood flow will create venous issues. Often times a person will experience the following symptoms with venous disease. In the legs, for example, one may face swelling, skin discoloration, ulceration and varicose veins. Additionally, aching, tenderness and heaviness may result from the blood not being properly pumped back to the heart.
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Varicose Veins
CVI may be associated with varicose veins. Varicose veins are swollen veins that you can see through the skin. They often look blue, bulging, and twisted. Large varicose veins can lead to skin changes like rashes, redness, and sores. Experiencing tired legs, tingling, itching and swollen ankles are all signs that varicose veins may be developing. Water from the veins can escape into surrounding tissue if the blood flow doesn't move quickly enough to reach the heart. The vein walls become soft and the venous valves no longer close properly and the blood lingers. There are 3 main factors (in addition to having a genetic predisposition) that contribute to varicose veins.
- Impeding upward blood flow from the legs.
- Chronic coughing
- Constipation
- Heavy Lifting
- Obesity
- Pregnancy
- Prolonged sitting or crossing of the legs
- Tight clothing
- Anything that relaxes the wall of the veins.
- Alcohol
- Heat
- Hormones (birth control medication, menopausal hormones, pregnancy)
- Anything that could interfere with muscle-pumping action.
- High heeled shoes
- Paralysis
- Sitting or standing for long periods of time
- Impeding upward blood flow from the legs.
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Compression Stockings
Compression stockings are primarily worn by people who are ambulatory (able to walk, not confined to a bed). These people typically spend a great deal of their time on their feet, causing the circulation of blood to fight against the effects of gravity. This can result in a slowing or pooling of blood, ultimately leading to venous insufficiencies or edema. People who have these indications find a great deal of relief in wearing compression stockings. Compression stockings help to support the leg and reduce the diameter of the veins so the valves can close again, which ultimately will move the blood in the proper direction. The smaller the diameter of the veins means the blood will flow more quickly, preventing any blood clots from forming. Wearing compression stockings will help prevent new varicose veins from forming while simultaneously controlling the existing venous disease. You may need to wear compression stockings daily for the rest of your life. The levels of compression in these stockings range from 15-20 to 50 mmHg.
Characteristics of compression stockings
- High levels of compression
- Open/closed toes
- Knee high, Thigh high, Pantyhose, Maternity-Pantyhose
- Variety of colors
- 2 way stretch elasticity
- Weartime- four to six months
Caring for your stockings
- Hand wash in warm water with liquid detergent.
- No Woolite as this will harm the elasticity in the stockings.
- Do not dry in the dryer or in direct sunlight.
- Be careful with application- do not snag.
- Reorder every four months and remeasure annually.
INDICATION TABLE
- Class 1: (20-30 mmHg-Moderate compression)
- Light venous insufficiency
- Prevention of problems during pregnancy
- Mild varicosities
- Hereditary tendency toward varicose veins
- Class 2: (30-40 mmHg-Firm compression)
- Moderate venous insufficiency
- Tendency toward edema
- Post thrombosis
- Post sclerotherapy
- Severe varicosities
- Healed venous ulcer
- Orthostatic hypotension
- Class 3: (40-50 mmHg-Very Firm compression)
- Severe edema
- Severe post healed ulcerations
- Lymphedema
- Severe chronic venous insufficiency
- Contraindications:
- Unreduced edema
- Open ulcer
- Weeping dermatitis
- Acute thrombophlebitis
Note: Always start with the lowest compression a person can tolerate.
More serious cases of CVI may be treated with injections, called sclerotherapy, or with surgical procedures. Fewer than 10 percent of people with CVI require surgery to correct the problem.
You can help avoid leg swelling and other symptoms by occasionally raising your legs and avoiding standing for long periods of time to decrease the pressure in the veins. When you do need to stand for a long period, you can flex your leg muscles occasionally to keep the blood flowing. You can also help lessen the symptoms of CVI by maintaining your ideal body weight or losing weight if you are overweight.
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Antiembolism Stockings
The primary uses of antiembolism stockings are by hospitals and bedridden patients. Patients who are confined to bed and are immobile use antiembolism stockings for prevention of blood clots. When a person is confined to bed, they are positioned in a horizontal position. Because of this the circulation of blood is not greatly affected by the forces of gravity. Accordingly, a very light compression is all that is needed to stimulate blood flow. Antiembolism stockings provide this with a compression of approximately 12mmHg.
Characteristics of antiembolism stockings
- Not cosmetically appealing
- Usually white
- Usually open toed
- Poor elasticity and poor water resistance
- Weartime- three to four weeks
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Lymphedema
Lymphedema is an abnormal accumulation of fluid in the interstitial space. The lymphatic system collects and filters the interstitial fluid of the body. Historically, lymphedema wasn't recognized as being a serious health problem; however, this is slowly changing due to education and awareness. The danger with lymphedema comes from the constant risk of developing an uncontrolled infection in the affected limb. In addition, swelling and decreased wound healing may be a side effect.
Causes
Lymphedema may be inherited (primary) or caused by injury to the lymphatic vessels (secondary). It is most frequently seen after lymph node dissection, surgery and/or radiation therapy, in which damage to the lymphatic system is caused during the treatment of cancer, most notably breast cancer. In many cancer patients this condition does not develop until months or even years after their therapy has concluded. Lymphedema may also be associated with accidents or certain diseases or problems that may inhibit the lymphatic system from functioning properly. It can also be caused by a compromising of the lymphatic system resulting from cellulitis. While the exact cause of primary lymphedema is still unknown, it generally occurs due to an impairment of the lymphatic system. Lymphedema may be present at birth, develop at the onset of puberty, or not become apparent for many years into adulthood. Some cases of lymphedema may be associated with other vascular abnormalities. Lymphedema affects both men and women. In women, it is most prevalent in the upper limbs after breast cancer surgery and lymph node dissection, occurring in the arm on the side of the body in which the surgery is performed. It may also occur in the lower limbs or groin after surgery for colon, ovarian or uterine cancer in which removal of lymph nodes is required. In men, lower-limb primary lymphedema is most common, occurring in one or both legs. Surgery and/or treatment for prostate, colon and testicular cancers may result in secondary lymphedema, particularly where lymph nodes have been removed or damaged. Some cases of lower-limb lymphedema have been associated with the use of Tamoxifen, due to blood clots and deep vein thrombosis (DVT) that can be caused by this medication.
Symptoms
Symptoms may include a heavy swollen limb, severe fatigue or localized fluid accumulation in other body areas, including the head or neck, discoloration or tightening of the skin. Often one may see an increased risk of infection because protein rich fluids build up creating a breeding ground for bacteria. Lymphedema should not be confused with edema arising from venous insufficiency. However, untreated venous insufficiency can progress into a combined venous/lymphatic disorder which is treated the same way as lymphedema.
Treatment
Mild lymphedema can be treated by a certified healthcare professional. Moderate to severe lymphedema is often treated by the above mentioned professional focusing on massage, bandaging, skin care and some type of compression garment.