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The lymphatic system is the second circulatory system, made up of small vessels and groups of lymph nodes. These lymph nodes are mainly situated around the neck, armpits, abdomen, groin and around other lymphatic tissue such as the tonsils, liver and spleen.

The lymphatic vessels transport a colourless fluid called lymph. This lymph fluid carries fats, proteins, dead cells, bacteria, viruses, heavy metals, pathogens and white blood cells (lymphocytes).

The lymphatic system has no pump, unlike the blood circulatory system which is driven by the heart. It relies solely on muscular and skeletal movement, which means it can become quite sluggish.

The lymph fluid is passed through to the lymph nodes, where it is filtered and bacteria are destroyed, before being eliminated via the kidneys.

The white blood cells (lymphocytes) are formed within the lymph nodes and are responsible for fighting infection and building the body's immunity.

Lymphoedema is a swelling of the limbs and body due to the build up of lymph fluid which carries waste products around the body, including large proteins, fats, water, dead cells, bacteria and white blood cells. Lymph fluid plays an important role in the body's defence against infection.

Lymphoedema occurs when damage to the drainage routes causes the damming effect of the lymph fluid. Lymphoedema has various causes:

• Removal of the lymph nodes as part of a cancer treatment

• A congenital condition

• Damage resulting from an accident

After surgery, where any lymph nodes are removed, there will be a certain amount of post-operative swelling. This is part of the healing process and usually settles around 8-10 weeks or so. However, if there are still signs of swelling to an area i.e. breast, chest, back, arm, hand, fingers, abdomen, groin, genitals, legs, feet or toes, then this may be the start of Lymphoedema. The swelling could also occur several months or years after the operation.

The area may also feel tight, with discomfort that tends to feel like a dull ache, due to the extra fluid accumulating. If the area is swollen, this may also lead to stiffness within the joints. Gentle movement exercises will help to alleviate this. These should be given by a specialist.

Science does not know why some people develop Lymphoedema after surgical removal of the lymph nodes. You can however minimise the risk:

Exercise - This should be of a non-repetitive nature, i.e. swimming, walking, yoga, pilates.

Skin care - It is essential the skin be kept in optimum condition with no dryness. Applying a moisturising cream daily will prevent dryness and cracks in the skin. Any opening in the skin can give rise to the risk of infection.

Avoid having your blood pressure or blood sample injections taken from the area at risk.

Avoid any cuts or scratches to the area. Always wear protective clothing whilst gardening, washing up or sewing.

Always use an insect repellent.

Avoid getting sunburnt and use a high protection factor daily of SPF 30+.

Avoid tight restrictive clothing around the area, including rings and watches.

Take care when cutting your nails and do not cut the cuticles.

If flying, consider using a compression garment, obtained from a Lymphoedema practitioner or GP.

Carry on with life as normal, trying not to strain the limb i.e. avoid lifting heavy shopping, heavy gardening, (pulling & pushing).

Extreme changes in temperature can increase swelling i.e. avoid spending a long time in a hot bath, steam or sauna, where the body changes temperature at a faster rate than usual.

If you suspect you show signs of Lymphoedema, please contact your consultant and a MLD Lymphoedema practitioner.

The most widely used treatment for Lymphoedema is Manual Lymphatic Drainage (MLD). This is a specialist massage therapy to the lymphatic system, only to be carried out by specially trained Lymphoedema practitioners. The principal aim is to redirect fluid away from the swollen areas towards healthy lymphatic nodes to be drained and eliminated.

After an initial consultation, a course of treatments is usually required; 5-20 daily treatments over a 1-4 week period. This may then need to be followed by regular weekly or monthly sessions or further courses at 6-12 month intervals.

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If the limb has an area that is hot, red, shiny, painful to touch and if flu-like symptoms occur, contact your GP as soon as possible as you may need antibiotics that should be taken immediately.

Always quickly treat any cuts, scratches or insect bites with an antiseptic product.

Lymphoedema affects people in many different ways, physically and emotionally. By following these guidelines, symptoms can be reduced and you can lead as normal a life as possible:

Try not to sit, stand or have the limb static for a long period of time. Avoid continuous, repetitive work.

Always wear your compression garment and remember it on long journeys and flights.

Avoid extremes of temperature.

Avoid a blood pressure cuff and the affected limb being used to take blood. If both arms are affected, then blood can be taken from the foot.

Wear non-restrictive clothing and a good fitting bra with wide straps.

Wear appropriate footwear and avoid straps that can dig into the Lymphoedema.

Avoid carrying heavy shopping, lifting heavy items or heavy gardening.

Follow a good skin care routine, never allow the skin to become dry.

Always use a good sunscreen of SPF 30+.

Never allow the area to become sunburnt.

Use an insect repellent.

Always have a supply of antibiotics to hand. In case of infection, these should be taken immediately.