Lipoedema

What is it?

Lipoedema is a hereditary and chronic disease that is present in one out of every ten women. The condition varies in severity.

Lipoedema is a disorder in the creation of fat tissue and causes problems with the drainage of fluid via the lymphatic system. As a result, subcutaneous fat (lipids) and fluid (oedema) accumulates, especially around the buttocks and legs. Continuous accumulation of fatty tissue can lead to poor drainage of the lymph and cause lymphoedema.

Since the condition is not well understood yet, the wrong diagnosis is often made. The condition is sometimes confused with obesity or with oedema from another source.

Characteristics:

Lipoedema is usually found in women and begins or worsens with a hormonal change (puberty, postpartum or during menopause).

Swelling:

• is symmetric
• is around the hips, upper and lower legs
• stops at the ankle
• remains, even after losing weight

Are your ankles and feet also swollen? Than it is possible that you have lymphoedema.

Symptoms

• sensitive, painful and swollen legs
• sensitivity to touch

Causes

The cause of the lipoedema is unknown. Hereditary factors seem to play a role.

When lipoedema is present, there is often an issue of reduced strength with the locomotor apparatus. The ankle, foot and knee bands are weak and the supportive connective tissue is slack. You also have reduced muscle strength. These factors can have negative effects on proper or optimal posture and can limit your physical movements.

Factors that play a role in lipoedema

Hormonal factors

Lipoedema usually arise during times of hormonal changes (puberty, pregnancy or menopause).

Obesity

Approximately 70-80% of patients with lipoedema are overweight.

Food

Lipoedema is often accompanied by a disturbed eating pattern. A dietitian can discuss your eating pattern and help you reach a balance between calorie intake and calorie expenditure. Unsupervised diets are usually disappointing in the long-term.

Too little exercise

Patients who have lipoedema have, on average, 30% less muscle strength. This leads to inactivity. In addition, the lymph system is completely dependent on the pump function of the muscles to drain fluid. The risk of venous oedema and/or lymphoedema increases as the (muscle) pump function weakens.

Poor heart function

Patients with poor heart function often have fluid accumulation

Multiple lipoedema stages

Phase one

At this early stage, it can be difficult to differentiate lipoedema from excess fat on the lower body. The following specific characteristics indicate lipoedema:

• extra fat on the buttocks, thighs and calves, but not on the ankles or feet
• pain when pressure is applied to the affected area
• no impression is left when pressing against the skin

Phase two

Without further treatment, lipoedema can advance to phase two.

Characteristics of phase two include:

• subcutaneous fat accumulation or bumps
• additional exacerbation of the lower limbs
• discolouration and an irregular or bumpy appearance on the skin

Phase three

Fat keeps accumulating on the lower body and can make mobility increasingly difficult. Other signs of this phase include excess fat from the buttocks to the ankles, and large fat deposits around the knees.

Phase four

This advanced stage is also known as lipo-lympoedema. It may take more than ten years before the condition reaches this stage. Fat accumulation from lipoedema finally blocks or damages lymph nodes, which means that lymph fluid cannot be drained well. Symptoms include:

• lower body swelling, including parts of the body that had not yet been affected, such as the ankles and feet
• uneven distribution of abnormal fatty tissue in the legs, which can lead to movement problems
• development of lipoedema in the arms

Diagnosis

It is challenging to diagnose lipoedema. Subjective symptoms often play a role. The diagnosis is made using a combination of the medical history (conversation) and clinical examination.

Lipoedema often goes unrecognised because it is assumed to simply be obesity or lymphoedema. Lipoedema is quite different from lymphoedema, however. With lipoedema:

• there is swelling on the back of the hands and feet
• fluid accumulation usually starts on the buttocks and hips and then decreases With lymphoedema, it tends to be the opposite:
• you cannot make any indentations on the skin
• there is dimpling of the skin on the thighs, often called 'cellulitis'
• you may bruise easily
• you may have a painful or cold feeling, especially in your lower legs
• there is no decrease in the symptoms after elevating your legs

All sorts of technical testing try to rule out other pathologies. A Doppler duplex ultrasound can rule out venous oedema, and a lymph scintigraphy can either confirm or rule out lymphoedema. If metabolic disorders are possible, endocrinological testing should be considered.

Treatment

Lipoedema is a chronic disease that cannot be cured. Treatment is focused on alleviating symptoms and to stabilise or reduce leg circumference.

A multidisciplinary approach is often necessary (vascular surgery, dietitian, physical therapy, psychologist, plastic surgery). Since lipoedema cannot be prevented, the treatment is focused more on factors that negatively affect lipoedema.

Conservative treatment

Address being overweight

If the body weight is normal, additional dieting will not reduce lipoedema. If you are overweight, additional fat where lipoedema is present will not go away easily with dieting. Prevention is better than cure. For lipoedema, weight loss is important to prevent a rapid progression of the lipoedema. Involving a dietitian can be very useful.

Keep exercising

It is important to keep moving regularly. Endurance sports such as hiking, jogging or swimming stimulate the lymph system and burn fat. Sports counteract extra weight, ensure that you have sufficient muscle mass and that you maintain your endurance.

Compression therapy

With oedema, you must wear custom therapeutic elastic stockings (type II support stockings) in order to counteract the extra fluid accumulation and to facilitate lymph drainage. This is indicated if there is venous or lymphoedema in addition to lipoedema.

Supportive stockings can be painful and bothersome at first, but with time, this will improve significantly.

Physical therapy

If significant lymphoedema is present, physical therapy, in combination with manual lymphatic drainage and supportive stockings, can be very beneficial.

Manual lymphatic drainage

Read more here about lymphatic drainage.

No medication

There is no good medication to treat lipoedema. Diuretics, other medication and all sorts of anti-cellulite creams have absolutely no effect on the condition.

Communication with peers

Sometimes psycho-social help or contact with other patients who have lipoedema can be supportive and contribute to an improved self-image.

Surgical treatment

In a minority of cases, surgical treatment may be considered. Two surgical treatments can be effective:

Liposuction (suctioning out fat tissue)

This treatment is not curative, but can help the patient function better afterwards. Liposuction can improve pain symptoms, swelling and physical appearance, which then results in an increased quality of life.

Multiple session are often required to thoroughly treat the entire length of the extremities. It is understood that you will need to lead a healthy lifestyle and watch your diet after the treatments.

Excision (cutting out) the excess fat tissue

During this procedure, large accumulations of fat are cut out if, for example, they interfere with walking or present an obstruction. If there are also (many) varicose veins with the lipoedema, a minimally invasive laser procedure can be considered.

Latest publication date: 10/01/2024
Supervising author: Dr Willaert Willem