Lymphorrhea: Understanding And Managing Chronic Weeping Legs

What Is Lymphorrhea

Lymphorrhea is not always fully understood and experiencing lymphorrhea can be confusing, distressing and overwhelming. While generally referred to as ‘leaking lymph fluid from the surface of skin’, this simple description of lymphorrhea doesn’t fully address the causes of lymphorrhea or provide steps for proper lymphorrhea treatment.

Lymphorrhea is a medical condition, generally a side effect of having lymphedema, characterized by the weeping or leaking of clear, straw-colored, or light amber-colored lymph fluid beads (lymphorrhea drops) which leaks or trickles out through an opening in the surface of the skin. Lymphorrhea most commonly occurs in the legs, but it can also affect any area of the body.

Lymphorrhea can be described as being much like a pinhole leak because lymphatic fluid will take the path of least resistance, and having a tiny opening in the skin provides that path for the continual escape of leaking lymph fluid. Over time the flow of the lymph fluid leak can increase as the size of the pinhole increases. As the volume of leaking lymph fluid rises, the condition takes on the appearance of “weeping legs”, and is often referred to as “leaky legs”.

Managing and stopping the lymph leak involves immediate care of providing localized pressure at the site of the lymph fluid leakage, and treatment of the underlying swelling (edema).

What Causes Lymphorrhea

Lymphorrhea is generally viewed as a potential complication of having lymphedema, a condition which often occurs as a result of cancer treatment which increases the risk for developing lymphedema, or due to the result of being born with a compromised lymphatic system (primary lymphedema).

Lymphorrhea is caused by high tissue pressure resulting from severe or unmanaged lymphedema. Lymphorrhea is characterized by leaking lymph fluid that occurs when the pressure from swelling inside affected skin tissue becomes too high for the skin to contain lymphatic fluid, or an opening in the skin’s surface causes the lymph leakage. Due to the pressure within the skin tissues, even a simple or very minor knock or scratch to the skin can result in a wound, which can quickly lead to significant lymph fluid leadage. In the case of a knock or scratch, blood might be mixed in with the lymphatic fluid.

The two primary factors which contribute to the development of lymphorrhea legs include:

severe lymphedema which results in chronic swelling that builds up so much pressure inside the tissues that the skin can no longer contain the lymphatic fluid
skin micro-tears or wounds that are caused by high tissue pressure resulting in the tiny cracks and abrasions, ultimately resulting in lymph fluid leakage through the compromised skin (weeping legs or leaking legs)

Lymphorrhea is also more likely to occur when other secondary contributing factors combine to create an ideal setting for lymphorrhea legs to develop. These other factors which may contribute to the development of lymphorrhea include:

immobility or sedentary lifestyle
standing for long periods
not wearing compression garments or compression bandages
heart failure
development of health conditions such as breathing difficulties or cellulitis
low protein levels (low albumin)
cancer treatment or progression affecting the lymphatic system

What Are Lymphorrhea Symptoms

One of the most common and early symptoms of lymphorrhea is a general feeling of tightness, tenderness, and swelling of the skin, even if you can’t tell exactly where it’s located and don’t know why it is occurring.

Leaking lymphatic fluid is another common symptom, which may include the presence of tiny droplets of fluid (lymphorrhea drops) beading up on the skin. When this occurs it indicates that a lymph fluid leak has developed.

Other common lymphorrhea symptoms include fragile skin which has a sensation of extremely hot or cold, appearance of blisters, cracks or breaks in the skin, and skin that is constantly wet. You may also have a feeling of deep pain within the skin.

Shifts in body temperature or the development of a fever can also be a symptom of lymphorrhea that may indicate that a secondary infection has developed.

How To Treat Lymphorrhea

Lymphorrhea often develops suddenly and therefore it is important to understand and watch for the symptoms of lymphorrhea. Also, since lymphorrhea usually develops as a side effect of having lymphedema, you should get appropriate advice from your lymphedema therapist regarding the development and treatment of lymphorrhea legs.

