Persistent limb swelling can be caused by lymphoedema. In this Q&A, Dr Allen Wong, Consultant in Plastic, Reconstructive and Aesthetic Surgery Service at Sengkang General Hospital (SKH), answers your questions about the condition.
Worried about a persistent limb swelling? It could signal lymphoedema.
What is lymphoedema?
Lymphoedema is a chronic condition caused by lymphatic system damage which can significantly impact a person's quality of life.
Lymphedema occurs when the lymphatic system, which helps drain excess fluid from tissues, becomes impaired. This
leads to swelling, usually in the arms or legs, but it can also affect other areas of the body.
How does lymphoedema come about?
Lymphoedema can develop:
After cancer treatments that affect lymph nodes, such as breast cancer surgery,
From infections or trauma
Morbid obesity
Congenital conditions (birth defects)
The early warning signs of lymphoedema aren’t always obvious. Before noticeable swelling appears, you might experience a feeling of heaviness in your limb(s), difficulty fitting into clothes, or skin that feels unusual or different (leathery or hardened).
What puts a person at risk of lymphoedema?
Risk factors include:
Having undergone cancer surgery (particularly those involving lymph node removal),
Having a family history of the condition, or
Obesity (having a BMI of 40 or higher)
Lymphoedema is manageable so get diagnosed and treated early!
While lymphoedema is a long-term condition, early detection and proper management can make a significant difference in preventing the condition from becoming severe.
Recent surgical advances in lymphoedema, such as reconstructive procedures which restore lymphatic function and reduce swelling, offer new hope for patients. If you notice persistent swelling or discomfort, seek medical advice as soon as possible.
Whether you're concerned about risk factors, early signs, management strategies or treatment options, this forum is a space to explore these aspects. Get the answers you need by sending in your questions to this Q&A for this month!
About Dr Allen Wong
Dr Allen Wong is a Consultant in Plastic, Reconstructive and Aesthetic Surgery Service at Sengkang General Hospital (SKH) and President of the Lymphedema Society of Singapore.
He specialises in modern microsurgical and supermicrosurgical techniques for lymphoedema treatment, with a focus on improving patient outcomes through innovative surgical and non-surgical approaches.
Dr Wong is dedicated to raising awareness about lymphoedema and empowering patients with knowledge on early intervention and treatment strategies.
Dr Wong has published extensive research on modern lymphoedema treatments and continues to advance surgical innovations in the field. His work aims to enhance patient care, improve surgical outcomes, and provide evidence-based solutions for those living with lymphoedema.
Questions and answers on managing lymphoedema
1. Question by Anonymous
Dear Dr Allen Wong,
Good evening! Many thanks for offering to advise on lymphoedema.
My Profile: Single Female, age 51 yrs, weight 122kg, On medication for Thyroid, Cholesterol & High BP. Body type hourglass with heavy thighs, heavy calves and heavy upper arms.
I think I have water retention in my entire body especially lower legs and swollen ankles and wrist also due to some water retention in my forearms.
Generally, my motions are fine, got fatty liver and I think urine output is not as much as water intake.
I am trying for weight reduction and explored options, but not so successful due to sedentary lifestyle
Please advise the reason for water retention and how to naturally improve.
Answer by Dr Allen Wong
Dear Anonymous,
Thank you for reaching out and sharing your concerns. Before attributing the swelling or “water retention” to lymphoedema, it's essential to consult a doctor to evaluate for more common and potentially serious systemic causes of generalized edema:
Once these potential systemic causes are ruled out or managed, and if swelling persists especially in a localized or asymmetric pattern, that’s when it becomes reasonable to consider:
Weight loss will improve overall health, and weight loss medications or surgery can be considered.
2. Question by Chao
Dear Dr Wong,
My questions are:
a) Even if there seems to be a family history, can it be cured?
b) Are fluid tablets one of the main treatments to keep this condition in check, and is there any adverse effects from taking fluid tablets?
c) Is bad circulation in legs a factor and can this be improved?
Thank you.
