Lymphostasis of the lower extremities: what are the dangers of leg swelling?

A fairly large number of people experience swelling of the legs. When swelling of the foot or lower leg with tense veins is observed in the evening, and the swelling disappears in the morning, this is not good: these are distant harbingers of varicose veins or thrombophlebitis... But if the swelling becomes more noticeable every day and does not go away in the morning, then a no less alarming diagnosis is likely - lymphostasis of the lower extremities.

Lymphostasis is what doctors call a pathology of the lymphatic system, which is expressed in the complete cessation of lymph circulation (lymph flow). That is, the lymph stops performing its functions and constantly draining the body's tissues. And edema is a clinical manifestation of this pathological process. In this case, the legs suffer the most, and in women five times more often than in men.

Lymphostasis of the lower extremities (lymphedema, lymphatic edema) is a chronic disease with swelling of only one or both legs at once. The disease does not go away on its own, but progresses to an irreversible form, in which the formation of fibrous tissue leads to thickening of the legs - elephantiasis (elephantism).

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Causes of lymphostasis of the lower extremities

Among the factors that contribute to the development of leg lymphostasis, experts name kidney disease, cardiovascular disease, pathologically low levels of total protein in the blood (hypoproteinemia), varicose veins, damage to the lymphatic vessels with their blockage or compression (for example, by tumors or inflammatory infiltrates).

The cause of lymphostasis of the lower extremities may be chronic damage to the lymphatic vessels by streptococcus and other microorganisms against the background of weakened immunity. In addition, the cause of lymphostasis may be congenital defects of the lymphatic system.

In case of a congenital anomaly, lymphostasis is called primary, and the disease begins to make itself known in childhood, worsening with age. Acquired lymphostasis of the lower extremities is defined as secondary and appears, as a rule, only on one leg - as a result of injuries, inflammation, tumors of the lymph nodes or lymphatic vessels, radiation therapy or surgical treatment of the vessels of the limb. Lymphostasis of the lower extremities during pregnancy is most often observed in the case when the lymph circulation disorders in the expectant mother are congenital, and this is primary lymphedema.

It should be noted that the disruption of the outflow of lymphatic fluid in lymphostasis is accompanied not only by edema. Stagnation of lymph slows down the removal of toxins from tissue cells, and this, in turn, increases the acidity of the skin, causing unpleasant itching. As a result, the skin becomes thicker and denser, its protective function decreases, and microbes from the upper layer of the skin can freely penetrate into the subcutaneous tissues, causing various inflammations.

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Symptoms of lymphostasis of the lower extremities

The course of lymphostasis of the lower extremities has three stages: reversible edema (lymphedema), irreversible edema (fibredema) and elephantiasis.

Typical localization of swelling at the first stage of the disease is the ankle joint, the base of the toes and the muscle layer between the metatarsal bones on the back of the foot. The swelling is easily palpated, almost painless, the skin over the swollen area is pale and often forms a fold. In the cold season, after several hours of rest, the swelling may almost disappear or decrease significantly.

The main symptom of lower limb lymphostasis at the second stage (irreversible edema) is the spread of constant edema up the leg, which does not go away even after a long rest. Moreover, the nature of the edema also changes: it becomes denser (a mark from pressing remains for a long time), and it is simply impossible to gather the skin into a fold. Patients with chronic lower limb lymphostasis 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 a long stay on the legs, there may be cramps.

This stage lasts for a long time, and as the disease progresses, the skin of the affected limb darkens (sometimes with a bluish tint), the skin becomes stretched and painful, and the stratum corneum of the epidermis thickens and becomes rough (hyperkeratosis).

Symptoms of elephantiasis - the third stage of lymphostasis of the lower extremities - proliferation of connective tissue in the skin, subcutaneous tissue and between the muscles of the leg and an increase in the volume of the leg so much that it resembles an elephant's limb. At the same time, even the bones become thicker, and ulcers and inflammation may appear on the skin.

Diagnosis of lymphostasis of the lower extremities

Diagnosis of lower limb lymphostasis begins, as usual, with anamnesis and examination of the affected leg. A biochemical blood test and urine test are also prescribed. To exclude possible chronic venous insufficiency or thrombosis of the blood vessels of the extremities, a duplex scan of the veins is done. To determine the exact size and structure of the lesion, the doctor prescribes an ultrasound of the soft tissues and vessels of the legs. As well as an ultrasound of the abdominal organs and pelvis - to identify provoking or concomitant pathologies.

For a more detailed examination of the patient's lymphatic system, as well as to confirm the final diagnosis, lymphography or lymphoscintigraphy can be used, which provide a clear picture of the lymphatic vessels of the extremities and the degree of their patency.

