Lipedema – Millions of women visit their doctors with complaints of painful, heavy, and swollen legs. Most receive frustrating advice to lose weight by eating less or exercising more. Despite following this advice, swollen legs remain fat legs.
This is a common scenario for women who suffer from lipedema. Because lipedema closely resembles weight gain, it is often misdiagnosed. Patients receive no treatment, and many blame themselves for a medical condition that requires a specialized approach.
This guide will discuss the indications, causes, symptoms, the four stages of lipedema, and the most conservative and surgical treatment options.
What is Lipedema?
Lipedema is classified as a chronic proteinaceous swelling. Lipedema presents as the accumulation of fat cells. Fat from lipedema is often distributed as a swelling downstream, accumulating on both sides of the legs.
Medical experts say that lipedema occurs from 5 to 11% of women and is very rare in men. Unfortunately, lipedema is poorly understood by many, and many medical professionals often misdiagnose lipedema as either obesity or lymphedema.
Body fat is responsive to a caloric deficit and improved diet. This is not true for lipedema, as lipedema resists weight loss. This means that you may lose a significant amount of weight from the upper body, and the leg swelling from lipedema will remain.
Identifying Lipedema Symptoms
The earlier this disorder is diagnosed and treated, the easier it is to manage. Patients experience Lipedema through both physical and non-physical symptoms that set this disorder apart from average weight gain.
Physical Symptoms
The physical symptoms of lipedema show distinctive characteristics and follow certain patterns:
- Disproportionate Fat Distribution: Lipedema patients have a lower body that is more voluminous than their upper body.
- Symmetrical Fat: Lipedema patients’ fat gain is symmetrical swelling in all directing on both the right and left of the body.
- The “Bracelet” effect: The swelling due to Lipedema leads to a “bracelet” of fat where swelling ceases at the wrists and ankles.
- Pain and tenderness: The affected regions is frequently painful to the touch and leads to a range of painful responses from skin contact.
- Easy Bruising: The delicate state of affected lipedema skin causes it to bruise easily.
- Nodular Texture: The fat beneath the skin is nodular causing a rough and uneven appearance to the touch.
Non-Physical Symptoms
The Non physical symptoms have a significant impact on both the mental and emotional wellbeing of the patients. Diagnosed patients are at risk of developing conditions such as chronic anxiety, depression and body dysmorphia. Due to the nature of the disorder, patients are at risk of developing decreased mobility and hence, chronic exhaustion due to the effort required to perform simple daily tasks.
Causes and Risk Factors
Lipedema is poorly understood. So far, research identifies the role of genetics and hormones.
Lipedema is a genetic condition. A family history of lipedema is found in 20% – 60% of patients. Therefore, if your mother or grandmother’s legs were unusually painful and fat, you become more at risk for the condition.
Hormones are integral with developing lipedema. As hormones level shift, symptoms with lipedema will suddenly increase in severity or become more apparent. For many women, the symptoms typically start via controlled hormones (First, symptoms can start during alteration such as the start of puberty, the start of using hormonal contraceptives, or during, the start of or through perimenopause (the start of the final stages of menopause).
It is important to know that lipedema is not caused by a poor diet or poor lifestyle. Though it is common for patients with lipedema to have a high BMI due to the genetically caused condition, the developed abnormal fat cells are entirely unrelated to the calories consumed by the patient.
The Four Stages of Lipedema
Without treatment, lipedema only gets worse. True to many fields, treatment is most effective when started earlier. The condition progresses in four stages.
Stage 1
This is where the symptoms of lipedema are the most subtle. While the skin generally looks normal, the hyperplastic tissue isn’t visible to the eye. Throughout the affected tissue are clusters of fat that are palpable. Patients in this stage of lipedema often notice tender tissue that bruises easily.
Stage 2
The smoothness of the skin begins to vanish, and it begins to form an uneven appearance. In the second stage, its surface starts to resemble a walnut or cottage cheese, where the large nodules of fat form under the skin. Pain usually becomes more frequent and more intense.
