Diagnosis & treatment
Lipoedema – abnormal fat distribution
Lipoedema is not a build-up of fat caused by being overweight; it is an abnormal distribution of fat over the thighs, lower legs and hips. It is associated with an increased number of pathologically modified fat cells. Since it is almost exclusively women who suffer from lipoedema, experts suspect that the causes are hormonal. Amongst the few men with lipoedema, the liver is often damaged.
Symptoms of leg lipoedema
- Negative Stemmer's sign
- Tendency to spider veins
- Tendency to bruise easily
- Increased swelling of the lower legs later in the day
- Symmetrical swelling
- Pain on contact or pressure
- Family history
- Soft, knotty skin with typical pitting
In some cases, the arms are also affected. Lipoedema is always symmetrical. There are "pillar-like" changes and deformations of the legs, with "saddlebags" around the hips and bottom. If the disorder spreads down the legs, we talk about the "baggy trouser" effect, since the deformed swelling generally ends at the ankle but the fat overlaps onto the feet.
Lipoedema is sensitive to pressure and touch. In the advanced stage, even close-fitting clothing can be painful.
What are "saddlebags"?
The term "saddlebags" is used colloquially to describe the build-up of fat on the bottom, hips and insides of the knees which occurs almost exclusively in women.
Diet-resistant accumulations of fat
Often, it is actually women with slim upper bodies who are affected. If the accumulation of fat persists despite dieting and exercise, these "saddlebags" can be a sign of lipoedema. Another indication of lipoedema is a tendency to suffer from spider veins, to bruise easily and to feel pain on contact or pressure.
Unlike lymphoedema, it is always both legs that are affected – and sometimes the arms too.
Differences between lipoedema and lymphoedema
There are several ways to distinguish lipoedema from lymphoedema
- Stemmer's sign is negative – that means that you can lift up a fold of skin over the second or third toe or on a finger
- Tendency to spider veins
- Tendency to bruising
- Increased swelling of the lower leg later in the day
- Lipoedema is always symmetrical, that means it affects both legs
- Sensitive to pressure and touch
- In the advanced stage, even close-fitting clothing can be painful
Stemmer's sign is positive – that means that you can't lift up a fold of skin at the second or third toe
Risk factors and causes
Lipoedema almost only affects women and girls. Experts think that the causes are hormonal. Lipoedema generally first appears towards the end of puberty, during pregnancy or during the menopause. In addition, a tendency to develop lipoedema seems to be hereditary.
How to prevent it
During the early stages of lipoedema, exercise and a healthy diet can help. You should exercise around three times a week, but for at least 45 minutes. Compression stockings must be worn any time you exercise, as this will prevent any further swelling.
Tips for living with lipoedema
Lipoedema is a chronic disorder. Alongside the medical treatment provided, your personal behaviour will also determine how well you can live with oedema.
Exercises are a good idea, but only if you wear compression stockings or bandages. Without compression, your legs would swell up even more because of the movement. The following types of exercise are most suitable:
- Power walking
- Aqua jogging
- Comfortable clothing
Make sure that you wear loose clothing and comfortable, flat shoes. Do not wear tight belts or bras.
- A balanced diet
Lipoedema is not a build-up of fat caused by being overweight. It therefore cannot be treated by weight loss diets. However, losing weight combined with exercise (wearing compression stockings) can have a positive effect. You should avoid putting on weight in any case. If you are overweight, you should try to keep your body mass index (BMI) between 19 and 25.
Medications and creams unfortunately have absolutely no effect on lipoedema.
- Skin care
Hygiene is particularly important for oedema patients. You should always use cleansing and skincare products that have a neutral pH. Deodorants should not be used in the areas where you have oedema.
How is lipoedema treated?
Lipoedema occurs almost exclusively in women and girls. Diet and exercise cannot treat it successfully, but compression therapy achieves very good results. It prevents the oedema from developing any further. So rest assured, you can do something to tackle your oedema.
Compression garments will reduce lipoedema or make sure it doesn't get any worse. In Stage 1 often just seamless, round knit compression stockings in compression class 2 (CCL 2) or 3 (CCL 3) are worn. In most cases, however, experts recommend flat-knit compression garments.
The stockings should be worn every day if possible and on at least three days a week (and also when you do excercises). Your doctor or medical supply will be happy to advise you. Patients in Stage 2 should only wear flat-knit compression stockings (with seam).
In Stage 3, complex physical decongestion therapy (CPD) is used, as it is for lymphoedema. It starts in Phase 1 with manual lymph drainage followed by application of a compression bandage. This phase is followed by the maintenance phase, when compression garments are worn. Once again, flat-knit products are used, because the material is less elastic and offers the best pressure stability.
Other forms of treatment: liposuction
Another form of treatment is liposuction, where the fat is actually sucked out. Pitting of the skin may occur after this intervention. However, this can be largely avoided by wearing special compression garments. Before undergoing liposuction, you should talk to your doctor to see whether this is the best option for you.
To summarise: If your legs, hips or bottom are getting bigger, don't just think about dieting. Ask your GP (or a phlebologist) whether you might have lipoedema. If you do, take the advice you're given as in regard to your treatment and make sure you get plenty of exercise – but always wearing compression garments. Eat a healthy, balanced diet. In this way, you'll stay fit and mobile – even if you do have lipoedema.