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Treatment of lymphostasis of the lower extremities

Where is lower limb lymphostasis treated? In specialized clinics or departments of general clinics, where there are lymphologists or phlebologists. In the treatment of this disease, self-treatment is fraught with disability. After all, the appearance of persistent swelling of the legs can be a symptom of many other diseases, so the primary task is to make the correct diagnosis. And only specialists can do this.

Treatment of lower limb lymphostasis is not an easy task, and doctors fight this disease simultaneously in two directions - physical and medicinal. Thus, complex treatment of lower limb lymphostasis includes, first of all, an attempt to mechanically rid the lymphatic system of excess lymph volumes.

To do this, patients are advised to keep the sore leg elevated as often as possible and to place a bolster or pillow under it at night.

Massage is also prescribed for lower limb lymphostasis. This is not just a massage, but a special lymphatic drainage massage (manual lymphatic drainage), which activates the contraction of lymphatic vessels and thereby helps the lymph move. Due to this, leg swelling is significantly reduced, and the volume of the sore leg in the first two stages of lower limb lymphostasis (lymphedema and fibroedema) can decrease by 10-15 cm.

In addition, hardware massage is used - pneumatic compression. In this case, a mandatory condition for achieving positive results of physiotherapeutic methods of treating lymphostasis of the lower extremities is the use of special bandaging. For this, the attending physician selects an elastic bandage of appropriate density or medical compression hosiery in the form of special stockings and knee-highs.

Drug treatment of lymphostasis of the lower extremities

The main goal of treating lower limb lymphostasis is to restore the outflow of lymph from the tissues of the affected leg as much as possible. For this purpose, so-called phlebotonic drugs are used, the pharmacological action of which is aimed at improving lymphatic drainage and microcirculation in the tissues.

The most common of them (including in European medical practice) is the bioflavonoid Detralex (diosmin, phlebodia, vazoket). The drug Detralex is used to treat symptoms of venous-lymphatic insufficiency: one tablet twice a day (during meals). The course of treatment is from two to six months. The drug has virtually no side effects, except for diarrhea and dyspepsia in case of individual intolerance. Use during pregnancy and breastfeeding is permissible.

Such drugs for lymphostasis of the lower extremities as troxerutin, troxevasin, paroven, venoruton are effective in the treatment of edema in the first and second stages of the disease.

They increase the tone of the veins and improve their lymphatic drainage function. Troxerutin gel is applied morning and evening to the skin of the swollen area of the leg, lightly massaging until completely absorbed (the drug is applied only to intact skin). And Troxevasin is taken 1 capsule 3 times a day.

The homeopathic preparation lymphomyosot stimulates metabolism, improves lymphatic drainage and enhances the removal of toxins from tissues. Release form - tablets for oral or sublingual administration, as well as drops. The dose for adults is 10 drops 2-3 times a day 30 minutes before meals. Lymphomyosot N in ampoules of 1.1 ml is intended for injections: adults are prescribed one ampoule up to three times a week, in case of acute illness - daily. This medicine is contraindicated in diseases of the thyroid gland.

Glycoside saponin from horse chestnut fruits is the basis of the venotonic and antiexudative drug escin (other trade names are aescin, venoplant, escusan, venastat, venitan, Theiss Venen gel). The drugs have different forms of release. Thus, venastat in tablet form is taken - 40 mg 3 times a day after meals, washed down with plenty of water. Venastat gel is applied to the skin of the affected areas of the limbs several times a day. Contraindications: hypersensitivity, renal failure, early pregnancy, lactation period, renal dysfunction.

Side effects of the drug include: feeling of heat, nausea, skin rash, urticaria, swelling of subcutaneous tissue.

In the drug treatment of lower limb lymphostasis, drugs for systemic enzyme therapy (Wobenzym, Phlogenzym) are used, which have an anti-inflammatory, anti-edematous and fibrinolytic effect and increase immunity. The dose of Wobenzym is 5 tablets three times a day 40 minutes before meals (with a glass of water). Phlogenzym is taken 3 times a day, 2 tablets - half an hour before meals, also with plenty of water.

Diuretics (water pills) are used with caution in the treatment of lower limb lymphostasis by specialists, since the fluid that accumulates in the tissues (transudate) during lymphatic edema has the ability to quickly regain lost volume. So diuretics (for example, furosemide) are not always prescribed for lymphedema.

In cases of inflammation of the subcutaneous tissue (erysipelas) or lymphatic vessels (lymphangitis) accompanying lymphostasis of the lower extremities, injections of antibacterial drugs from the penicillin, oxytetracycline and sulfonamide groups are used.

