Jacqueline McWatt, a 53-year-old part-time hairdresser from Bonnybridge in central Scotland, suffered years of agonising swelling and mobility loss after routine varicose vein surgery triggered lymphoedema, an incurable condition managed through non-surgical therapy.
The mother of four had undergone what was intended to be a simple procedure to remove swollen and twisted veins under her skin, but delicate lymphatic vessels were damaged during the operation. Shortly afterwards, her legs became hard, swollen, and painfully heavy, making walking almost impossible.
Because McWatt had given birth to two children in two years, doctors repeatedly dismissed her complaints as pregnancy strain that would settle down. "It was quite a lonely time and I felt isolated and depressed," McWatt said. "I was trying to cope with a newborn baby, a one-year-old and two other children and was in so much pain that I could barely bend my legs, even to do simple things around the house."
Doctors insisted nothing was wrong, but McWatt noticed her legs were swelling. "All the while, doctors were saying there was nothing wrong with me, but I felt like my legs were getting bigger and bigger and were disproportionate to the rest of my body," she said. She eventually received a diagnosis of lymphoedema, a condition where damaged drainage vessels cause fluid to collect in body tissue.
Although lymphoedema cannot be cured, McWatt successfully reduced her symptoms and regained her mobility through non-surgical treatments, including manual lymphatic drainage. "After my first session, I could bend my legs again, and I was feeling so much better," she said, and she now maintains her mobility through annual massage sessions and daily compression stockings.
Causes of Lymphatic System Damage
The lymphatic system is a network of tiny vessels that functions as the body's drainage network, collecting excess fluid from tissues and returning it to the bloodstream. Unlike the circulatory system, it lacks a central heart to pump fluid and relies instead on everyday physical movement and muscle contractions.
When lymphatic vessels become blocked or damaged by surgery, cancer treatments, infection, injury, or obesity, fluid accumulates in tissues to cause persistent swelling, primarily in the arms or legs. In some cases, people are born with abnormalities in their lymphatic system that cause the condition to develop.
National Health Service estimates indicate around 200,000 people live with lymphoedema in the UK, though specialist organisations believe the true figure may exceed 400,000 because many cases go undiagnosed. The condition affects more people in the UK than multiple sclerosis, motor neurone disease, HIV, and Parkinson's disease combined.
Rising sufferer numbers are driven by an ageing population, increasing obesity rates, and improved cancer survival. Surgery to remove lymph nodes, particularly for breast and gynaecological cancers, frequently damages the lymphatic system, as does radiotherapy.
Several prominent public figures have spoken publicly about their struggles with the condition. US television host Wendy Williams, 62, and Oscar-winning actress Kathy Bates, 78, who starred in Misery, have both shared their experiences. Bates developed lymphoedema in both arms after undergoing a double mastectomy for breast cancer in 2012, during which lymph nodes were removed.
British mathematician and television presenter Hannah Fry, 42, developed lymphoedema in her leg following treatment for cervical cancer diagnosed in 2020. After undergoing a radical hysterectomy, she explored the long-term consequence of her treatment in her BBC documentary Making Sense Of Cancer and later paid privately for corrective surgery.
Early Warning Signs and Infection Risks
Medical experts warn that early signs of lymphoedema are easily missed. Carol-Ann Barrett, a specialist practitioner for Manual Lymphatic Drainage UK, said: "Lymphoedema is not curable, but it is very maintainable. When it progresses, the tissue becomes more damaged, which makes it harder to treat. This is why intervening early to prevent progression is important."
Early symptoms can be surprisingly subtle, such as a feeling of heaviness, tightness, or fullness in an arm or leg. Patients may first notice that a ring or watch feels tighter, that clothes or shoes no longer fit comfortably, or that pressing gently on swollen skin leaves a temporary dent. In some cases, symptoms do not present until 20 years after surgery.