The general treatment protocol for lymphorrhea treatment includes:

Clean the affected area: Gently wash the skin surrounding the lymph leak with mild soap and water to lower the risk of bacterial skin infections, such as cellulitis, from developing.
Practice skin care: Protect your skin by carefully cleaning the affected area and apply a moisturizing layer (moisturizing cream or emollient) to protect the skin. It's recommended that you use a specially formulated lymphedema skincare product (a moisturizer, lotion, cream, or gel) because off-the-shelf, perfumed lotions could actually dry out your skin and make your condition worse. The use of appropriate skincare products will form a protective barrier at the wound site and help prevent further cracking or breakdown
Apply and use absorbent dressings: Use a sterile, non-adherent, and highly absorbent wound dressing to cover the weeping sites, absorb the lymph fluid, and protect the compromised skin from further trauma. Note that you should avoid using adhesive dressings that can tear and further damage fragile skin.
Apply compression: Pressure is the main way to stop leaking lymph fluid resulting from lymphorrhea. Applying specialized short stretch compression bandages, compression leg wraps, or other appropriate compression garments will helps reduce the underlying tissue pressure. Depending on the severity of the lymph leakage, the use of compression will often stop the leaking lymph fluid within 24 to 48 hours.
Consult with your healthcare provider: A doctor or lymphedema specialist should evaluate the lymphorrhea lymph fluid leak to check for infection and adjust the treatment protocol if needed.

Note that treating lymphorrhea with compression presents special and unique challenges that need to be considered. The leaking lymph fluid will quickly cause the components of the overlying multilayer compression bandage to become wet and saturated, which will require repeated changes of the compression bandages to prevent the skin from becoming macerated. Macerated skin opens up additional health issues such as added pain or swelling, tissue damage and increased chances of infection. To help manage weeping legs you should use a highly absorbent wound dressing that can adequately accumulate the volume of lymphatic fluid resulting from lymphorrhea, thereby providing a dry treatment environment.

Read about the Eclypse super absorbent wound dressing for weeping legs.

How Can Lymphorrhea Be Prevented

The best preventative for any health concern is to maintain your personal medical health at its highest level. However, there is no full proof way to prevent the development of lymphorrhea. There are certain steps which you can take which will help reduce the risk for the onset of lymphorrhea, especially if you are at risk for its development.

Practice daily skin care: Skincare is a vital aspect of lymphorrhea prevention. Ensuring that your skin is cleaned and moisturized is the best proactive approach to help prevent lymphorrhea from developing or worsening. Washing and moisturizing your skin daily will help prevent the development of cracks in the skin which contribute to the development of lymphorrhea.
Follow proper nutrition: A healthy, well-balanced diet will help you to maintain a healthy body weight which can help improve lymphatic and venous return.
Gently move your legs: Engage in light, low-impact muscle movements, such as seated ankle pumps, walking in place, or other exercises, which will help pump lymph fluid through the lymphatic channels in your leg. If you are able, exercising at a higher level will also help move lymphatic fluid as well as contribute to your overall physical health.
Elevate the affected area: Elevate your limb above the level of your heart and keep it elevated which will help gravity naturally drain the lymphatic fluid back toward the center of the body.
Apply compression: Performing self or assisted manual lymphatic drainage massage (part of lymphedema complete decongestive therapy) will help move lymphatic fluid through the lymphatic channels, preventing it from accumulating and creating high tissue pressure. You should also wear your compression garments or bandages as prescribed by your healthcare provider.

In addition to practicing self-help, you should also get ongoing assessment and advice from your healthcare provider regarding lymphorrhea prevention or treatment. Your doctor or lymphedema therapist can best advise on specific treatment pathways and determine the appropriate use of compression wraps, compression bandages, or compression garments to help prevent or manage your lymphorrhea.

What To Do If Lymphorrhea Develops

Despite your best efforts to prevent the onset of lymphorrrhea, unfortunately it develops. Now what?

Lymphorrhea by itself is not always immediately dangerous, but it can become a life-threatening condition if left untreated, depending on its severity, location, and secondary complications which may arise. If lymph fluid leakage develops in conjunction with redness, heat or pain in the affected area, there is a high likelihood that you have cellulitis and you should seek immediate medical attention.

If you experience weeping legs or other symptoms of lymphorhhea, you should consult with your healthcare provider to determine whether your condition is the result of lymphorrhea and if necessary, to develop a lymphorrhea treatment plan. You should also notify your healthcare provide if the lymphatic fluid leakage does not being to slow after 48 hours of proper compression bandaging, or if you experience dizziness or dehydration.

Proper skin care will remain essential as part of your lymphorrhea treatment. At this point, your skin will be under very high tissue pressure and will have been compromised at the site of the leaking lymph fluid. The site of the lymph leakage also creates a portal for bacteria which can lead to infection such as cellulitis.

