Lymphoedema

What is lymphoedema?

Lymphoedema is long-term swelling that happens when fluid called lymph builds up in part of your body. This happens when the system of tiny vessels and glands that normally drains it (the lymphatic system) is not working well. The fluid that builds up in lymphoedema contains more protein than ordinary tissue fluid, which helps explain why lymphoedema behaves differently from other types of swelling. Without treatment, the affected area is more prone to serious skin infections and the tissue can change permanently.

Lymphoedema most often affects an arm or legs. It can also affect the chest, breast, head, neck, or genital area. It is a long-term (chronic) condition that cannot be cured, but with the right care most people can manage it well and stay active. Early and consistent treatment reduces the risk of complications.

Lymphoedema is not the same as the short-term swelling that follows a sprain or a long flight. With lymphoedema, the swelling stays.

Lymphoedema is also not the same as lipoedema, which is a separate condition where fatty tissue builds up in the limbs (most often the legs and hips). The two are sometimes confused, and a person can have both at the same time. If unsure, ask a doctor or lymphoedema therapist.

Who is at risk

Primary lymphoedema is present from birth, even if the swelling does not appear until later in life. The lymphatic system did not form as it should.

Secondary lymphoedema develops because the lymphatic system has been damaged. Common causes include:

• Cancer treatment, especially when lymph nodes are removed by surgery or treated with radiotherapy. The risk is higher with treatment for breast, gynaecological, prostate, melanoma, head and neck, or other cancers.
• Severe or repeated skin infections (cellulitis), insect bites, or untreated fungal infections.
• Long-standing problems with veins.
• Carrying extra weight over many years.
• Limited movement after stroke, severe arthritis, or other illnesses.
• Less commonly, injuries, certain medications, or a tropical parasite infection (rare in Australia).

Not everyone with these risks will develop lymphoedema. If you have had cancer treatment, the chance of developing lymphoedema depends on the treatment you had and your individual situation. Ask your treating team what the risk is and what to watch for.

After axillary (armpit) surgery, some people develop tight, cord-like bands under or along the inner arm that restrict shoulder movement. This is called cording or axillary web syndrome. It is a known complication, not a sign that cancer has returned. Stretching exercises and lymphatic drainage massage resolve it in most cases. Mention it to your doctor or treating team if you notice it.

Signs to watch for

Lymphoedema often starts slowly. Early signs are easy to miss. Tell a doctor or lymphoedema therapist if any of these appear in a part of the body at risk:

• A heavy, full, or tight feeling
• Aching or discomfort that does not settle
• Clothing, watches, rings, shoes, or a bra feeling tighter on one side
• Skin that looks puffy, shiny, or stretched
• Pressing the skin with the thumb may leave a dent that takes a few seconds to fade (pitting oedema). This is most common in earlier stages
• In later stages, the tissue can feel firmer and may no longer dent when pressed (non-pitting oedema)
• The limb looks bigger than the other side
• It is harder to move the wrist, elbow, ankle, or knee

Early changes can come and go before the swelling becomes permanent. Do not wait for the swelling to become obvious.

For people at risk (for example, after cancer treatment or other surgery that affected lymph nodes), ask your treating team about a baseline assessment with a lymphoedema therapist before any swelling appears. Some services also offer bioimpedance, a brief test to detect fluid changes before swelling is visible. Early detection means treatment can start sooner, which may prevent lymphoedema from becoming established.

Getting a diagnosis

A lymphoedema-trained doctor, nurse, or therapist will ask about history (including any surgery, radiotherapy, or other risk factors), look at and feel the area, measure the size of both limbs and compare them, and check the skin and movement.

Part of the assessment is working out what is causing the swelling, because lymphoedema can look like lipoedema, vein problems, or swelling from heart, kidney, or liver conditions, and sometimes more than one is present. A doctor experienced in lymphoedema can confirm the diagnosis, look for an underlying cause, and decide whether any tests are needed. Getting this right matters, because the treatment differs.

