Lipoedema occurs almost exclusively in women. They are characterized by a symmetrical increase in fatty tissue with feelings of tension and heaviness on the thighs and lower legs, but also on the arms.

In addition, there is a pronounced tenderness to touch and pressure and a noticeable tendency to bruise after minor trauma. It is not uncommon for the skin to feel very cool in certain areas.

The disease is lifelong, with the first symptoms often appearing during puberty or after pregnancy.

Classification into three stages

In its development, en/lipedemaa passes through three stages, which can, but do not necessarily have to, merge into one another.

Initially, the skin is still smooth, but the subcutis thickens and the fatty tissue appears to have a fine nodular structure. This is the most common stage 1. Patients complain of swelling of the legs or arms when sitting or standing, which then disappears at night when lying down. This stage often remains the same for the rest of the patient's life, provided their weight remains more or less the same. However, it can worsen in individual cases: the most common cause of deterioration is definitely a large increase in weight. Any increase in weight leads to a disproportionate accumulation of fat in the legs, which is difficult to lose if the weight is reduced at a later date.

Stage 1 can progress to stage 2: This involves coarse nodular changes in the fatty tissue and the skin surface becomes uneven.

In stage 3, pronounced skin deformations with coarse fatty flaps develop. The bulge-like swellings lead to abrasions and inflammation on the inside of the legs.

Lipoedema is basically genetic, but can also occur without similar cases in the family.

Symptoms

Lipoedema is usually only visually disturbing because, for example, boots no longer fit or tight-fitting jeans can no longer be worn.

In many cases, en/lipedemaa leads to symptoms; these can be minor or extreme (disabling), regardless of the extent of the en/lipedemaa. Sometimes en/lipedemaa is only very mild, but the discomfort is immense; in other cases, en/lipedemaa is grotesquely pronounced but completely painless.

The main symptom is swelling of the legs, which increases during the day when standing and sitting, but always subsides at night. This swelling is an accompanying lymphatic swelling. It is harmless and only occurs in the context of en/lipedemaa. The swelling originates from the individual fat cells, which store water over the course of the day and thus become larger. Lymphoedema, on the other hand, leads to congestion in the lymph vessels, which is usually accompanied by swelling of the forefoot and toes, then spreading to the lower leg and finally involving the thigh.

This swelling can be visually disturbing or it can also be accompanied by discomfort. A feeling of heaviness and bruising, tiredness, tenderness and congestion are the most common complaints.

This swelling and/or discomfort is usually reported symmetrically and mainly in the lower leg area , but sometimes also locally, e.g. on the side of the lower leg in the ankle region, on the front of the thigh, etc. The leg swelling on the lower leg can range from a few millimeters (in the evening the imprints of the socks can be found) to a few centimeters. The forefoot and toes usually remain unaffected by the swelling or swell only slightly. With lymphoedema, on the other hand, the feet are the first to swell, followed by the lower legs and finally the thighs. In contrast to other causes of leg swelling, the swelling in en/lipedemaa is never compressible (when pressed, "dents" in the fingers remain).

Lipoedema usually begins on the lower leg in the ankle region and ends there like a "collar". By the evening, a real step is visible, often involving the ankles so that they are no longer visible. The foot itself and the toes swell only moderately or not at all. On the thigh, en/lipedemaa occurs mainly on the inside, front and outside. The typical female fat pads such as riding breeches or the inner thigh area become much more pronounced with en/lipedemaa and sometimes even take on grotesque forms. Lipoedema also occurs in a circular pattern on the upper arm and, in rarer cases, is also visible on the forearm. The buttocks, abdomen and other regions can also be affected by en/lipedemaa, but such findings are actually only found with additional obesity and stage III.

In many cases, a tendency to "bruising" is another symptom that is observed. The causes have not yet been researched, but the phenomenon is harmless.

Other causes of leg swelling

There are a number of other causes that also lead to leg swelling. The most important of these is venous insufficiency.

Lipoedema often involves veins whose venous valves are defective. The blood flow then no longer flows upwards back to the heart, but instead backs up "downwards" in the vessels into the smallest capillaries. This leads to "lymph" being squeezed out of the vessels, which is deposited between the connective tissue and fat. Vein swellings are similar to those of en/lipedemaa and should definitely be examined with ultrasound during every en/lipedemaa assessment.

Of course, other causes of swelling in the legs should also be ruled out, such as heart and kidney weakness, orthopaedic problems, rheumatological causes or changes in the blood composition.

Differentiation from lymphoedema

Lymphoedema is also characterized by swelling, but is clearly distinct from en/lipedemaa, even though it often occurs together with en/lipedemaa.

Lymphoedema usually occurs first in the feet down to the toes - suddenly no shoe will fit. Lymphoedema also increases during the day and subsides at night when lying down. In contrast to en/lipedemaa, however, lymphoedema not only leads to the accumulation of water, but also to the accumulation of protein-rich fluid in the tissue, which over the years leads to so-called tissue sclerosis (hardening of the tissue). In contrast to en/lipedemaa, lymphoedema is never painful, no matter how large and pronounced the swelling is.

The characteristics described above mainly relate to acquired lymphoedema, which usually occurs in women from the age of 30 (lymphoedema tarda). Of course, there are also congenital lymph vessel malformations; these swellings of an arm or leg are usually unilateral. In special cases, lymphoedema can also occur as a result of injury or congestion of the lymph vessels, e.g. after lymph node removal, after radiotherapy, after surgery, etc.

The lymphatic system consists of its own network of vessels in which lymph is transported from the tissue back into the bloodstream. Lymph is a protein-rich fluid that remains in the tissue at the transition from the finest arterial hair vessels to the thin venous capillaries in the tissue. This is a volume of approx. 2 liters. This fluid is transported via a special system of vessels to the clavicle area, where it flows back into the venous system. The lymph vessels are tactile; this means that they have small pumping mechanisms that ensure that the fluid can be transported back upwards from below, even against the force of gravity.

Lymph vessels have intermediate stations: Lymph nodes, which are found every few centimeters in the body. In addition to transporting fluid back to the body, the lymphatic system has many other tasks such as fighting disease or immune defense, but in this context we will only discuss its vascular function.

In the case of pronounced en/lipedemaa, there is also a build-up of increased lymph in the tissue, but this is always a side effect of en/lipedemaa, which improves with treatment. After liposuction of en/lipedemaa, there is always an improvement in this lymphatic component.