Lymphostasis of the lower extremities: what threatens the swelling of the legs?
Last reviewed: 23.04.2024
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Legs swell near enough large numbers of people. When there is swelling of the foot or lower leg with tense veins in the evening, and swelling disappears in the morning, then this is not good: these are distant harbingers of varicose veins or thrombophlebitis ... But if the swelling becomes more and more noticeable every day, then here it does not go away probably no less alarming diagnosis - lymphostasis of the lower extremities.
Lymphostasis doctors call the pathology of the lymphatic system, which is expressed in the complete cessation of the circulation of lymph (lymph). That is, lymph ceases to perform its functions and perform constant drainage of body tissues. And edema is a clinical manifestation of this pathological process. In this case, the most affected are the legs, and women are five times more likely than men.
Lymphostasis of the lower extremities (lymphedema, lymphatic edema) is a chronic disease with edema of one or both legs. The disease does not go away by itself, but progresses into an irreversible form, in which the formation of fibrous tissues leads to a thickening of the legs - elephantism (elephantism).
[Causes of lower limb lymphostasis
Among the factors contributing to the development of foot lymphostasis, experts call diseases of the kidneys, cardiovascular system, pathologically low total protein in the blood (hypoproteinemia), varicose veins, damage to lymph vessels with their blockage or squeezing (eg, tumors or inflammatory infiltrates).
The cause of lymphostasis of the lower limbs can be covered in a chronic lesion of lymphatic vessels with streptococcus and other microorganisms on the background of weakened immunity. In addition, the cause of lymphostasis can be birth defects of the lymphatic system.
With a congenital anomaly, lymphostasis is called primary, and the disease begins to make itself felt in childhood, exacerbating with age. The acquired lymphostasis of the lower extremities is defined as secondary and appears, as a rule, only on one leg - due to trauma, inflammation, lymph node tumors or lymphatic vessels, radiotherapy or surgical treatment of the extremity vessels. Lymphostasis of the lower extremities during pregnancy is most often observed in cases when violations of lymph circulation in a future mother are congenital in nature, and this is the primary lymphedema.
It should be noted that the violation of the outflow of lymphatic fluid with lymphostasis is accompanied not only by swelling. Stagnation of lymph inhibits the removal of toxins from tissue cells, which in turn increases the acidity of the skin, causing unpleasant sensations of itching. As a result, the skin becomes thicker and thicker, its protective function decreases, and microbes from the top layer of the skin can freely penetrate into the subcutaneous tissues, causing various inflammations.
Symptoms of lymphostasis of lower extremities
The course of lymphostasis of the lower extremities has three stages: reversible edema (lymphedema), irreversible edema (fibredema), and elephantiasis.
Typical localization of puffiness in the first stage of the disease is the area of the ankle joint, the base of the fingers and the muscle layer between the metatarsal bones at the rear of the foot. Edema is easily palpated, almost painless, the skin over the swollen place is pale and often forms a crease. In the cold season after several hours of rest, swelling can almost disappear or decrease significantly.
The main symptom of lower limb lymphostasis in the second stage (irreversible edema) is the spreading of permanent swelling up the leg, which does not go away even after a long rest. And the nature of the edema also changes: it becomes denser (there is a long trace of depression), and it is simply impossible to gather the skin in a fold. Patients with chronic lymphostasis of the lower limbs complain of pain and a feeling of heaviness in the affected leg. The leg begins to deform, and it becomes difficult for the patient to bend it when walking. And with prolonged stays on your legs may be cramps.
This stage proceeds for a long time, and as the disease develops, the skin of the affected limb darkens (sometimes with a bluish tinge), the skin stretches and causes pain, and the horny layer of the epidermis thickens and coarsens (hyperkeratosis).
Symptoms of elephantiasis - the third stage of lymphostasis of the lower extremities - proliferation of connective tissue in the skin, subcutaneous fat and between the muscles of the leg and an increase in the volume of the leg so that it resembles the finiteness of the elephant. In this case, even the bones become thicker, and ulcers and inflammations can appear on the skin.
Diagnosis of lymphostasis of lower extremities
Diagnosis of lymphostasis of the lower extremities begins, as usual, with an anamnesis and examination of the diseased leg. Also, the delivery of biochemical blood analysis and urinalysis is assigned. To exclude a possible chronic venous insufficiency or thrombosis of the blood vessels of the limbs, duplex scanning of the veins is done. To determine the exact size and structure of the lesion, the doctor prescribes ultrasound of soft tissues and vessels of the legs. And also ultrasound of the abdominal cavity and small pelvis - to identify provoking or accompanying pathologies.
For the purpose of a more detailed examination of the patient's lymphatic system, and also to confirm the final diagnosis, lymphography or lymphoscintigraphy can be used that give a clear picture of the lymphatic vessels of the extremities and the degree of their patency.