In some cases, a doctor may also order tests, such as ultrasound, lymphoscintigraphy (a scan of the lymphatic system), bioimpedance (a small electrical measurement that picks up fluid changes), or other specialised imaging. Most of the time, careful clinical examination is enough, without a scan.

Treatment and self-care

The most effective approach combines daily self-care with treatment from a lymphoedema therapist. The four core elements are skin care, movement and exercise, compression, and lymphatic drainage. Together this is called complex lymphoedema therapy. Weight management, positioning, and other measures can also help in particular cases.

A lymphoedema therapist is an allied health professional with extra training. Many people are managed by a lymphoedema therapist, usually with their GP. More complex lymphoedema may also need a doctor experienced in lymphoedema and, where relevant, input from a wound clinician, physiotherapist, dietitian, psychologist, or vascular specialist.

Skin care

Healthy skin is the strongest protection against infection. Daily skin care matters for anyone with lymphoedema or at risk of it.

• Wash gently with a mild soap and pat dry, including between fingers and toes.
• Moisturise daily with a fragrance-free moisturiser.
• Treat cuts, scratches, insect bites, and cracked skin promptly. Clean the area, apply antiseptic, and cover it.
• Treat fungal infections early. These can show as athlete's foot or any red, scaly, or itchy patch (especially between the toes). Ask your pharmacist or GP if unsure.
• Use sunscreen and insect repellent outdoors.
• Wear gloves for gardening, cleaning, and washing up.
• Avoid long periods in very hot water (long hot baths, saunas, hot tubs, very hot showers), which can make swelling worse.
• Where possible, avoid having blood pressure measured, blood taken, or injections in an at-risk limb. Recent evidence has loosened this guidance for some people; ask a therapist what applies.

Movement and exercise

Movement helps the lymphatic system drain fluid. Sitting still for long periods makes lymphoedema worse. Aim to move every day; walking, swimming, gentle yoga, tai chi, and water aerobics all help. Resistance and weight-training exercises are safe and do not worsen lymphoedema when built up slowly. If a compression garment has been prescribed, wear it during exercise. Ask the treating team about a personalised exercise plan.

Compression

Compression is the most important part of lymphoedema treatment.

• For new or worsening swelling, the therapist may start with bandaging for a few weeks to bring the size down. This is hard work, but only for a short time.
• Once the limb has reduced, a fitted compression garment (sleeve, glove, stocking, wrap, or other custom garment) is worn during the day to keep the limb at its new size.
• Some people also wear a night compression garment; the therapist will advise if this is needed.
• Compression garments need replacing every 3 to 6 months. They lose their strength with washing and time.
• Garments should be washed as the manufacturer recommends, usually by hand or on a gentle cycle.
• Compression is not suitable for everyone. People with significant circulation problems in the legs, some heart conditions, or reduced sensation may need a different approach. For this reason, a proper assessment always comes first and compression should not be started without professional advice.
• Stop wearing a garment that feels too tight, painful, or causes skin damage. Check with the therapist before wearing it again.

Lymphatic drainage

Manual lymphatic drainage (MLD) is a gentle, specialised form of massage given by a trained therapist that helps move fluid through the lymphatic system. Simple lymphatic drainage (SLD) is a simplified version that the therapist can teach people with lymphoedema, family member or carer, to use at home.

Positioning

When sitting or lying down for long periods, support the affected limb on a cushion or footrest so it is not hanging down. Avoid crossing the legs at the knee or ankle. Letting the limb hang down for short periods is fine; longer periods can make swelling worse.

Weight management

Carrying extra weight adds to the load on the lymphatic system and can make lymphoedema harder to manage. A GP can help with safe and sustainable approaches when weight is a concern.

Other options for certain cases

These are not first-line treatments, but they can help in particular situations. Ask your lymphoedema therapist or lymphoedema doctor whether any might be suitable.