Answer by Dr Allen Wong
Hi Caroline, thank you for your questions:
a) While lymphoedema is not technically curable, they can be effectively managed and significantly improved with the right approach, even in familial lymphoedema.
b) Fluid tablets (also known as diuretics) are not the main treatment for lymphoedema. If your swelling is related to another cause (e.g., heart or kidney), then short-term diuretic use may be helpful, but it must be prescribed under careful medical supervision. Long-term use of diuretics can cause electrolyte imbalances, dehydration, and kidney strain.
c) Yes, poor circulation in the legs is a common contributing factor, especially if you experience: Cold feet or bluish toes, varicose veins, swelling that worsens after standing or sitting for long periods. Circulatory issues can affect both the venous and arterial system, and the treatment should be prescribed by an appropriate vascular specialist.
3. Question by Angela
Hi Dr Allen Wong,
I had received the following email message on Lymphoedema which I suspect I might have this problem.
My right leg started swollen from 2020 on the ankle and foot areas with water retention and in year 2023, slightly above the ankle of foot had a patch of dark red colour formed on my skin.
I went to have a check in year 2024 but till now nothing found on the cause of this dark redness formed on my skin at my right leg below the knee cap.
However, during the check, found that I had been diabetic happened last year Jun 2024 but was under control and reversed back to normal condition after a course of Metformin with one tablet in a day and one at night. I’m still on the medication till today.
I had checked on my heart and all ok. I had yearly checked with my GP and noted I have Fatty Liver. Next month I’ll have a check on my liver.
In Nov/Dec 2024, I had a blood test at and found that I had Thyroid. After a course of medication, my Thyroid reversed back within 3 months after taking Camazol. I’m asked by Doctor to continue taking 2 tablets of Camazol a day cut down from initial 6 tablets then 4 and now 2.
For your information, I’m 65 years old and on the fatty side of 75kg with height of abt 150-152cm. I weighed 85kg in Jun 2024 then went down to 71.5kg and today weighs 75kg.
I would be appreciated to have advice from you on how to solve my right leg problem at your earliest convenience.
Hope to hear from you soon! Thank you!
Answer by Dr Allen Wong
Dear Angela,
Based on what you’ve described, here are two leading possibilities:
An evaluation by a vascular specialist or lymphoedema specialist should be able to help diagnose and offer the appropriate treatment for it.
4. Question by Ajay
Dear Dr A Wong,
I am concerned about the condition in my mum’s legs.
She has been getting large swelling in both her legs since last month, although she has suffered from oedema for many years. She has been advised by her doctors to wear compression stockings and a band around her legs during the day.
She has noticed an increased swelling since her recent stay at a hospital in February. Unfortunately, she does have a chronic kidney condition in the form of a large staghorn stone in her right kidney rendering it non-functioning and she also suffers from Atrial Fibrillation. So, she is on medication for these conditions.
Doctors feel that some medications treating her kidneys cause fluid issues in her body and treating the swelling caused by water retention with some medication have a negative impact on her kidneys. So, she is stuck in a very bad place.
Is there any dietary advice you can offer and is reconstructive surgery to restore lymphatic function a possibility in an 81-year-old female with the above conditions? Please advise, thank you.
Answer by Dr Allen Wong
Dear Ajay,
Your mum’s swelling is likely multifactorial, meaning there are several overlapping causes:
The key to treatment is to adopt a multidisciplinary approach and optimise all issues.
For dietary recommendation, please minimise sodium intake, control fluid intake (as per your doctors), have a balanced diet and minimise fried or oily food.
There are options for lymphatic reconstruction in an 81-year-old patient, but she will need to be carefully evaluated and optimised first.
5. Question by Jason
Morning Dr. Wong,
I'm not sure if my conditions is related to Lymphoedema.
The veins on my lower left leg look like is swollen and is most obvious after a long walk.
At night the toes twitch and needs to give the toes a tuck n massage. When water is sprayed around the calf area it also causes the leg to twitch.
When bending the leg there is cracking sounds around the knee n ankle area but not painful.
The right feet are not as bad compared to the left. Looking forward for your advice, thank you.
Answer by Dr Allen Wong
Hi Jason,
Based on the information you have shared, it may not be related to lymphoedema. There may be underlying chronic venous insufficiency.
6. Question by Chris
Hi Dr Wong,
Is lymphoedema preventable? If yes, how? Thanks.
Answer by Dr Allen Wong
Hi Chris,
Some forms of lymphoedema may be preventable, especially those related to cancer and the effects of its treatment. Modern techniques such as Immediate Lymphatic Reconstruction may reduce the risks of lymphoedema and prevent it from occurring.