Without treatment, soft swelling can harden into fibrosis, creating hard, scar-like tissue that is much more difficult to treat. Lorraine Brown, co-chair of the British Lymphology Society, said: "Sometimes when symptoms are mild they get dismissed as minor. But when symptoms have progressed and changes to the skin and tissues occur, the symptoms are harder to manage and complications such as cellulitis are more likely to develop."
Cellulitis, a bacterial skin infection that can spread rapidly and lead to fatal sepsis, is one of the most serious complications. Damaged lymphatic systems struggle to fight infection, while each bout of cellulitis inflicts further damage. In advanced cases, skin breakdown causes lymphorrhoea, where lymph fluid leaks through the skin. Barrett said: "Once lymphoedema progresses, you can start to develop all sorts of other comorbidities, skin breaking down, and even conditions like lymphorrhoea, where the lymph literally pours out of the limb."
Non-Surgical Therapies and Daily Management
The main treatment for managing swelling is decongestive lymphatic therapy, a combination of measures designed to reduce swelling and stop fluid building up again. A key component is compression, using specially fitted sleeves, stockings, or bandages to squeeze trapped fluid out of tissue.
Research indicates compression can be highly effective, but garments may need to be worn for 15 to 20 hours a day and can be tight, uncomfortable in hot weather, and difficult to put on and take off. Basic compression garments are available on the NHS, but additional pairs or alternative designs cost from £30 to more than £200 each.
Decongestive therapy also includes manual lymphatic drainage, a specialized massage that uses gentle movements to encourage lymph fluid to drain away. Barrett said "it's this combination that really helps to control lymphoedema day to day," but noted access can be patchy. She stated many women are never taught self-administered routines and patients are "very lucky" to be offered it on the NHS, adding many do not reach specialist services until their condition is already advanced.
Regular physical activity such as walking, swimming, cycling, and resistance training helps muscle movement propel lymph fluid through the body. While experts once feared exercise could exacerbate lymphoedema, recent studies show it improves lymphatic function and quality of life. Careful skin cleaning and moisturising further reduce infection risks.
Weight Control, Surgery, and New Research
Obesity is strongly linked to lymphoedema, with scientists theorising that chronic inflammation associated with excess weight damages the lymphatic system. Dr Antonio J. Forte, a US lymphoedema expert and surgeon, said: "If you are obese and you go back to a healthy weight, there is a decrease in your inflammatory markers. This could potentially help with lymphoedema." Evidence also suggests an anti-inflammatory diet rich in fruit, vegetables, and fibre may help ease symptoms.
While GLP-1 drugs such as Ozempic and Mounjaro are not lymphoedema treatments, Dr Forte said the jabs could potentially help severely obese patients by helping them lose weight. Barrett agreed that "any weight you lose is going to have a significant impact on lymphoedema," though she stressed the condition affects people of any size and weight loss is not appropriate for every patient.
In severe cases, surgery may be considered. One technique, lymphovenous anastomosis, involves connecting tiny lymphatic vessels to nearby veins to create a new drainage route. The delicate microsurgery costs around £15,000 and is available to select NHS patients at a small number of specialist centres, and presenter Hannah Fry opted to pay privately for the procedure. Liposuction can also remove fibrotic tissue, though it is not widely available on the NHS.
A study published this month in the journal Nature found that compounds called cyclodextrins could reduce swelling and help repair damaged lymphatic vessels in mice. Although the findings generated excitement, researchers noted it could be years before it is known whether the approach works in humans.
For McWatt, learning to manage her lymphoedema after nearly two decades has improved her mobility, confidence, and self-image. "Managing my lymphoedema has even changed how I dress. I used to try and hide my body, but I wear dresses and sandals now," she said. "It can be quite debilitating and it definitely does affect your confidence, but I think the more awareness that’s out there, the better. When I started this journey nearly 20 years ago, there wasn’t a lot of information out there. As time has gone on, understanding has got a lot better and GPs are recognising lymphoedema more and more. There’s not one quick fix, but through a combination of things I’ve been able to improve my symptoms."