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Frequently Asked Questions About Lymphorrhea

What Causes Lymphorrhea

Lymphorrhea occurs when the tissue pressure within the skin becomes so great that the skin is unable to contain trapped lymphatic fluid, resulting in a lymph leak. Physical injury, trauma or wounds, insect bites, surgical incisions, or infection, such as cellulitis, can also compromise the skin barrier which creates an exit point for pooled lymph fluid. Leaking lymph fluid will exit the body through tiny pores, cracks, blisters, or skin abrasions in the compromised skin. Lymphatic fluid becomes trapped or builds up when the lymphatic system is damaged, blocked, or overloaded, causing lymph fluid to accumulate. Lymphedema is generally the primary cause of a compromised lymphatic system.

What Causes Lymphedema

While people can be born with a compromised lymphatic system (primary lymphedema), most lymphedema occurs as a result of treatment for cancer, which increases your risk of developing lymphedema. When lymphedema develops as a result of cancer treatment it is referred to as secondary lymphedema.

Other causes of secondary lymphedema include:

Tumors, which can physically block lymphatic vessels, channels, or lymph nodes
Surgery involving lymph node dissection (generally for breast, pelvic, or prostate cancer) can damage or disrupt normal lymphatic drainage pathways
Radiation therapy can cause scarring and inflammation that weakens or blocks lymph vessels
Venous Insufficiency, which is poor blood flow in leg veins, causes fluid retention and severe edema which impacts lymphatic flow
Other health conditions such as heart failure, liver disease, kidney disease, or protein-calorie malnutrition can lead to systemic fluid overload that results in weeping legs

What Is The Difference Between Lymphedema And Lymphorrhea

Lymphedema and lymphorrhea are closely related medical conditions involving the body's lymphatic system, however they are not the same thing. Lymphedema is a chronic condition that occurs when the lymphatic system is damaged, blocked, or otherwise compromised. Lymphedema is characterized by the abnormal buildup of protein-rich lymphatic fluid in the body's tissues, usually affecting the arms or legs. If the tissue pressure within the skin becomes so great that the skin barrier is unable to contain the trapped lymph fluid, lymphorrhea can develop.

Where Does Lymphorrhea Occur

The most common place for lymphorrhea to occur is in the legs (lymphorrhea legs). However, lymphorrhea can affect any area of the body.

Who Is Susceptible To Lymphorrhea

Anyone who has primary or secondary lymphedema is at a higher risk of developing lymphorrhea. Any form of edema, which is swelling that occurs when excess fluid is trapped within the body and can’t redisperse normally through the body’s fluid movement systems, also increases your chances for lymphorrhea. Trauma to the skin, including surgery, wounds, insect bites, skin infections or other conditions which can compromise the skin barrier will also increase the risk of lymphorrhea.

Is Lymphorrhea Dangerous Or Life Threatening

Lymphorrhea itself is not considered to be immediately dangerous or life-threatening, but left untreated, lymphorrhea can become life-threatening depending on its severity, location, and secondary complications that arise from having it.

Vigilance is key to limiting the progression of lymphorrhea to a more severe stage. If redness, heat, or pain develop in the affected area, you should immediately seek medical attention as these symptoms could indicate that a cellulitis infection has developed.

When Does Lymphorrhea Become Dangerous

Should lymphorrhea develop, the primary risk to your health is the risk of severe bacterial skin infections such as cellulitis, which can lead to more serious complications. The protein-rich leaking lymph fluid is caustic to normal skin, which irritates the skin and causes erosion, maceration, and open wounds if left untreated. This skin breakdown allows bacteria to easily enter, which can lead to severe bacterial skin infections like cellulitis, that can spread to the bloodstream to cause sepsis which is a life-threatening condition.

In extreme cases, large-scale internal or external lymphatic leaks can cause dangerous drops in blood volume, severe hypoproteinemia (abnormally low levels of blood protein), or hypovolemic shock which occurs when your body experiences massive fluid loss.

You should seek immediate medical attention if you notice:

Signs of a spreading skin infection, which includes rapidly expanding redness, warmth, increasing or throbbing pain, pus, or fever.
Sudden, severe swelling or pressure in your limb.
Continued or significant lymph fluid leakage.
Dizziness, extreme weakness, or signs of dehydration.

Can Lymphorrhea Be Cured - How To Get Rid Of Lymphorrhea

Managing and stopping leaking lymph fluid can be successfully done with proper lymphorrhea treatment. The weeping (leaking) of lymph fluid through the compromised skin is caused by high tissue pressure resulting from severe or unmanaged lymphedema. The primary treatment protocol for lymphorrhea is applying pressure to treat the underlying swelling caused by the lymphedema. Localized pressure is typically provided by compression bandaging for lymphedema, but can also be achieved through the use of compression wraps or compression garments.