Obesity-related lymphoedema is also preventable via the maintenance of healthy weight and BMI.
7. Question by Ming
Dear Dr,
My grandma, who is wheelchair-bound, has been suffering from swollen legs and feet for the past few years.
Her polyclinic GP says it is due to her “heart and kidney conditions”. And recommended her to limit her sodium and fluid intake. Despite that, her legs and feet continue to be very swollen.
Is there anything that can be done to alleviate her lymphoedema?
Would a consult with someone like yourself or any of your colleagues from the Plastic, Reconstructive and Aesthetics Surgery Service be possible? And if so, how can a referral be obtained?
Thank you in advance for reviewing my question.
Answer by Dr Allen Wong
Dear Ming,
There may be multiple possible causes for the swelling in your grandmother’s legs. This includes:
It is important to be evaluated and diagnosed by a doctor before commencement of appropriate treatment.
Referral letters to visit a lymphoedema specialist can be obtained from polyclinic or CHAS GP clinics.
8. Question by Ping Ying
Dear Dr,
What can be done to make wearing of compression garments more comfortable? Thank you.
Answer by Dr Allen Wong
Dear Ping Ying,
Compression garments are one of the most important tools in managing lymphoedema and chronic leg swelling, but they can be tricky to wear comfortably.
Here are some simple and effective tips to help make compression garments more tolerable and easier to wear:
a) Start with the right fit
Get measured by a trained lymphoedema therapist for the correct size and compression class. Custom garments may be needed for patients with very small ankles, large thighs, or asymmetrical limbs.
b) Prepare the skin
Apply a non-greasy moisturiser at least 30 minutes before wearing to avoid stickiness. Ensure skin is clean, dry, and free of talcum powder before applying garments. If there’s itching, redness or sensitivity, switch to cotton-lined or hypoallergenic garments.
c) Time it right
Put on compression garments first thing in the morning when swelling is minimal. If it’s too warm, try putting the garment in the fridge briefly before applying, this can make it feel cool and soothing on the skin.
d) Use donning aids
Rubber gloves: Help grip the fabric and prevent snags.
Donning devices: Like the Sigvaris Doff N’ Donner, Juzo Slippie, or Medi Butler.
Silicone foot slip liners: Reduce friction while sliding the garment over the foot.
e) Air-conditioned room
Cooler temperatures reduce sweating, making the garment less sticky and easier to tolerate. Less skin irritation from heat rash or chafing under the garment.
9. Question by Rachel
Hi Dr Wong,
Can lymphoedema develop before I notice any visible signs like swelling?
Why do some parts of my body feel heavy even when they don’t look swollen, and should I be worried if the heavy feeling comes and goes? Thank you for your advice.
Answer by Dr Allen Wong
Hi Rachel,
Yes, early (or “subclinical”) lymphoedema can exist without obvious swelling. In fact, the first signs of lymphatic compromise are often subjective symptoms, like:
Heaviness or tightness in a limb
Aching or tingling
Fatigue in the arm or leg
Indent marks from socks or bras that linger longer than usual
These may come and go, especially in early stages and are often worse at the end of the day, with heat, or after travel or prolonged standing.
I would advise for you to be evaluated by a lymphoedema specialist.
10. Question by Mdm Tan
Good day, Dr Wong
Will going for lymphatic massages help with swelling caused by lymphoedema?
How effective are they, are the effects long lasting?
Are there risks involved with lymphatic massages, and if yes, what are they?
Thank you.
Answer by Dr Allen Wong
Hi Mdm Tan,
Yes, when done properly by certified lymphatic therapists, lymphatic massage (specifically, Manual Lymphatic Drainage or MLD) can be very helpful in reducing swelling caused by lymphoedema. It’s often used as part of Complete Decongestive Therapy (CDT), which also includes compression therapy, skin care, and exercise.
MLD is most effective in early or moderate lymphoedema (International Society of Lymphology Stages 1–2). Unfortunately, the effects are not permanent — the body continues to produce lymph fluid daily.
Ongoing maintenance is needed: either through self-MLD, compression wear, or repeat sessions, depending on the severity.
Think of it like physiotherapy, it’s not a one-off fix, but part of a long-term management plan.
