Lipoedema is a disease of unknown aetiology, which predominately affects women. Lipoedema manifests at puberty, pregnancy or during menopause. It is described as a ‘bi-lateral, symmetrical, flabby swelling’ of the legs, that arises from deposition of adipose tissue, starting at the hips and descending downwards, ending at the ankles. Common signs are tenderness to pressure and minor trauma causing bruising.
The prognosis of uncomplicated lipoedema is good if diagnosed early. However, regarding healing, the prognosis is poor, unless adequate treatment is provided. If patients receive treatment before they are 35, the likelihood of a better outcome is higher. Otherwise the disease progresses and approximately 17 years after onset, on average, the combination form or ‘lipo-lymphoedema’ may occur.
Lipo-Lymphoedema is a combination of lipoedema and lymphoedema. This is when the lymphatic system becomes compromised due to the ‘strangulation’ of the lymphatics by these fat cells.
It must be stressed however, that lipoedema is not a subjective problem. It is not a matter of ‘fat legs’. Lipoedema is a disease that requires treatment and dieting will NOT improve it. However, a healthy, calorie conscious, low fat, low carbohydrate diet along with exercise, is recommended.
Treatment MUST be preceded with a comprehensive and thorough examination and consultation. The treatment of choice – Decongestive Lymphatic Therapy (DLT) would initially be too uncomfortable. So, several sessions of Manual Lymphatic Drainage (MLD) is recommended until the patient can tolerate the pressure of bandages.
Once compression bandages are cautiously applied, a noticeable reduction is made, even though the ‘oedema’ is not pitting. Wearing compression hosiery will support the tissues and make the patient much more comfortable.