Selecting an appropriate compression garment is probably the most challenging task in Lipedema treatment. It is important to begin the discussion of garments early in the course of treatment. It often takes time for patients to adjust to the fact that they will need a garment. In many instances, patients must pay all or part of the cost of the garment, and they will need to plan in advance for the expenditure.Important factors to consider when choosing a compression garment are: coverage, compression class, appearance, custom-made versus ready-made, material, construction, suspension, skin condition/sensitivity, donning/doffing, and cost and source of payment.
When considering coverage, preventing edema distally or proximally to the garment is important. During the decongestive phase of Lipedema treatment, the therapist will have learned whether, for instance, a bandage to the knee has caused an increase in knee or thigh volume. In that case, the patient will need a garment to the thigh or perhaps to the waist. Usually an arm sleeve will be accompanied by a separate glove or gauntlet to prevent trapping fluid in the hand. Some individuals never experience significant edema in the hand. If therapists back off on bandaging the hand during treatment and the patient does not experience any additional edema, this guides the decision as to whether to order a gauntlet, which just covers the back of the hand, or a full glove with edema control for all of the fingers. Some patients find they can even do without any hand garment, but in our practice, we always order at least a gauntlet since it is very difficult to predict exactly how every patient will respond.
Medical grade garments are available in various compression classes measured in millimeters of mercury (mmHg). These are standardized as:
Class I: 20-30 mmHg
Class II: 30-40 mmHg
Class III: 40-50 mmHg
Class IV: 50-60 mmHg
In a stocking, these numbers are the compression at the ankle with a gradually decreasing compression gradient to the top of the garment. Many ready-made stockings have a higher stretch fabric over the upper thigh called a mantissa. Even garments with the same fabric throughout will give lower compression over a larger diameter body part. Arm sleeves are generally Class I or II, and gloves and gauntlets are typically Class I. Lower extremity garments are generally Class II or III. Additional compression for the leg can be gained by using a higher compression class of garment or by layering a knee-high stocking under or over a longer stocking.
Frequently Asked Questions:
"Why do I have to wear my compression garment/bandages when I exercise?"
When an individual has lipedema, the pressure of the edema stretches out the skin so that it no longer provides a firm surface for the muscles to contract against. Exercise causes increased blood flow which caused an increase in lymph load in an already compromised limb. The compression of the garment/bandage provides a "new firm skin" for the muscles to contract against so that the pressure will be exerted on the lymph vessels and the fluid will move. Without the garment/bandage, the skin will just stretch and the force of the muscle contraction will not be translated to the lymph vessels. The involved limb could swell more if you exercise without compression.
"Why do I need to change my compression garment twice a day?"
Compression garments are made of elastic materials that stretch out after wearing for about 12 hours. The areas where a limb bends (knee, elbow) stretch out more than the rest of the garment and then those areas do not receive the correct amount of compression which can allow pooling of edema fluid that can cause constriction at those areas. Some individuals can wear compression garments day and night and do not need to bandage their involved limb at night. These individuals should change their garments in the morning and again in the evening. Others may need to apply compression bandages for nighttime wear or use an alternative device such as a Reid sleeve, Tribute, or Jovi. Consult with your treatment team to discuss which option is right for you.
"Why do I have to wash my compression garment every time I change it?"
Compression garments are made of elastic materials that stretch out after wearing. Washing them daily helps them to retain their elasticity as well as removes perspiration, bacteria and dead skin that accumulate inside the garment from normal wear.
"Why do I have to wear compression on my affected limb 24 hours a day?"
Our tissues are supplied with oxygen and nutrients by the blood. This blood is pumped around the body by the heart. With every beat of the heart, blood is filtering into our tissues. 90% of the blood volume in the tissues is picked up by the veins and brought back to the central circulation. 10% of the fluid volume in the tissues can only be brought back to the central circulation by the lymphatics. So, even when you are sleeping, even if your arm is elevated, blood is getting to your tissues (thank goodness!). Remember that in an impaired lymphatic system, the muscles need something to contract against to assist the flow of lymph fluid. Otherwise, the fluid will just pool under the skin and the limb will swell overnight. Then you may not be able to fit properly into your compression garment the next morning. That 10% of fluid volume, the lymph fluid, amounts to 2 liters a day in the whole body. Remember that a compression garment is not engineered to "reduce" a limb. It is engineered to "hold" a limb that has already been reduced. However, you should always discuss your individual case with your treatment team, as there are no absolutes and each person is different. 24 hour compression may not be right for you.
"Why can't I put my garment in the dryer?"
You can but the heat will ruin the elasticity of the garment and perhaps shrink it. Some manufacturers say that you can put them in the dryer, but that will wear them out faster and they are costly to replace. Garments are best air dried - out of direct sunlight.