Lymphatic massages are generally safe when done by a certified lymphoedema therapist, but certain precautions and contraindications apply.
Do NOT perform MLD in these situations:
Active infection (cellulitis) — massage can spread the infection
Congestive heart failure — may overload fluid return to the heart
Untreated deep vein thrombosis (DVT) — risk of dislodging a clot
Kidney failure or fluid overload states — massage can worsen systemic swelling
Always inform the therapist of medical conditions, cancer history, or surgery, as they’ll need to adjust the approach.
11. Question by Arnold
Dear Dr,
Is there a difference between limb swelling caused by water retention as opposed to lymphoedema?
How do I tell if I have one or the other? What tests do I need to undergo to find out?
Are both treated differently? When it comes to preventing further swelling, are both conditions managed similarly?
Thank you for taking the time to answer my questions.
Answer by Dr Allen Wong
Dear Arnold,
You can refer to the table below on the difference between limb swelling caused by water retention vs lymphoedema.
Cause
| Systemic issues: heart, kidneys, liver, hormones, high salt intake | Local lymphatic system damage or underdevelopment |
Onset
| Often sudden or over days
| Gradual, progressive over months/years |
Location
| Usually symmetrical: both legs, or whole body | Often one limb, or asymmetrical |
Pitting?
| Yes – press with a finger, and a dent remains
| Early: may pit; Late: non-pitting, firm, thickened skin |
Time of day
| Worse by end of day; improves overnight or with rest
| Persistent; doesn’t fully go away with elevation |
Skin changes
| Usually, normal skin | Skin thickening, folds, redness, “peau d’orange” texture |
Other signs
| Swelling may shift (e.g., facial puffiness, abdominal bloating)
| May have heaviness, tightness, reduced mobility, infections |
Response to diuretics
| Often improves
| Typically, does not respond |
Blood tests and scans will be able to differentiate between the two. The patient should be evaluated by a doctor first prior to these tests.
Yes, they are treated with very different management approaches.
12. Question by Cheong
Dear Dr,
I heard having lymphoedema puts one at risk of infection, is this true? If yes, why?
What advice would you give to prevent infection to a swollen limb?
Answer by Dr Allen Wong
Dear Cheong,
In lymphoedema, the lymphatic system which normally helps drain fluid and fight infection becomes impaired. As a result:
Fluid builds up in the tissues (especially protein-rich lymph), creating a perfect environment for bacteria to grow. The area has weaker immune surveillance, meaning your body doesn’t fight off bacteria as effectively in that region.
Skin can become stretched or cracked, making it easier for bacteria to enter through tiny breaks. The swollen limb is often warm and moist, which can further encourage bacterial growth. This puts patients at risk of a serious skin infection called cellulitis — a common and sometimes recurrent problem in lymphoedema.
To prevent infection:
Keep skin clean, moisturised, and intact
Nail and wound care
Avoid injections, blood pressure cuffs, or blood draws on the affected limb
Wear compression garments properly
Choose breathable clothing and footwear
Have an emergency antibiotic plan
Daily inspection of limbs for wounds
13. Question by Emily
Hi Dr Wong,
Both my foot swell at the evening when I stand too often or move or work the whole day.
Is there any medication and any solution to resolve it permanently? Any prevention to avoid happening too often. Should consult the polyclinic over my condition, thanks.
Answer by Dr Allen Wong
Hi Emily,
While swelling in both feet towards the end of the day is quite common, especially after prolonged standing or walking, it is very important that you seek medical attention to determine the underlying cause, rather than assume it’s only due to fatigue or daily activity.
Swelling in both feet (bilateral swelling) can have many possible causes. It’s crucial to rule out serious medical conditions first before attributing it to lifestyle or vein issues.
Your doctor will help assess for:
Systemic conditions:
- Heart issues (e.g. heart failure)
- Kidney problems (fluid retention)
- Liver dysfunction (low albumin)
- Thyroid disorders
- Side effects from medications
Vein problems:
- Chronic venous insufficiency (leaky leg veins)
- Varicose veins or vein valve weakness
Lymphatic issues:
- Early or chronic lymphoedema
- Swelling that doesn’t resolve overnight and slowly worsens over time
Each of these requires different treatment, so a proper diagnosis is essential.
14. Question by Phyllis
Dear Dr. Allen Wong,
My husband's left ankle has been swollen for at least 2 years.