If complex treatment of lower limb lymphostasis has not produced the desired effect and lymphatic sacs and fibrosis have appeared on the affected leg, then surgeons take up the matter. During the operation, bypasses are created for the outflow of lymph (lymphovenous anastomoses), and this makes it possible to significantly improve the condition of patients with chronic lower limb lymphostasis.

Treatment of lymphostasis of the lower extremities with folk remedies

A proven and very effective folk remedy for treating lymphostasis of the lower extremities is compresses with baked onions and birch tar. To do this, bake an onion in the husk in the oven, peel it and mix it with a tablespoon of birch tar (you can buy it at the pharmacy). The mass is applied to a cotton cloth and applied (fixed with a bandage) to the sore spot overnight. The course of such procedures lasts two months.

In folk medicine, there is a recipe for a medicinal infusion, for the preparation of which you should take 350 g of honey and 250 g of crushed garlic. The mixture is infused for one week, and then taken for two months, a tablespoon three times a day - an hour before meals.

A decoction of plantain leaves (1 part), dandelion leaves (1 part) and immortelle flowers (2 parts) is recommended. The mixture of medicinal plants is poured with 0.5 liters of boiling water, infused for 5-6 hours and taken 100 ml 4 times a day before meals - for a month.

It is useful to drink this drink twice a day: add a tablespoon of natural apple cider vinegar and a teaspoon of honey to a glass of warm boiled water.

Treatment of lymphostasis of the lower extremities with leeches

In the treatment of lymphostasis of the lower extremities, the main task is to use a comprehensive approach (physiotherapy, bandaging, medications) to free the lymphatic system of the legs from excess lymphatic fluid and restore lymph circulation in the affected lower extremities.

Long-term use of anti-inflammatory and diuretic drugs, as well as drugs aimed at increasing the tone of 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 lower limb lymphostasis, including its extremely severe form – elephantiasis, it is advisable to use hirudotherapy: with the help of medical leeches, the lymphatic drainage function of the veins can be significantly improved. The use of leeches increases the overall therapeutic effect of treatment, since swelling and tension in the lower limbs are reduced. This prolongs the period of remission of patients and increases their level of activity.

Leeches are placed - 3-5 pieces twice a week (the course of treatment is 8-10 sessions) - on the collecting lymphatic vessels (lymphatic collectors) and on places corresponding to the projection of the venous system of the legs. As a result of the therapeutic effect of leeches, collateral (roundabout) lymph flow is stimulated, since additional lymphatic vessels, which were not the main lymph outflow routes, are connected to the removal of excess lymph from the tissues of the affected limbs.

However, some lymphologists note that treating lymphostasis of the lower extremities with leeches is useless, since leeches are not able to relieve swelling.

Exercise therapy for lymphostasis of the lower extremities

We have already discussed the necessity and effectiveness of special massage, and now we will talk about the benefits of exercise therapy for lower limb lymphostasis. You cannot do without exercise therapy for such a diagnosis. Doctors say that it is best for such people to go in for swimming or "Nordic walking" (with ski poles). But there is also gymnastics for lower limb lymphostasis.

The following exercises for lower limb lymphostasis are recommended to be done twice a day for 10-15 minutes. These exercises should only be done with a compression bandage (or in compression stockings).

So, let's begin. The first and main exercise is "bicycle with one leg". It is done lying down, with the healthy leg completely at rest. Here you will have to remember how to ride a bicycle, and not be lazy to move not only the hip joint, but also the ankle - as if you were pressing 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 straight legs, bend, straighten and spread your toes;
• with straight legs, rotate your feet alternately to the right and left, and then write figure eights with your feet;
• without lifting your feet off the floor, bend your knees, pressing your heels to the back of your thighs, and then straighten your legs again;
• Make rotational movements with the raised leg alternately to the right and left, then lower the leg to the starting position.

As you can see, the exercises are simple, the main thing is to do gymnastics for lymphostasis of the lower extremities every day.

Diet for lymphostasis of the lower extremities

Nutrition for lymphostasis of the lower extremities is of great importance, since in the vast majority of cases this disease affects people who are overweight.

A diet for lower limb lymphostasis involves limited consumption of salt and liquid. As is known, excessively salty food contributes to the accumulation of fluid in tissues and complicates recovery.

Nutritionists advise consuming no more than 100 g of plant and animal protein per day. Next – fats. Patients with this diagnosis should consume at least 10 g of animal fat and 20 g of vegetable oil per day.

To reduce calories, you need to limit your carbohydrate intake, so give up wheat bread (loaves, buns, etc.), sugar, pasta, semolina and rice porridge, not to mention sweets, halva and ice cream. But fermented milk products, as well as cabbage, zucchini, pumpkin, carrots, beets, apples and citrus fruits are not only good for your health, but also very tasty.

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