• Intermittent pneumatic compression pumps used at home, prescribed and set up by a therapist.
• Low-level laser therapy, mainly for fibrosis (firm, thickened tissue).
• Lymph taping with elasticised kinesiology tape, which may be helpful for some people.
• Specialised surgery that creates new pathways for lymph fluid (called lymphovenous anastomosis, or vascularised lymph node transfer), in selected cases. Surgery does not replace daily self-care and compression.

There is no medication that cures lymphoedema and supplements have little evidence of benefit. Medications may be used to treat infections or other related problems. Diuretics do not treat lymphoedema on their own, though they may be needed for other conditions.

When to seek help urgently

Cellulitis

Cellulitis is a skin infection that people with lymphoedema get more easily and more often. Knowing the warning signs and acting quickly is one of the most important things to do. Treated early, it usually settles fast. Left untreated, it can make lymphoedema permanently worse.

For people with lymphoedema who have had cellulitis before, it is worth agreeing a plan with a doctor in advance. Some people are given a course of antibiotics to keep at home, so treatment can start straight away if an episode begins after hours or away from home. Starting early is what keeps people out of hospital.

See a doctor on the same day if any of these appear in or near the area at risk:

• A patch of skin becomes red, hot, or painful
• The swelling suddenly gets worse
• Feeling feverish, shivery, achy, or generally unwell
• Red streaks spreading from the area

If a patch of skin turns red, mark the edge with a pen so you and your doctor can see whether it is spreading.

If a GP cannot be reached in Australia, contact healthdirect on 1800 022 222 (Australia-wide, 24 hours). Outside Australia, contact your country's health advice line.

In Australia, call 000 (Triple Zero) if the person is very unwell, confused, very short of breath, or if the redness is spreading quickly. Outside Australia, contact your local emergency services.

Cellulitis is treated with antibiotics. Take the full course of antibiotics, even if symptoms improve before the course ends. After more than one episode of cellulitis, it is worth asking a doctor about preventive antibiotics and what to do if it returns.

Treat fungal infections early, especially athlete's foot. Fungi create small breaks in the skin that bacteria can enter, and this is one of the most common triggers for cellulitis in lymphoedema.

Other reasons to seek same-day medical advice

• Skin that is leaking fluid (lymphorrhoea)
• A wound that is not healing
• New lumps or unusual changes in the affected area

Living with lymphoedema

Lymphoedema can be tiring to manage. It is normal to feel frustrated, self-conscious, or worn down at times. Many people also experience changes in body image, in how they relate to a limb that no longer looks or feels the way it used to, and in how lymphoedema fits with work, exercise, intimacy, and social life. These feelings often come and go rather than resolving cleanly.

Talking to someone trusted helps. A GP, lymphoedema therapist, or counsellor can listen and refer on for further support if needed. Joining a peer support group is another route; talking to people who understand can make things easier. For sustained low mood, anxiety, or distress, a psychologist or counsellor experienced in chronic illness or body-image work can help directly.

A few practical tips:

• Lightweight clothing
• Suitcases on wheels
• Talc can make compression garments easier to put on
• Sunscreen and insect repellent in a bag for outings
• Wear the compression garment, move regularly, and avoid sitting still for long periods when travelling

Support and resources

Australasian Lymphology Association (ALA): lymphoedema.org.au. The National Lymphoedema Practitioners Register lists registered therapists across Australia.

Lymphoedema Association of Australia (LAA): lymphaustralia.org.au, 1300 852 850. Patient support and peer connection.

healthdirect: healthdirect.gov.au/lymphoedema, helpline 1800 022 222 (24 hours).

About this resource

This information sheet was prepared by Dr Kheng Soo, Consultant Physician (FRACP). Dr Soo's clinical practice includes the medical assessment and management of lymphoedema, lipoedema, and chronic oedema. Consultation and referral information: www.drkhengsoo.com

If you are living with lymphoedema, seek advice from your doctor or registered lymphoedema therapist about an appropriate management plan.

Last reviewed: June 2026. Next review: June 2028.