These two conditions are regularly confused with each other and both are regularly dismissed as weight gain. Getting the distinction right changes the treatment entirely.
Lymphoedema
Swelling caused by a problem with the lymphatic system, where lymph fluid does not drain properly and accumulates in the tissue.
It can be primary, meaning the lymphatic system did not develop normally, or secondary, meaning it developed after damage to the system. Secondary is more common and the frequent causes are cancer treatment, particularly lymph node removal or radiotherapy, as well as surgery, infection or trauma.
It usually affects one limb, is often asymmetrical, and typically starts distally, in the hand or foot. Early on the swelling may reduce overnight. Over time the tissue changes and it stops doing that.
Lipoedema
An abnormal accumulation of fat tissue, almost exclusively in women, usually symmetrical, and characteristically affecting both legs while sparing the feet. That sparing is one of the clearest distinguishing signs.
It is typically painful and tender to touch, bruises easily, and does not respond to dieting in the affected areas, which is the source of enormous frustration for people who have been told repeatedly to lose weight.
It often begins or worsens at times of hormonal change, such as puberty, pregnancy or menopause.
Why they get missed
Both are commonly mistaken for obesity, and people are frequently told to lose weight for years before anyone names the actual condition. Lipoedema in particular does not respond to weight loss in the affected areas, so the advice fails and the person is often blamed for the failure.
The two can also occur together, which is called lipo lymphoedema.
If your legs are painful, tender, bruise easily, are symmetrical, and your feet are unaffected, that is worth having assessed properly.
What physiotherapy treatment involves
For lymphoedema: manual lymphatic drainage, compression therapy, exercise prescribed to support lymphatic flow, and meticulous skin care, since infection is a real risk. Education on self management matters enormously, because this is a long term condition managed rather than cured.
For lipoedema: compression, manual therapy, exercise that is tolerable given the pain, and support around the fact that this is a recognised condition and not a failure of willpower. Managing any co existing lymphoedema matters too.
For both, treatment is ongoing rather than a course that finishes, and the goal is control, comfort and preventing progression.
When to get assessed
Persistent swelling in a limb, especially after cancer treatment. Legs that are painful and tender rather than simply large. Swelling that does not settle overnight. Repeated skin infections in a swollen limb. Or a long history of being told to lose weight without the affected areas responding.
What we do
Assessment and treatment for both conditions across our Adelaide clinics, including manual lymphatic drainage, compression management and prescribed exercise, with hydrotherapy available where land based exercise is difficult.
For the bigger picture, read The Complete Adelaide Guide to Getting Real Relief From Pain and Injury.
