Lipoedema treatment and compression
The use of compression to treat lipoedema patients cannot reverse the adipose tissue/limb enlargement and a change or reduction in limb shape/size will generally not be seen. This is often a disappointment to many who may have been led to believe it will. However, there are potential benefits for using it:
- It can help to support loose, floppy tissues and provide a streamlining effect to an uneven or distorted limb shape/size. This in turn improves general mobility and gait and improves the appearance of the distorted limbs
- Helps to reduce the pain and discomfort so many lipoedema patients experience (though the thought of applying the garments may feel daunting, once in place it can often prove very comfortable)
- The graduated effects of the compression will help to reduce oedema (swelling of fluid) which may be present in some lipoedema patients (either because of dependency or a secondary lymphoedema). The use of compression is a MUST for such patients
A recent survey by LipoedemaUK (2018) l Suggest: asked the members who currently use compression and found:
‘If it is worn more often, compression seems to help relieve the pain associated with the condition (IF THEY ARE A GOOD FIT), and can help to improve activities of daily living and quality of life considerably
(particularly in the earlier stages of the disease)’.
If the decision to use compression is made, careful assessment is required to ensure there are no contra-indications to its use. This will involve assessment of the vascular system (to rule out arterial impairment), the heart, the neurological status and the skin condition (to ensure damage from garment application is minimised). The type and extent of the swelling will be noted, as well as the general health of the patient, whether there are any co-morbidities, the presence of pain, oedema, and the ability of the person to use/wear the compression.
The type of compression to be used will then be discussed and chosen appropriately. This may include one or more of the following:
Medical graduated compression garments are not the same as support tights – they have been specifically designed and manufactured to deliver appropriate levels of graduated compression. Garments are generally available on prescription as a ready-to-wear garment (off the shelf) or custom-made (made to measure - to fit a patient precisely). Both need careful measuring/fitting by a trained professional to ensure a good fit and good compliance.
There are different forms/types of compression garments:
- Circular-knit garments that do not have a seam. They tend to be very elastic and as such tend to work into creases and skin folds. They are best suited to those with a normal (if larger) limb shape and size. For patients with large lobes/limb distortion, they may not be the most ideal type of garment (though made to measure varieties are now available)
- Flat-knit garments are often thicker and firmer than circular knitted products and have a seam where they are stitched together. They are much more suited to patients who have uneven or distorted limbs as the garments can ‘bridge’ the creases and folds.
Applicators to help apply and remove garments are available, and tips on how to use, wear and care for them is generally provided.
Statement from the LipoedemaUK survey (2018):
‘Patients require support, encouragement (physical/psychological) to use compression appropriately and effectively & need encouragement/peer support to commit to using/wearing it daily’.
Adjustable Compression Wraps
These medical compression devices are more rigid than compression garments and are made of sections of inelastic fabric pieces that wrap around the limb and secure with ‘Velcro’ fastenings. They are designed for more easy application and removal by the patient/carer and are often less painful to use. They allow the level of compression to be adjusted and are much longer lasting than compression garments (though bulkier and less pleasing to the eye).
Wraps are used more commonly in lipoedema patients who have a secondary oedema (fluid) too – or who have painful limbs and cannot manage to apply garments.
Like compression garments and wraps, compression (or multi-layer) bandaging is only beneficial to those patients who have severely distorted and painful limbs and a secondary oedema within the adipose tissues (not for those with pure lipoedema). Bandages are often applied 2-3 times per week for 4-6 weeks, generally by a trained practitioner (though patients can be taught to self-bandage on occasions) and will involve the hands or feet too.
The bandages can be bulky – but should still allow freedom of movement – and once the course of bandaging is complete then measurements should be taken for appropriate compression garments to maintain and optimise results achieved.
Intermittent Pneumatic Compression Therapy (IPC)
An IPC is an electrical air pump that inflates/deflates chambers within specifically made garments. One of the benefits of IPC is to help reduce oedema (by improving venous/lymphatic return and reducing oedema formation). This treatment is generally used during a course of compression bandaging for patients who have complex lipoedema (with secondary oedema). However, they are also known to help reduce pain so particularly helpful for lipoedema patients as they can be used in the comfort of their own home. This treatment method is also beneficial for those unable to tolerate compression garments (the pressure of the pump can be altered and adjusted to a more comfortable level of treatment). As always, careful assessment is advised before such devices are used – and full instructions should be given for their use and care.
Whilst medical compression may not be necessary or indeed useful for all patients with lipoedema – it is most definitely recommended for such patients who have a secondary oedema within the swelling. It is also helpful for many with painful lipoedema limbs, and those who have severe limb shape and distortion that affects mobility and range of movement.
In such patients the word compression may be misleading and the word ‘support’ maybe better. Certainly, many patients are finding benefit from using general support tights, leggings and certain sportswear that is becoming increasingly popular in tennis, jogging, cycling and other sports. This type of garment does not generate much graduated compression but does provide greater support to the tissues/muscles and worth trying if traditional compression garments are not necessarily working for you.?