Understanding Lymphoedema

What is lymphoedema?

Lymphoedema is a long-term, progressive condition that causes swelling in the body's tissues when the lymphatic system is damaged or unable to drain fluid effectively. It can affect almost any part of the body and may cause discomfort, heaviness, reduced mobility, skin changes and a greater risk of infection. For many people, lymphoedema also has a wider impact on daily life, confidence, clothing choices, work, relationships and emotional wellbeing, often requiring ongoing management such as compression, skin care, exercise and monitoring to help control symptoms and reduce complications.

Woman at home resting her hands on a leg covered by a compression stocking, showing one way people manage lymphoedema in daily life.

More than simply swelling

Lymphoedema can affect different parts of the body and can vary considerably from one person to another.

For some people it may affect mobility, comfort, clothing, the need to wear compression garments, skin care or everyday activities.

The way lymphoedema affects one person may therefore be very different from the way it affects somebody else.

Why understanding matters

Lymphoedema is not always visible or well understood.

A person may need additional time, consideration or assistance even when their condition is not immediately obvious.

Symptoms can also change from day to day. Swelling, discomfort, fatigue or the effects of compression garments may make some activities more difficult at certain times than at others.

Understanding this can help avoid assumptions and make it easier to offer appropriate support when it is needed.

Lymphoedema is individual

LymphAware ID does not assume that everyone living with lymphoedema has the same needs or experiences.

Different locations

Lymphoedema can affect limbs and other areas of the body, depending on the individual and underlying cause.

Different needs

Some people may use compression garments, require assistance with mobility or have other practical considerations.

Different experiences

Symptoms, treatment needs and day-to-day impact can vary significantly, which is why patient-selected information is important.

Complications of lymphoedema

Cellulitis signs and prevention

Cellulitis is a bacterial infection of the deeper layers of the skin. People living with lymphoedema are more vulnerable to it, and prompt treatment is important if an episode is suspected.

Possible signs an episode may be starting

Changes can include skin becoming painful, hot or more swollen, with redness or inflammation. Redness may be less obvious on brown or black skin.

Some people also feel generally unwell or develop flu-like symptoms, a raised temperature, or feel hot, cold or shivery.

If skin becomes painful, hot and swollen, seek urgent medical advice from a GP or NHS 111.

Reducing the risk where possible

Good skin care can help reduce the chance of bacteria entering through damaged or cracked skin. Keep the skin clean and moisturised and look out for cuts, scratches, bites or other damage.

Clean and protect minor skin injuries promptly, try to avoid cuts and insect bites, wear suitable footwear or protective gloves where appropriate, and treat fungal skin infections such as athlete's foot.

Cellulitis cannot always be prevented, but protecting the skin and responding quickly to signs of infection can help reduce risk and complications.

Understanding lymph flow

Superficial and deep lymphatics

What is sometimes called the “shallow” system is usually described clinically as the superficial lymphatic system. The deep fascia—the strong sheet of connective tissue around muscles—is the landmark that separates it from the deep system.

Three-dimensional cutaway illustration of skin, fatty tissue, fascia and muscle. Green superficial lymphatic vessels are shown above the fascia, while a separate green deep lymphatic vessel runs beside an artery and vein below the fascia. — The deep fascia is the dividing line: superficial collecting vessels sit above it in the subcutaneous tissue; deep collecting vessels sit below it. Original LymphAware ID 3D illustration, based on the anatomical arrangement described by Suami H, *Anatomical Theories of the Pathophysiology of Cancer-Related Lymphoedema* (2020). Simplified for explanation and not to scale.

The key difference

Superficial vessels collect fluid from the skin and the tissue just beneath it. Deep vessels drain muscles, joints and other deeper structures.

The two systems have separate routes through much of a limb, then connect or converge nearer the centre of the body. Both ultimately return lymph to the bloodstream.

More pressure is not better. Pressing harder through the skin does not provide direct access to the deep lymphatics. Manual lymphatic drainage uses light, precise skin movement because it is intended mainly to influence superficial tissues and vessels.

