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What is lipedema?
In the case of lipedema, the subcutaneous fatty tissue is increased. The symmetrical fat deposits mostly affect the legs, and more rarely the arms.
The chronic fat distribution disorder occurs almost exclusively in women, often after hormonal changes such as puberty or pregnancy.
In addition to the visible increase in fat, there are regular noticeable complaints such as pain and increased sensitivity of the skin to pressure.
In order to alleviate the symptoms, prevent complications and counteract an increase in fat deposits, affected women should see a doctor as early as possible.
Lipedema is a fat distribution disorder, which, depending on its appearance, is also known as saddlebags or suave pants phenomenon or as a pillar leg. An increase in the subcutaneous fat is characteristic of the chronic disease. The always symmetrically distributed fat deposits occur mainly on the legs, and more rarely on the arms. In addition, those affected tend to store more water in the tissue, which leads to the formation of so-called edema. According to the definition, lipedema is only present if, in addition to the increase in fat tissue, there are regularly noticeable symptoms - such as an uncomfortable feeling of tension or pressure and increased sensitivity to touch of the skin.
Hands and feet remain unaffected, as does the trunk. This is why there is a disproportion between the proportions of the slim upper body of people of normal weight and the voluminous lower half of the body. This appearance and the associated stigmatization can be psychologically stressful and affect the self-esteem of those affected.
Even with lipohypertrophy, the subcutaneous fatty tissue on the legs is increased. In contrast to lipedema, this is a purely aesthetic phenomenon that does not lead to noticeable symptoms. However, lipohypertrophy can sometimes be a precursor to lipedema.
Women's disease with many affected
Lipedema occurs almost exclusively in women, most commonly between the ages of 20 and 30. It usually begins shortly after puberty or after pregnancy can then progress over time. It often takes years before the disease, which is estimated to affect between 500,000 and a million women in Germany, is diagnosed. Many patients only seek medical advice when neither exercise nor various diet attempts have solved the problem. Treatment as early as possible is important in order to stop or at least delay the progression of lipedema.
Usually the fatty tissue on the legs increases in lipedema. An early and frequent distinguishing feature is therefore that the women affected need a larger size for trousers than for blouses or sweaters.
How does lipedema develop?
The exact causes of lipedema have not yet been fully researched.
Hereditary predisposition and hormonal changes such as puberty or pregnancy play a role in the development of the disease.
In addition to the proliferation and enlargement of the fat cells, the blood capillaries become more permeable, so that fluid collects in the tissue.
Together, these typical diseases lead to increased pressure in the subcutaneous fatty tissue, which then causes complaints such as feelings of tension and pain.
The causes of lipedema have not yet been conclusively clarified. One thing is certain, however: diet and body weight can make the disease worse, but they have no major influence on its development. This can already be seen in the fact that slim women can develop fat distribution disorders as well as normal and overweight women.
It is noticeable that two or more female members of a family are often affected. Therefore, hereditary predisposition apparently plays a role in the development of the disease. The same goes for the female hormones. Lipedema can basically occur at any point in life. Usually, however, it begins after hormonal changes such as puberty, pregnancy, the use of hormonal contraceptives or, more rarely, with the menopause.
More fat cells, permeable blood capillaries
There are two reasons for the increase in subcutaneous fatty tissue typical of the disease. On the one hand, the number of fat cells increases, on the other hand, these also become larger. In addition, the permeability of the fine blood vessels known as capillaries increases in the affected regions. As a result, more fluid from the vascular system gets into the surrounding tissue. If this accumulation of water can no longer be removed sufficiently, edema forms.
All of this means that the pressure in the tissue increases in the case of lipedema. The result is a feeling of tension, an increased sensitivity to pressure and touch and pain. In addition, the more fragile capillaries make the patients prone to hematomas. Even barely noticeable bumps can cause these bruises, colloquially known as bruises, under the skin.
Lipedema is extremely rare in men. If they fall ill, then only in connection with pronounced hormonal disorders - caused by liver cirrhosis, for example - or after hormone therapy for the treatment of cancer.
How does lipedema express itself?
Lipedema is characterized by an increase in fatty tissue on both sides, which usually affects the lower half of the body.
Depending on the appearance and extent of the accumulation of fat, three stages of the disease are distinguished.
Acute symptoms of the chronic disease include severe swollen legs, increased tenderness of the skin, pain, and a tendency to bruise.
