Lymph drainage during pregnancy
Lymph drainage is a form of physical therapy that is used to treat lymphedema. Lymphedema is caused by the accumulation of lymph fluid in the tissue. As a component of the complex physical decongestion therapy, lymphatic drainage is firmly established in patient treatment and enjoys great popularity. Targeted hand movements carried out by a physiotherapist stimulate the lymph flow and thus unblock the edema. Lymphatic drainage also follows its general pattern of action during pregnancy. There is no separate lymphatic drainage for pregnancy.
General information on the topic can be found here: Lymphatic drainage
Indication for lymphatic drainage during pregnancy
Around two thirds of women suffer from water retention in their feet and legs during pregnancy. The exact causes for these "heavy legs" have not been conclusively clarified. Many factors come together that ultimately lead to the edema.
In general, no lymphatic drainage is necessary. Most edema occurs due to mild weakness in the veins towards the end of pregnancy. The venous valves become leaky and the blood can no longer flow back to the heart as well. This increases the pressure in the vein and parts of the blood are pressed into the surrounding tissue. This explains the typical edema on the ankles and lower legs. After the birth, the water retention normalizes again, so that lymphatic drainage is almost never necessary. It is therefore rarely prescribed by a doctor. Of course, you can make use of this service as a private payer, but strictly speaking there is no indication.
However, it is different with real pregnancy edema. This occurs as part of pregnancy-related nephropathy (a kidney disease) - or high blood pressure. In this case, drug therapy and manual lymph drainage are indicated. It must be noted, however, that lymphatic drainage in the area of the abdomen and pelvis must not be performed during pregnancy. Chronic lymphedema of the legs that existed before pregnancy can also be an indication for lymphatic drainage. Since doctors have only a very small quota to prescribe lymphatic drainage, they are usually rarely prescribed during pregnancy. Lymph drainage is only prescribed if it is absolutely necessary, for example in the case of pronounced nephropathy or high blood pressure.
Edema of pregnancy
Edema of pregnancy occurs as part of so-called gestoses. These are pregnancy diseases such as high blood pressure (pregnancy-induced hypertension), preeclampsia or HELLP syndrome. The cause of the edema is reduced kidney function (renal insufficiency). This means that less water is excreted and water is retained in various parts of the body. In addition to medicinal measures, manual lymphatic drainage can also be considered as a therapeutic measure. If there are no contraindications, lymphatic drainage is a good way to treat the pronounced edema. A combination therapy is usually carried out, which for example also includes wearing compression stockings. However, whether lymphatic drainage makes sense must be clarified on a case-by-case basis.
Read more on the subject at: Edema in pregnancy
Carpal tunnel syndrome
Many pregnant women suffer from carpal tunnel syndrome during their pregnancy. A nerve (median nerve) at this bottleneck - the carpal tunnel - is constricted by water retention in the tissue. Typical symptoms are nocturnal pain in the arm and hand, tingling in the fingers and numbness in the thumb and forefinger.The question of lymphatic drainage for carpal tunnel syndrome during pregnancy is often asked. However, lymphatic drainage is not indicated in this case and does not improve the symptoms. Other treatments, such as wearing a splint or using cortisone (see also: Cortisone in pregnancy) are possible.
Risks of lymphatic drainage during pregnancy
Lymphatic drainage as such does not pose any risks in and of itself if performed on a person who has no contraindications for this method. It is - even during pregnancy - a very gentle treatment method that does not cause any discomfort.
However, there are diseases in which lymphatic drainage must not be performed. In these cases, risks can arise. An important risk is the leaching of germs in the event of an acute infection or inflammation in the tissue. This is particularly dangerous for pregnant women, as not only their own well-being but also the child's well-being is endangered. There is also the risk that the lymphatic drainage on the legs will loosen blood clots, so-called thrombi, and wash out the bloodstream. This can lead to a life-threatening pulmonary embolism. However, this risk is only real if leg vein thromboses are known in the pregnant woman or the risk of such thromboses is greatly increased. In addition, lymphatic drainage can put stress on the heart if the heart is weak (heart failure). Lymphatic drainage in the abdomen and pelvis is risky during pregnancy and must therefore not be carried out. This can endanger the existing pregnancy.
Before lymph drainage is carried out during pregnancy, potential risks that may arise in connection with certain previous illnesses must be clarified.
Contraindications for lymphatic drainage during pregnancy
Although lymphatic drainage is a very gentle treatment option, there are contraindications for this therapy option. These contraindications must be strictly observed, especially during pregnancy, in order to protect the well-being of the mother and the child. Depending on the region of the body, a distinction is made between various contraindications. Lymphatic drainage must not be performed in the area of the legs during pregnancy if there is a risk of thrombosis, acute infectious inflammation or heart failure. Lymph drainage of the abdomen and pelvis is always contraindicated during pregnancy - regardless of previous illnesses. Lymph drainage on the neck should not be performed if the thyroid gland is overactive or if there is a cardiac arrhythmia.
Duration of a lymphatic drainage
The duration of the lymphatic drainage varies greatly depending on the extent of the water retention. A session can take anywhere from 20 to 60 minutes. In addition, several sessions are usually necessary for a successful result. However, this question must be clarified individually with the treating physiotherapist.
Does the health insurance company pay for the lymphatic drainage?
There is the possibility of reimbursement for lymph drainage. Experience has shown, however, that lymph drainage is paid for during pregnancy, as there is rarely an urgent indication. Lymphatic drainage is usually prescribed after breast cancer surgery or other operations and is then covered by health insurance. In pregnancy, however, there is often no valid reason to pay the costs. If, on the other hand, there is severe edema of pregnancy or pronounced kidney failure, a doctor can prescribe lymph drainage so that the costs are also covered. It is advisable to inquire with your own health insurance company.
How high are the costs?
The cost of lymphatic drainage varies and often depends on the physiotherapy practice in which the treatment is being carried out. The duration of the session, the type of edema and the amount of work also play a role in the cost calculation. Usually the costs for a session are in the mid double-digit range. The average price can be estimated at around 50 euros per session with a duration of 30 minutes.