Treatment of lymphostasis of the lower extremities
Where is the lower limb lymphostasis treated? In specialized clinics or departments of clinics of a broad profile, where there are physicians-lymphologists or doctors-phlebologists. In the treatment of this disease, self-activity is fraught with disability. After all, the appearance of persistent swelling of the legs can be a symptom of many other diseases, so the first priority is to put the correct diagnosis. And do it only by specialists.
Treatment of lymphostasis of the lower extremities is not an easy task, and doctors are fighting this disease simultaneously in two directions - physical and medicamentous. Thus, the complex treatment of lower limb lymphostasis involves, first of all, an attempt to mechanically rid the lymphatic system of excess lymphatic volume.
For this, patients are advised to keep the leg in elevated position as often as possible, and roll a cushion or pillow for the night.
Massage is also prescribed for lymphostasis of the lower extremities. This is not just a massage, but a special lymphatic drainage massage (manual lymphatic drainage), which activates the contraction of the lymphatic vessels and thus helps the progress of the lymph. Due to this, the edema of the legs is significantly reduced, and the volume of the diseased leg in the first two stages of lymphostasis of the lower extremities (lymphedema and fibredema) can be reduced by 10-15 cm.
In addition, apply hardware massage - pneumocompression. At the same time, an obligatory condition for achieving positive results of physiotherapeutic methods for treating lymphostasis of the lower limbs is the use of special bandaging - bandaging. For this, the attending physician selects an elastic bandage of appropriate density or a medical compression jersey in the form of special stockings and golfs.
Medicamentous treatment of lymphostasis of lower extremities
The main task of treatment of lower limb lymphostasis is the maximum possible recovery of lymph drainage from the tissues of the diseased leg. For this, the so-called phlebotonics preparations are used, the pharmacological action of which is aimed at improving lymphatic drainage and microcirculation in tissues.
The most common of them (including in European medical practice) is the bioflavonoid detralex (diosmin, phlebodia, vasocet). Detralex is used to treat symptoms of venous-lymphatic insufficiency: twice a day on a pill (during meals). The course of treatment is from two to six months. The drug has virtually no side effects, except for diarrhea and dyspepsia with individual intolerance. Application in pregnancy and lactation is acceptable.
Such drugs for lower limb lymphostasis, like troxerutin, troxevasin, vapor, venoruton are effective in treating edema in the first and second stages of the disease.
They increase the tone of the veins and improve their lymphatic drainage function. Gel troxerutin is applied morning and evening to the skin of the swollen leg, slightly massaging until it is completely absorbed (the drug is applied only to intact skin). A troxevasin take 1 capsule 3 times a day.
Homeopathic drug lymphomiazot stimulates metabolism, improves lymphatic drainage and increases excretion of toxins from tissues. The form of the release is a tablet for ingestion or under the tongue, as well as drops. Dose for adults - 10 drops 2-3 times a day for 30 minutes before meals. Lymphomyosot H in ampoules of 1.1 ml is for injection: adults are prescribed one ampoule up to three times a week, in case of acute disease - every day. This medicine is contraindicated in cases of thyroid gland diseases.
Glycoside saponin from the fruits of horse chestnut forms the basis of the venotonic and antiexudative escin preparation (other trade names are aescin, venoplant, escusin, venastat, venitane, theiss Venen gel). Preparations have different forms of release. So, venastat in the form of tablets is taken - 40 mg 3 times daily after meals, washed down with a lot of water. Gel venastat is applied to the skin of affected limb sites several times a day. Contraindications: hypersensitivity, renal failure, early pregnancy, lactation period, renal dysfunction.
Among the side effects of the drug: a feeling of heat, nausea, skin rash, hives, swelling of the subcutaneous tissue.
In medicamentous treatment of lymphostasis of the lower limbs, preparations for systemic enzyme therapy (wobenzyme, phlogenzyme) are used that have anti-inflammatory, anti-edematous and fibrinolytic effects and increase immunity. The dose of vobenzima is 5 tablets three times a day 40 minutes before meals (with a glass of water). Flogenzim is taken 3 times a day for 2 tablets - half an hour before eating, also with plenty of water.
Diuretics (diuretics) in the treatment of lymphostasis of the lower extremities are used with caution, as the fluid accumulating in the tissues (transudate) with lymphatic edema is characterized by the ability to quickly gain lost volume. So diuretics (eg, furasemide) with lymphedema are not always prescribed.
With concomitant lymphostasis of the lower extremities, inflammation of the subcutaneous tissue (erysipelas) or lymphatic vessels (lymphangitis) resort to injections of antibacterial drugs of the penicillin, oxytetracycline and sulfonamides.
If the complex treatment of lymphostasis of the lower extremities did not give the desired effect and the lymphatic sacks and fibrosis appeared on the aching leg, then surgeons are taken for the job. During the operation, detours for lymph drainage (lymphovenous anastomoses) are created, and this makes it possible to significantly improve the condition of patients with chronic lymphostasis of the lower extremities.
