A lady e-mailed asking me to highlight a condition she suffers with, that she was certain others suffer with too, and don’t know, or can’t doanything about. Lipoedema or lipedema, is a chronic long term condition typically involving an abnormal build-up of fat cells in the legs, thighs and butt. The condition occurs almost exclusively in women, although there have been rare cases reported in men.One of the most frustrating things about lipoedema, is that the vast majority of health professionals aren’t trained to recognise it, and so many women go their whole lives without obtaining a diagnosis.

Lipoedema is most likely to appear at puberty, before which time a young person will most likely have had a ‘normal’ body shape. However, it can also appear during other hormonal changes.  It can be very distressing, when a young woman finds certain areas of her body do not reduce in the same way as her friends and family, despite following the same healthy diet and exercise routines.

Signs and Symptoms

The legs become enlarged from the ankles up to the hips. Both legs are usually enlarged at the same time, and to the same extent. The feet are not affected, and this creates a ‘bracelet’ effect or ‘band-like’ appearance just above the ankles. The hands are not usually affected either, although the arms occasionally can be. The degree of enlargement caused by lipoedema differs between individuals, and it can gradually worsen over time. As well as becoming enlarged, affected areas of the body may:

• – Feel soft, ‘doughy’ and cold
• – Be tender to touch
• – Bruise easily
• – Ache or feel painful
• – Have small broken veins under the skin.

The condition can progress to cause fluid retention (lymphoedema) in the affected legs. The combination of these symptoms can lead to reduced mobility and psychological issues, such as low self-esteem.

Cause

The cause of lipoedema is not known, but there is a family history of the condition in some cases, and it seems likely that the genes you inherit from your parents play a role. Given lipoedema tends to start at puberty or at times of hormonal change, such as pregnancy or the menopause, it suggests hormones may also have an influence. Although the accumulation of fat tends to be worse in people who are obese, the condition is not caused by obesity, and can affect people who are a normal weight.

Diagnosis

You should see your GP if you have symptoms of lipoedema, so they can try to identify the cause. This will usually involve examining the affected areas of your body to help determine whether you have lipoedema or lymphoedema. Lymphoedema has similar symptoms to lipoedema, and can sometimes develop as a result of lipoedema, but it is caused by a build-up of fluid from the lymphatic system, rather than a build-up of fat cells. The skin of someone with lymphoedema will pit or indent when you press it, but this will not happen with lipoedema.

Treatment

As there has been little research into lipoedema, there is some uncertainty about the best way to treat the condition. Generally, the main treatment options are non-surgical treatments and liposuction.

Non-surgical treatments These can sometimes be helpful in improving pain and tenderness, preventing or reducing lymphoedema, and improving the shape of affected limbs, although they often have little effect on the fatty tissue. Several different treatments are designed to improve the flow and drainage of fluid in your tissues, such as:

• – Compression therapy – bandages or garments that squeeze the affected limbs
• – Exercise – usually low-impact exercises, such as swimming
• – Massage – techniques that help encourage the flow of fluid through your body.

These treatments are similar to the treatments for lymphoedema.

Liposuction

The only treatment that appears to be effective in reducing the build-up of fatty tissue associated with lipoedema is a procedure called tumescent liposuction. It involves injecting a liquid solution into the legs to help numb the area and reduce blood loss, before the unwanted fat is sucked out through a tube. This procedure can be an effective treatment with good results, but several separate operations may be necessary to remove the fat from the different parts of your body.

Also, non-surgical treatments may still be needed for a long period afterwards. For example, compression garments need to be worn after surgery, to prevent complications such as lymphoedema. Lipoedema does not respond to:

• – Elevating the legs
• – Diuretics (tablets to get rid of excess fluid)
• – Dieting – this tends to result in a loss of fat from areas not affected by the lipoedema, with little effect on the affected        areas.

Lymphoedema or lipoedema?

While these two conditions can look very similar, there are important differences. Lymphoedema is swelling under the skin caused by a build-up of fluid in the lymphatic system, which is the network of vessels that drains excess fluid from body tissue. Swollen skin caused by lymphoedema will pit or indent if you press it, but this does not happen in cases of lipoedema. A person with lipoedema may eventually develop lymphoedema as well, if the build-up of fat affects lymphatic drainage. This combination of the two conditions is known as lipo-lymphoedema.

Sadly there aren’t many avenues to aid with lipoedema, however, it is important to try to get a diagnosis, so at least you know which problem you are dealing with. There is one person that we know of who is certified to treat with lymphoedema, contact us, and we can put you unto her to see if she can assist you. Otherwise, see your GP to be diagnosed or referred to a specialist.                      

                                              Your feet mirror your general health . . . cherish them!