Lipedema, or "big leg syndrome," is a chronic, progressive disorder of the fatty tissue with a lymphatic component. It primarily affects women – 10 to 18 percent of women aged 25-65 suffer from it, significantly impacting their quality of life.
Lipedema is characterized by an abnormal, bilateral, and symmetrical distribution of subcutaneous adipose tissue in the lower limbs or, very rarely, the upper limbs, associated with moderate edema. It causes spontaneous pain when pressed or pinched, a feeling of tightness on the skin, and frequent bruising.
It is often confused with obesity, lipodystrophy or lymphedema and unfortunately remains relatively unknown to both the medical community and the general public.
However, it has a major impact on patients' body image and quality of life.
Lipedema primarily affects the legs (97% of cases). The increase in fat volume is accompanied by fragility of the blood capillaries that transport fluid to surrounding tissues and are more susceptible to blows, resulting in bruising or contusions.
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Lipoedema development and causes
Lipedema is a condition likely hereditary and related to periods of hormonal change such as puberty, pregnancy, or menopause. It usually begins gradually from adolescence onward and then progresses more or less rapidly, sometimes becoming very disabling. Lipedema is in no way related to nutrition, with which it is wrongly associated. This fluid released into the tissues is usually drained by the lymphatic system. In the long term, however, this constant irritation reduces the transport capacity of the lymphatic vessels, promoting the formation of edema, inflammation, and subsequently collagen deposits, which are responsible for the irreversible fibrotization of the adipose tissue and skin.
Causes: Hormonal imbalance: This can be caused by fluctuations in hormones such as estrogen, progesterone, and testosterone.
- Genetic predisposition: Certain genes may be associated with an increased risk of developing lipoedema.
- Overweight: Being overweight or having a higher than average body mass index (BMI) can increase the risk of developing lipoedema.
- Stress: Persistent high stress can lead to an increased risk of lipoedema.
- History of trauma: Previous injuries or trauma to the legs and hips may contribute to the development of lipoedema.
- Occupations: Occupations that require you to sit and/or stand for long periods of time can increase the risk of developing lipoedema.
- Medical conditions: Conditions such as diabetes, hypothyroidism, kidney disease and lymphedema can increase the risk of developing lipoedema.
- Medications: Certain medications, such as those used to treat cancer, can cause lipoedema.
Symptoms with diagnosis of lipoedema:
The diagnosis is mainly clinical, but in case of doubt, additional investigations may be necessary: CT scan, high-resolution ultrasound, MRI and lymphoscintigraphy.
- Swelling and heaviness of the legs/arms (also known as “stovepipe” or “pole legs”)
- Abnormal fat distribution from the hips to the ankles and feet, creating a pear-shaped silhouette
- Vulnerability of the superficial microcirculation leading to small bruises at the slightest impact
- Superficial venous insufficiency with frequent varicose veins and stretch marks near the joints
- Limited range of motion of the knee, ankle or elbow joints.
- Pain or tender skin (legs, arms, buttocks) when pressure is applied
Stages of lipoedema:
Based on anatomical and pressure findings, lipoedema can be divided into three stages. The severity of the symptoms or the volume of the edema are irrelevant.
- Stage 1: smooth skin surface, thickened subcutaneous fat, fine nodular fat structure.
- Stage 2: uneven skin surface, rough, lumpy fat structure.
- Stage 3: rougher and harder skin surface and subcutaneous tissue, large deformed fat pads.
What treatments are there?
Many people suffering from lipedema wonder if it is curable. While the pathological swellings cannot always be completely cured, proper treatment can at least significantly reduce them. Available treatments are more or less effective depending on the stage of the lipedema and the patient's expectations. Therefore, they must be examined on a case-by-case basis, as the treatment for the condition is not codified.
Physiotherapy
- Manual lymphatic drainage
- Decongestive physiotherapy with short extension bands of less than 100%
- Muscle exercises under multi-component bandages to release some of the retained water
Pressotherapie
- Pressotherapy, a pneumatic massage from distal to proximal, complements physiotherapy. It is performed using gliding wave massage and promotes blood circulation and lymphatic flow. Significant effects can be observed, particularly with medically certified devices like ours. They can reduce swelling, relieve pain, and remove stagnant fluid from tissue. This technology can be used in a physiotherapist's office, but also at home with a personal device.
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Surgery
- Liposuction to reduce volume and reshape the trochanteric region and inner thighs, with continuous elastic compression for the first 7 days, then daytime use only for 4 to 6 weeks. The procedures can be repeated up to 6 times, depending on the areas being treated, with an interval of at least one month between liposuctions.
- Skin resection of large masses on the inner thighs or calves, with decongestive physiotherapy (low-elasticity bandages) preoperatively to reduce the fluid component to facilitate wide resection, and postoperatively to stabilize the volume.
Complementary approaches
- Wearing custom-made elastic compression stockings of class 2 or 3 to maintain volume in the long term and to act on venous insufficiency
- Elevation of the limbs to reduce pain
- Physical activity to maintain muscle tone and stabilize weight, especially in a water environment to limit spontaneous superficial pain (aqua gym, aqua bike)
- Skin care: hydration
- Psychological care
Using a Pressotherapy system
The system of Nymph Consists of a pump and one or more cuffs, which are easy to use, safe, and effective for edema. It is important that you follow the instructions given to you by your nurse, therapist, or doctor regarding edema therapy.
Before using the system, remove any compression bandages or stockings. Sit comfortably and, if necessary, place a cylindrical cotton bandage or stockinette stitch on the affected limb. Place the cuff on the edematous limb to be treated and connect it to the pump.
Adjust the pump settings for lymphatic drainage to program B as advised by your doctor, then switch on the pump.
The cuff will alternately inflate and deflate, providing a gentle massage. This stimulates blood and lymph flow in your affected limb. If the pressure is too high and you experience discomfort, you can reduce the pressure setting on the pump. This can even be done during the ongoing therapy session.
It's important to follow the instructions given regarding duration and frequency of use. An edema therapy session lasts between 30 and 90 minutes.
After completing the edema therapy, the cuff and any cotton bandage should be removed. If you are wearing compression garments, you can put them back on. Years of experience have shown that very few problems have been experienced by people using this system. However, if you become short of breath, or your limb becomes swollen or painful, or if the skin becomes red and inflamed during the treatment, you should stop immediately and inform your doctor as soon as possible.