Stage 3
Skin and fat folds balloon, where skin and fat lobules are significantly disrupted. Walking becomes more difficult due to an altered gait, and the limbs become painful.
Stage 4
The last stage, lipo-lymphedema, becomes evident where fat begins to block the body lymphatic pathways. The inability for lymph fluid to drain leads to secondary lymphedema. Severe fluid build up and the abnormal fat become more evident.
How is Lipedema Diagnosed?
Clincial examinations, medical histories, and palpations have more efficiency for the diagnosis of lipedema than blood tests. The pinch test is used to examine the texture of the skin, where the signature texture of the skin is uneven.
The diagnostic process requires the condition to be differentiated from other issues.
- Obesity: General obesity affects the whole body, responds to diet, and does not typically cause pain when touched.
- Lymphedema: A condition affecting the lymphatic system. It is usually on a single limb and usually involves swelling in the feet and hands. An imprint can be left on the swollen area when pressure is applied. This phenomenon is referred to as pitting edema. An important distinction should be made between lymphedema and lipedema. Lipedema is bilateral, usually spares the feet, and is typically non-pitting in its early stages.
Diagnostic imaging, including but not limited to, ultrasounds or MRI scans are performed to exclude vascular diseases to make an accurate diagnosis.
Treatment Options for Lipedema
There are several treatments that are effective at symptom management, pain reduction, and slowing progressive disease, although there is no definitive cure for condition.
Conservative Management
Physicians often recommend starting with a non-invasive approach that focuses on improving day-to-day comfort.
- Manual lymphatic drainage (MLD): This is a form of a specialized massage technique designed to stimulate lymphatic flow, thereby removing excess lymphatic fluid.
- Compression Therapy: Swelling and associated discomfort are managed by the use of either surgically tailored custom compression garments or pneumatic compression devices.
- Exercise: Low impact activities, especially those performed in water, such as swimming and water aerobics, are encouraged. The water’s buoyancy creates an artificial compression, as well as reduces strain on affected joints.
- Dietary Changes: Although eating lipedema fat and inflammation is unlikely to make a considerable difference on the body as a whole, fat and inflammation may play a substantial role in secondary obesity.
- Skin Care: With lipedema, the skin may turn to a drier and a more severely fragile state, therefore, regular sanitation and thorough moisturization is necessary to lessen the risk of infections, such as cellulitis, that could further aggravate and damage the lymphatic system.
Surgical Treatment
Surgical treatment is one of the options to consider should conservative methods fail to provide relief.
- Lymph-Sparing Liposuction: Techniques that include water-jet assisted liposuction may be utilized to safely and successfully remove some of the abnormal fat cells. Surgeons utilize methods that limit the damage of the fragile lymphatic vessels.
- Bariatric Surgery: For patients that fall under the class obesity criteria with a BMI of 35 or more, doctors may suggest bariatric surgery. While this surgery will not treat the underlying lipedema, it may improve the function and reduce the load of the joints by decreasing total weight.
How to Manage with Lipedema
When faced with these diagnoses, the feelings are complex and overwhelming. One must establish a routine that involves daily compression, gentle movement, and self-care.
Finding a community that will uplift and support you and is integral to managing the emotional aspect of the diagnosis. Join a local support group or an online one. Another, just as vital, aspect is being your own advocate. Do the research. Stay abreast of the developments and tell your medical team what you need and your situation.
What to Do Next
Lipedema is a complex condition that will have a significant impact on your health. It deserves to be recognized and requires careful, specialized management. You are not alone in the heaviness, painfulness, and frustration of the condition.
If you relate to the symptoms in this booklet, keep a record of your experience, and see a healthcare professional that specializes in vascular or lymphatic disorders. The ability to walk with minimal pain and to a great extent restores your quality of life and your more than you realize.