As a long-term consequence, lipedema can lead to an altered gait pattern, misalignment of the joints and premature joint wear.
In lipedema, the fat deposits are always symmetrically distributed, i.e. on the same side on both legs or arms. It is also characteristic that the upper body, hands and feet are not affected and accordingly remain slim. Apart from these similarities, the disease can express itself differently from patient to patient.
If the subcutaneous fatty tissue increases, especially in the upper part of the thighs and buttocks, doctors speak of a saddlebag phenomenon. In a columnar leg, the fat is evenly distributed over the entire length of both legs. In the Suavenhosen phenomenon, lipedema extends from the hips to the ankles. But it can also be that the lower legs are primarily affected. Around 30 percent of women with a fat distribution disorder in the lower extremities also have lipedema on the arms. The fact that the disease only occurs in the upper extremities is rare.
The stages of lipedema
The fatty tissue in the thickened subcutaneous tissue is evenly distributed, and the surface of the skin is smooth.
Knot-like structures form in the subcutaneous fatty tissue, while bumps, waves and larger dents appear on the skin.
The heavily increased and hardened fatty tissue forms overhangs and furrows. These bulges of fat, known as dewlaps, arise mainly on the inner thighs and knees.
Symptoms: from swelling to joint wear
Heavy, swollen legs and arms
The fact that legs and arms feel heavy is partly due to the weight of the increased fat tissue. The second reason is the buildup of fluid in the tissues that can accompany lipedema. Standing or sitting for long periods of time and warm weather promotes this water retention. This explains why the legs are often severely swollen in the evening.
Tenderness and pain
The areas affected by lipedema are tense and sensitive to pressure. Even light touches are perceived as uncomfortable and painful. Some patients suffer from pain even without external pressure.
Since the fine blood capillaries in the increased subcutaneous fat tissue tear easily, hematomas can arise at the slightest cause. A barely noticeable bump is enough to cause a bruise.
Impairment of walking and chafing
In particular, pronounced fat deposits on the inner thighs can interfere with walking. Due to the constant rubbing against each other, the skin can chafe there. This sore running is accompanied by the risk that inflammation and infections will develop in the open areas.
With advanced lipedema in the lower legs, the tissue is sometimes so pressurized that the lymphatic fluid can no longer drain properly. Without treatment, the congestion causes what is known as secondary lymphedema, which causes the affected areas to swell even further, and usually also the feet. Phlebologists refer to this mixed form as lipo-lymphedema.
Misalignments and joint wear
Another possible consequence of the fat bulges on the inner thighs and the impaired gait are misalignments of the legs. The resulting incorrect load and the extra weight, especially on the knee, can cause the joints to wear out prematurely.
How is lipedema diagnosed?
The doctor diagnoses lipedema through a conversation with the patient and a subsequent physical examination.
Laboratory or imaging tests with which the disease can be unequivocally determined are not available to date.
In quite a few of those affected, lipedema is misinterpreted as being overweight or obese and therefore remains undetected for a long time.
Diet can help distinguish lipedema from obesity.
There is no such thing as a laboratory test or imaging procedure that can be used to reliably detect lipedema. The most important instruments in diagnosis are therefore the anamnesis interview and the physical examination. First, the doctor asks about typical symptoms such as heaviness, pain or a tendency to bruise. He also asks about hormonal changes such as menopause. Another valuable piece of information is whether other women in the family have the fat distribution disorder.
During the subsequent physical examination, the phlebologist first takes a close look at his patient and pays particular attention to how the body is proportioned and whether the fatty tissue is symmetrically increased. Then he feels the skin on the affected areas and presses in the tissue. It speaks in favor of lipedema that no dent is left behind.
Another indication of the condition is that pinching the outside of the thigh causes more pain for those affected than the inside. Usually it is the other way around. The Stemmer test helps to differentiate lymphedema from lipedema. If the fold of skin over the second and third toe or the index and middle finger can be lifted, this speaks against lipedema.
Overweight or lipedema? Diet provides information
It is not always easy to differentiate between overweight and obesity, which are primarily due to diet and lack of exercise, especially in the case of generally fuller patients. A diet can then provide clarity. If the disproportion between the proportions of the extremities and torso persists despite weight loss, this indicates lipedema.