What this means in practice

Superficial lymph flow can be supported by gentle skin movement, appropriate compression and regular movement.

Deep lymph flow is influenced more by muscle activity, joint movement, breathing and changing pressures within the body.

The two systems work together, so movement and appropriately prescribed lymphoedema management can support overall lymph drainage.

Above the deep fascia

Superficial lymphatics

Tiny lymph capillaries begin in the skin. They take up excess tissue fluid, proteins and immune cells, then pass the lymph into precollectors and larger collecting vessels in the subcutaneous tissue.

This is the system most closely associated with the swelling seen in peripheral lymphoedema. Its collecting vessels contain one-way valves and muscle in their walls, helping lymph move forwards in small sections.

Gentle skin movement used in manual or simple lymphatic drainage is designed to support this superficial system. The direction and suitability should be assessed and taught by a lymphoedema specialist.

Below the deep fascia

Deep lymphatics

Deep lymphatic vessels drain structures such as muscles and joints. They commonly travel beside the deeper arteries and veins rather than immediately beneath the skin.

Movement of muscles and joints changes pressure around these vessels. Breathing also changes pressure within the chest and abdomen, while pulsation from nearby arteries and the vessels’ own contractions can help propel lymph.

Deep lymph flow is therefore supported chiefly by normal body movement and changing internal pressures—not by applying forceful massage from the outside.

How lymph keeps moving

Unlike blood circulation, the lymphatic system has no single central pump. Flow comes from several mechanisms working together:

Vessel contractions and valvesCollecting vessels rhythmically contract, while one-way valves help prevent backward flow.
Movement and muscle activityWalking, joint movement and muscle contraction create changing pressure around lymphatic vessels.
Breathing and nearby pulsationPressure changes during breathing and movement from neighbouring blood vessels can support lymph propulsion.
Correctly fitted compressionCompression changes pressure in the tissues and can work with movement to help control fluid build-up when prescribed for the individual.

Sources: lymphatic anatomy, lymphatic flow and pumping, and NHS lymphoedema treatment guidance.

How lymphoedema can progress

Stages of lymphoedema

Lymphoedema is commonly described using four clinical stages, from Stage 0 to Stage 3. The stages describe changes in swelling and the tissues over time, but the condition can affect people very differently and does not always progress in the same way.

Illustrated guide showing the progression of lower-limb lymphoedema from Stage 0, where swelling is not visible, through mild and persistent swelling to Stage 3 with marked swelling and skin changes.

Important: these stages are a general guide rather than a prediction of what will happen to an individual. Lymphoedema may affect different parts of the body, and symptoms and severity can vary considerably from person to person.

Living with lymphoedema

Four cornerstones of self-care

Looking after lymphoedema often means combining several approaches. A lymphoedema specialist can help you choose what is appropriate for your body and your needs.

Person applying moisturiser to the skin of their lower leg.

Skin care

Keep skin clean and moisturised, and check for cuts or changes. Healthy skin helps reduce the risk of infection, including cellulitis.

Compression

Professionally fitted garments or wraps can help limit fluid build-up. Your specialist can advise on the right type and how to wear it.

Woman walking gently along a garden path.

Movement and exercise

Gentle, regular movement uses your muscles to support lymph flow and mobility. Activities can be adapted to your ability and affected area.

Therapist using gentle hand contact on a patient's lower leg.

Lymphatic drainage

Manual lymphatic drainage (MLD) is a gentle technique provided by a trained therapist. They may teach you simpler self-massage, called simple lymphatic drainage (SLD).

For safety: MLD is a specialist treatment, and SLD should be taught for the individual area and circumstances.

The best combination varies from person to person. Follow advice from your lymphoedema team about compression, activity and massage. Read the NHS guide to lymphoedema treatment.

Further information

Trusted sources about lymphoedema

For broader information about lymphoedema, its symptoms, management and available support, these independent sources may also be helpful.

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