Many women experience it suddenly or gradually over the years: swelling that doesn’t go away. The legs feel heavy, the back of the foot is tense, sometimes even getting dressed becomes a challenge. Until now, you may have thought it was due to being overweight, too little exercise or simply old age. But there may be more to it than that: lymphoedema.
In this article, we explain what lymphoedema is, how you can recognize it and why it is so important to differentiate it from lipoedema.
Lymphoedema is a chronic disease of the lymphatic system. The lymph fluid, which is normally transported through a fine network of lymph vessels in the body, accumulates in the tissue. This leads to visible and palpable swelling, usually in the legs or arms.
There are two forms:
The best known is lymphoedema of the legs: Calves, ankles and feet swell, shoes don’t fit as well, stockings cut in, the skin stretches. But other regions such as the arms or abdomen can also be affected by lymphoedema.
Lymphoedema usually develops slowly. Initially, those affected only notice a “feeling of heaviness” in the limbs. Only later do visible swellings appear. It is particularly typical for the swelling to occur asymmetrically – i.e. only on one leg or arm.
Typical symptoms:
Lymphoedema is often overlooked in the early stages, precisely because it initially causes no pain and the swelling is classified as temporary.
The lymphatic vessels work in the background every day, transporting fluid, proteins, waste products and immune cells back into the bloodstream. If this system is weakened or partially destroyed, an imbalance occurs: more fluid accumulates than can be transported away. As a result, lymphoedema develops.
Common causes and risk factors:
For those affected, this not only means physical discomfort, but also a considerable emotional burden: their own body feels “strange”, clothes no longer fit as they used to, everyday life and self-image are thrown out of balance.
Women with lipoedema in particular experience additional swelling of their already heavy, painful legs. This is because lipoedema and lymphoedema can influence each other.
Many women initially think of water retention or cellulite, even though lipedema or lymphedema – or both – are present in the background.
The therapeutic approaches differ significantly. Lymphoedema primarily requires decongestion and the establishment of functioning lymph circulation. Lipoedema treatment, on the other hand, involves not only decongestion but also pain relief and often the surgical removal of abnormal fatty tissue(liposuction). The correct diagnosis is therefore not just a label.
At LipoClinic Dr. Heck, we often experience how relieved women are when they are finally understood. Our experienced doctors know the typical lipoedema symptoms and can provide targeted advice and support to those affected.
Lymphoedema is treatable. The aim is not to “magic away” the condition, but to reduce swelling, prevent complications and significantly improve the quality of life of those affected.
The standard therapy is complex physical decongestive therapy (CDT), usually consisting of two phases: Decongestion and maintenance.
Important components of the therapy:
Surgical procedures currently only play a minor role in lymphoedema and are mostly used in specialized centers and selected cases.
You should seek medical advice if you:
Especially if pain, tenderness and a disproportionate distribution of fat on the legs or arms occur at the same time, lipoedema may also be present. This is something that is often overlooked in general care.
Lymphoedema is a chronic condition that can have a massive impact on your quality of life – but it is not a judgment, it is an impetus for action. The better informed you are, the clearer your path will be. Trust your body feeling.
If you suspect that you have lipoedema or are not sure where to classify your symptoms, the team at LipoClinic Dr. Heck is here for you. In a consultation, we will help you to better understand your symptoms and show you the differences between lipoedema and lymphoedema.
Lymphoedema is a chronic swelling in which lymph fluid “stagnates” in the tissue because the lymphatic system is overloaded or damaged. Legs and arms are most commonly affected, but hands, feet or the abdomen can also swell.
Lymphoedema occurs when the lymph vessels or lymph nodes can no longer remove enough fluid – for example due to congenital malformations, operations, lymph node removal, radiotherapy or infections. Severe obesity and lack of exercise can also put additional strain on the lymphatic system.
Temporary water retention (e.g. in the heat) usually disappears on its own and often affects both legs equally. Lymphoedema, on the other hand, is a chronic condition in which the swelling remains or increases over time and can lead to hardening and skin changes if left untreated.
Existing lymphoedema is considered chronic and usually persists for life. With consistent treatment, however, the swelling can be significantly reduced and stabilized so that everyday life is often much easier to cope with again.
In lipoedema, the fatty tissue is pathologically altered and places additional strain on the lymphatic system, so that so-called lipo-lymphoedema can develop over time. Many women with lipoedema then notice additional, sometimes severe swelling, which may indicate accompanying lymphoedema.
AWMF: Lipedema guideline: S2k guideline of the German Society for Phlebology and Lymphology(https://register.awmf.org/assets/guidelines/037-012l_S2k_Lipoedem_2024-01_01.pdf)
AWMF: S2k guideline: Diagnosis and treatment of lymphoedema(https://register.awmf.org/assets/guidelines/058-001l_S2k_Diagnostik_und_Therapie_der_Lymphoedeme_2019-07-abgelaufen.pdf)
AOK: What can be done against lymphoedema?(https://www.aok.de/pk/magazin/koerper-psyche/organe/lymphoedem-ursache-symptome-und-behandlung/)
Dr. Thomas Witte is Medical Director of LipoClinic Dr. Heck and a specialist in plastic and aesthetic surgery. With decades of surgical experience and a deep understanding of the individual needs of lipoedema patients, he is one of the leading experts in this field. His focus is on holistic, safe and empathetic care – always with the aim of restoring quality of life.
Medical Director
Specialist in plastic and aesthetic surgery
Specialist in surgery and hand surgeon