The crucial point in the diagnosis is that a doctor or the person concerned must first come up with the idea that lipedema could be behind the weight gain. And as early as possible, because the sooner the treatment begins, the better. The crux is that the fat distribution disorder is often misinterpreted as obesity and is therefore not recognized for a long time. Anyone who finds signs of the disease should contact a phlebologist as soon as possible.
How is lipedema treated?
Since lipedema cannot be cured causally, the therapy aims to improve the symptoms and prevent a further increase in the accumulation of fat.
Compression therapy, in the advanced stage manual lymphatic drainage, sport and movement are central components of the treatment.
To prevent lipedema from worsening, it is important that overweight patients lose weight and those of normal weight maintain their weight.
Another very effective treatment option is liposuction, in which the pathological fat deposits are surgically reduced.
There are two main goals in the treatment of lipedema: On the one hand, to improve the diagnosis itself and the symptoms associated with it. On the other hand, to counteract a further increase in fat deposits and to prevent impending complications such as lymphedema or gait disorders. Lipedema cannot be cured causally. However, if treatment is started early and carried out consistently, the chances are good that these therapy goals will also be achieved.
One of the basic building blocks is compression therapy. It delays or stops the increase in lipedema and alleviates the symptoms. In order for this effect to develop optimally, the patients must regularly wear their compression stockings, tights, leggings, cycling shorts or bolero jackets. In addition to this, the so-called intermittent compression - a compression treatment with devices - can also be helpful.
Swimming, walking, cycling - exercise helps
According to the current treatment guidelines, manual lymphatic drainage is also an integral part of the therapy concept in advanced stages of the disease. A special massage technique stimulates the removal of fluid accumulations in the tissue. However, some experts criticize this recommendation as being too general. They advise not to prescribe manual lymphatic drainage until lymphedema has been proven beyond doubt and provided that the compression therapy is carried out consistently.
However, there is no doubt that those affected should exercise a lot. All sports that take place in water, such as swimming or aqua jogging, are ideal for lipedema. On land you can do gymnastics, walking, jogging and cycling. Sport and exercise are also so important because they use up calories. Because lipedema patients have to take special care that their weight does not increase further due to an unfavorable lifestyle. Physical activity and, if necessary, a change in diet can prevent this and also help to reduce existing excess weight.
As a long-term study shows, the increase in lipedema over the years correlates with the increase in body weight. To prevent this, overweight patients should lose weight and normal weight patients should not gain weight. If the affected women manage to maintain or reduce their weight after the diagnosis, the lipedema will not become more pronounced, according to the result of the examination.
Liposuction as a therapy option
However, none of these treatment measures can reduce lipedema itself or even completely eliminate it. The only way to reduce the abnormally increased subcutaneous fatty tissue is surgical liposuction. Using techniques such as ultrasound, water jets or vibrations, the doctor first detaches the fat cells from the surrounding tissue during such a liposuction and then sucks them off using a thin, tube-like instrument - the endoscope.
Various studies have shown that the procedure significantly improves the symptoms of lipedema up to and including freedom from symptoms, usually for many years. Some patients continue to need compression therapy, others can do without this treatment. According to scientific studies, liposuction also has a positive effect on mobility, possible complications and quality of life. However, the disease is not eliminated once and for all. If women gain weight again, lipedema will also develop again. It is therefore crucial for the success of the treatment to keep body weight permanently under control.
However, it can happen that the lipedema develops again afterwards. The operation, which usually only requires local anesthesia, is considered to be low-risk. However, the possibility of complications such as wound infections or bleeding cannot be ruled out.In addition, those affected should know that they usually have to pay for the liposuction themselves. In the case of lipedema, the statutory health insurance companies have so far only covered the costs for the procedure in exceptional cases and upon individual application. This is another reason why patients considering liposuction should seek detailed advice in advance, preferably from an experienced phlebologist.
How does lipedema work?
Both in the current guidelines and in numerous medical textbooks, lipedema is still defined as a chronic and progressive disease. Which means that the fat distribution disorder inevitably progresses and worsens accordingly. However, this assumption is now increasingly wavering. Experience shows that the findings do not change over many years and the patients remain symptom-free if they consistently carry out compression therapy and regularly exercise two to three times a week and - most importantly - maintain their weight.
What happens relatively often is that those affected do not gain weight as a result of the disease, but also gain weight. As a result, the lipedema can worsen. This is good news for the patients. Because it means: Lipedema does not progress but remains stable - even if your body weight remains stable.
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