Lipoedema can be confused with lymphedema, and distinct disease and is often known as a ‘Painful Fat Syndrome”
How Lipoedema Develops
Lipoedema literally means ‘fluid in fat’. This happens by leakage of small amounts of fluid from the blood capillaries in the skin. Fluid leakage from these blood capillaries is usually absorbed by adjacent lymph capillaries and is returned through the body’s system of lymph vessels to the blood circulation. When lipoedema is present the growing, spongy layer of abnormal fat cells prevents absorption of the excess fluid by the lymph vessels. This results in stagnant oedema sitting in between the fat cells causing inflammation that increases fat deposition and then fibrosis.
Lipoedema is almost exclusively a female disease and starts at puberty, pregnancy or menopause, and hormonal changes may influence its development. Because it is regularly seen in multiple female family members, this indicates a primary genetic cause of the disease.
Is it Lipodoema Lymphoedema or Obesity?
Lipoedema affects the whole leg, hips and buttocks and often the arms. With Obesity, the fat accumulates over the whole body, but the fat of lipoedema does not typically affect the trunk, and some patients can be very slender above the waist. Lipoedema fat forms a layer that is different to normal body fat; it contains small nodules that may be felt with palpation.
Where Lipoedema is present the circulation is very poor and the Lipoedema affected fat cells do not break down to provide energy during typical dieting or exercise. Therefore while diets or bariatric surgery may reduce other stores of body fat significantly, the Lipoedema fat does not budge.
The legs, hips and buttocks are most often affected with lipoedema, but the feet are affected. There is a defined ‘cuff’” at the ankle where the fat swelling starts. The swelling of lipoedema is markedly symmetrical on both legs; whereas in Lymphoedema this is not the case.
Lipoedema tissue can be very painful to the touch. Easy bruising is another identifier because the blood capillaries are soy fragile. The symptoms of pain and easy bruising are not usually seen in lymphedema or obesity.
Symptoms and Presentations of Lipoedema
It almost exclusively occurs in women
It affects both legs (and arms)
Generally the feet are unaffected except when there is so much pressure on the lymphatics. There is a very definite ‘cuff’ at the ankle where the fat deposits finish.
The tissue is negative Stemmer sign and pitting
It can be very painful and tender when even gentle pressure is applied
Capillaries are very fragile and the affected area bruises easily
Weight loss and diet do not impact on the condition