Treatment of lymphostasis of the lower extremities by alternative means
A proven and very effective alternative treatment for lower limb lymphostasis is compresses with baked onions and birch tar. To do this, you need to bake an onion in the oven, clean and mix with a tablespoon of birch tar (you can buy it in a pharmacy). The weight is applied to the cotton fabric and applied (with a bandage fixation) to the sore spot at night. The course of such procedures lasts two months.
In alternative medicine, there is a recipe for medical infusion, for the preparation of which should take 350 grams of honey and 250 grams of chopped garlic. The mixture is insisted for one week, and then two months are taken on a tablespoon three times a day - one hour before a meal.
Recommended decoction of leaves of plantain (1 part), dandelion leaves (1 part) and flowers immortelle (2 parts). A mixture of herbs pour 0.5 liters of boiling water, insist 5-6 hours and take 100 ml 4 times a day before meals - for a month.
It is useful to drink twice a day: in a glass of warm boiled water, add a tablespoon of natural apple cider vinegar and a teaspoon of bee honey.
Treatment of lymphostasis of the lower extremities by leeches
In the treatment of lymphostasis of the lower extremities, the main task is to use the complex use of all methods (physiotherapy, bandaging, drugs) to release the lymphatic system of the legs from excess lymphatic fluid and to restore lymph circulation in the affected lower limbs.
Long-term use of anti-inflammatory and diuretic drugs, as well as drugs aimed at increasing the tone of the veins and improving the rheological properties of blood (that is, reducing blood viscosity), unfortunately, does not always lead to the desired result.
Experts note that in the complex treatment of lymphostasis of the lower limbs, including its extremely severe form - elephantiasis, it is advisable to use hirudotherapy: with the help of medical leeches, lymph drainage function of the veins can be significantly improved. The use of leeches increases the overall therapeutic effect of treatment, as the swelling and tension of the lower extremities decrease. This prolongs the period of remission of patients and raises the level of their activity.
Leeches are put - on 3-5 pieces twice a week (the course of treatment makes 8-10 sessions) - on collective lymphatic vessels (lymphatic collectors) and on the sites corresponding to a projection of a venous system of legs. As a result of the therapeutic effect of leeches, the collateral (roundabout) lymph flow stimulates, as additional lymph vessels from the tissues of affected limbs are connected with additional lymph vessels that were not the main ways of lymph drainage.
However, some lymphologists point out that treatment of lymphostasis of the lower extremities by leeches is useless, since leeches are not capable of removing edema.
LFK with lower limb lymphostasis
We spoke about the need and effectiveness of a special massage above, and now - about the benefits of exercise therapy for lower limb lymphostasis. Without therapeutic physical education with such a diagnosis can not do. Doctors say that it is best for such people to engage in swimming or "Nordic walking" (with ski poles). But there is also gymnastics for lymphostasis of the lower extremities.
The following exercises for lymphostasis of the lower extremities are recommended to be done twice a day for 10-15 minutes. Perform these exercises only with a compression bandage (or in compression stockings).
So, we begin. The first and the main exercise is "one leg bicycle". It is done lying down, with the complete rest of a healthy leg. Here you have to remember how to ride a bicycle, and do not be lazy to move not only the hip joint, but also the ankle - as if you push the pedals - bending and unbending the sole of the foot.
The next exercise (and all the others) are performed sitting on the floor (15-20 times):
- with straightened legs to bend, straighten and push apart fingers on the feet;
- with your legs straightened, rotate your feet alternately to the right and left, and then write with the feet of the "eight";
- Do not tear off the feet from the floor, bend the knees, pressing the heels to the back of the hips, and then straighten the legs again;
- lifted leg to do rotational movements alternately right-left, then lower the leg to its original position.
As you can see, the exercises are simple, the main thing is to do gymnastics with lower limb lymphostasis daily.
Diet for lymphostasis of lower extremities
Nutrition for lymphostasis of the lower extremities is of great importance, since in the majority of cases, people with excessive body weight are affected by this disease.
The diet for lymphostasis of the lower limbs involves a limited intake of salt and liquid. As you know, excessively salty food contributes to the accumulation of fluid in the tissues and hampers recovery.
Nutritionists advise to consume a day not more than 100 g of protein of vegetable and animal origin. Next - fats. Patients with this diagnosis should eat at least 10 grams of animal fat and 20 grams of vegetable oil - during the day.
To reduce calories, you need to limit the use of carbohydrates, so give up bread from wheat flour (loaves, buns, etc.), sugar, pasta, manna and rice porridge, not to mention candy, halva and ice cream. But sour-milk products, as well as cabbage, zucchini, pumpkin, carrots, beets, apples and citrus fruits - is not only good for your health, but also very tasty.