He's a diabetic, 81 years, and is currently under treatment at Alexandra Hospital. The swollen part is at the inside of the ankle. Doctors at Clementi Polyclinic just take a brief look at it, ask a few questions, any pain here, here. When the answer is no, they'll say, then it's okay and change the subject.
Can you please help as I really like to find out what causes the swelling and treat it if necessary. Sure hope you can help.
Thank you in advance.
Answer by Dr Allen Wong
Dear Phyllis,
Thank you for sharing your concerns. Your husband’s swelling could be due to chronic venous insufficiency, lymphatic dysfunction (lymphoedema), joint-related issues, or other causes. To treat it properly, it’s important to first determine the exact cause.
I recommend a referral to a vascular or lymphoedema specialist for further evaluation.
15. Question by Annie
Hi Dr,
I have swelling (fluid retention) on both of my legs for about 9 months and cause me a lot of pain. May I know:
a) What are the possible causes of this?
b) What available tests to take?
c) What treatments can be done?
Thank you for your advice.
Answer by Dr Allen Wong
Hi Annie,
Bilateral leg swelling can be due to a range of conditions, including:
Systemic causes: heart, kidney, liver, or thyroid issues
Venous disease: such as varicose veins or valve failure
Lymphatic dysfunction: also known as lymphoedema
Medication side effects, inflammation, or immobility
Rather than doing tests on your own, it’s best to first see a doctor or specialist, who will:
Take a detailed history and physical exam
Then determine which tests are needed (e.g., blood tests, ultrasound, or lymphatic scans)
This ensures you get relevant, focused investigations, not unnecessary or incomplete ones.
Treatment depends entirely on the underlying diagnosis.
16. Question by Anonymous
Dear Dr Wong,
My Profile: Female, age 63 yrs, weight 62kg,
I am a stage 4 breast cancer patient. First discovered in 2014 (stage 0). Did mastectomy and breast reconstruction. Had 1 axilla lymph node removed.
In 2016 stage 1. Removed nipple and had 5 weeks of radiotherapy.
In 2022 had pain in axilla. Breast surgeon said it is scarring. In April 2023 neck lymph node swollen, discovered stage 4.
Had been having chemotherapy since April 2023. Currently on Trastuzumab + Eribulin. I have neuropathy in my left arm. Did nerve block with radiofrequency twice. Limited flexibility.
4 months ago developed swollen left arm. Oncologist suggested going for physiotherapy or wear a sleeve.
What would you advise? Thank you.
Answer by Dr Allen Wong
Hi anonymous,
It’s very likely you now have secondary lymphoedema of the left arm, due to damage or obstruction of your lymphatic system from:
Past axillary lymph node removal
Radiotherapy to the axilla, which can scar and block lymphatic flow
Possible cancer-related lymphatic involvement in more advanced stages
A general “physiotherapy” or wearing a sleeve is a good start, but given your condition, you would benefit more from specialist lymphoedema care.
I recommend consultation with a Lymphoedema Specialist and also a Certified Lymphoedema Therapist (CLT).
17. Question by Sharon
Hi Dr Wong,
My 86-yr-old mother has been suffering from very severe lymphoedema in both her very swollen legs since 2019.
There are round lesions and very cracked skin all over her legs till her knees. She has a BMI of about 43. A few years ago, she was hospitalised for cellulitis. But recently, her lesions are slowly disappearing but many are still there.
Due to this heaviness, her mobility is deeply impaired and not able to walk without her walking frame. Recently, she has been hospitalised in Changi hospital for a seizure and abnormal heart rhythm as well.
Is there anything you can do to alleviate her pain in her legs?
We are really looking forward to her to be able to walk with her walking frame again. She has even consented to be in a nursing home where specialty care can be given to her.
Thank you so much.
Answer by Dr Allen Wong
Hi Sharon,
The appropriate treatment for your mother’s lymphoedema can only be recommended after a thorough clinical assessment. This will help us understand the extent of the swelling, skin condition, functional impact, and any underlying issues like venous insufficiency or recurrent infections.
Once assessed by a lymphoedema specialist team, we can customise a treatment plan that may include compression therapy, skin care, physiotherapy, and in selected cases, surgery, all depending on her overall medical condition and goals of care.
Ref: G25
