What is Lymphorrhea?
Lymphorrhea is a leakage of lymphatic fluid. How does one come to discharge lymph from the body? Lymphorrhea is generally from tissue that has edema or lymphedema present. Edema is a fluid build-up while lymphedema is a fluid buildup of protein rich lymphatic fluid. SoâŠI guess you could say, all lymphedemas are edema but not all edemas are lymphedema.
Lymphorrhea appears as beads of clear fluid that seep through the skin. Not only is this distressing and uncomfortable, but it can be a risk of skin breakdown and cellulitis (skin infection). Lymphorrhea is also sometimes called âwet legsâ as it tends to occur in the legs.
Lymphorrhea Meaning
Like many medical terms, âlymphorrheaâ is a compound word of lymph + orrhea. Orrhea means flow or discharge, such as in menorrhea (the menstrual flow), pyorrhea (flow of puss) and of course the well known diarrhea, which needs to further explanation. So, as the above examples, lymphorrhea is a flow or discharge of lymph.
Lymphorrhea Causes
Lymphorrhea occurs most often in people with advanced progressive illness and reduced mobility with a predisposing factor of edema or lymphedema (Morgan, 2018). The edema can be due to chronic venous insufficiency, cardiac, renal or liver impairment, immobility or lymphedema (see below).
Lymphedema
There are two main causes of lymphedema – primary and secondary. Primary lymphedema is a condition you are born with, or develop without injury in your teens or early adulthood (lymphedema tarda).
Secondary lymphedema is common after cancer treatment. The incidence varies depending on the type of cancer and the treatment, itâs been noted to be about 30% in breast cancer patients (Shaitelman, 2015).
Lymphedema can occur after any surgery, even common procedures like knee replacements, cesarian sections or any surgery in which the lymph nodes or lymphatic system is damaged.
Once the edema or lymphedema fluid builds up under the skin, this causes the skin to stretch. This stretching can eventually lead to a tearing of the skin and a leaking of lymphatic fluid – lymphorrhea. Having an injury to the skin when it is already stretched can also cause lymphorrhea.
Chronic edema and lymphedema are becoming more common as several factors converge â aging, sedentary lifestyle and the increasingly prevalent chronic conditions of cancer, stroke, arthritis and chronic venous disease (Todd, 2017).
Events Leading to Lymphorrhea
When edema is present, there will be swelling, the change in the microenvironment with an increase in macrophages leads to inflammation, which then leads to skin changes, then superficial ulceration and finally lymphorrhea.
Lymphorrhea Treatment
Itâs important to treat lymphorrhea right away. The goal is to prevent further breakdown of the skin and reduce the risk of cellulitis (Todd, 2017).
The first step is to clean the skin with washing emollient, dry it and moisturize it (Morgan, 2018). Then, you will need to apply dressing that will not adhere to the skin, be absorbent and prevent maceration of the skin. Maceration is the result of skin that stays wet and it appears white, wrinkly and soggy. You are likely familiar with this appearance if youâve ever worn a band-aid in the bathtub or pool.
If the skin is red and/or if redness is spreading, if it is warm to the touch, painful or the there are flu-like symptoms, or generally feeling unwell or fatigued, there could be cellulitis. If so, you should seek immediate medical attention for this and IV and/or oral antibiotics will most likely be needed. You should not delay getting treatment for this, as cellulitis has the potential to get into the blood and cause sepsis. Use a pen to circle any red area on your skin, and make note of the time, this is helpful to see if the redness is increasing or decreasing and how quickly.
Lymphorrhea dressings will need to be changed regularly. corresponding to the amount of lymphorrhea discharged. Compression can be applied over the dressing.
For a quick and easily available dressing, feminine hygiene pads can be used as can diapers, be sure to use the unscented ones. But there are also specialized wound care dressings that have been cited in research such as: Cutimed Sorbio Sachet XL (Morgan, 2018).
In addition to changing the dressing, you may need to change your socks, shoes, sheets etc, with greater frequency, as sometimes lymphorrhea can produce a large volume of discharge and soak into your socks, shoes and sheets. Keeping the skin clean and dry is important so be prepared to change these more often.
Compression is the other essential component of lymphorrhea treatment. Without compression, it will take longer to get the lymphorrhea stopped (Morgan, 2018).
Lymphorrhea Wounds
Lymphorrhea can lead to skin breakdown and open wounds. Taking care of any wound is very important as wounds can spread both wider and deeper into the tissue. Itâs also critical to think about what is going on beneath the skin. If your veins are not working well, then delivery of oxygen and nutrients to help heal the wound will be compromised.
If you have a wound that is not healing then seek out a wound care specialist. This could be a physician, nurse, physical therapist, occupational therapist or podiatrist with special training in wound care. For very difficult to heal wounds, there are several high tech options that can be used like air mattresses, wound suction and hyperbaric oxygen.
Wound care nutrition is also important. While the wound care specialist can work on healing the wound from the outside – in, good nutrition can heal the wound from the inside-out. If you have a chronic wound or not sure how to improve your nutrition for wound healing, then see a registered dietitian.
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References for Lymphorrhea
Morgan K, Thomas M. The development of a ‘wet leg’ pathway for chronic oedema. Int J Palliat Nurs. 2018 Jan 2;24(1):40-46. doi: 10.12968/ijpn.2018.24.1.40. PMID: 29368551.
Shaitelman SF, Cronwell KD, Rasumussen JC, et al. Recent progress in the treatment and prevention of cancer-related lymphedema. CA Cancer J Clin. 2015 Jan-Feb;65(1):55-81.
Todd M, Lay-Flurrie K, Drake J. Managing ulceration and lymphorrhea in chronic oedema. Br J Community Nurs. 2017 May 1;22 Suppl 5(Sup5):S34-S41. doi: 10.12968/bjcn.2017.22.Sup5.S34. PMID: 28467225.
