Why can lipedema symptoms not be easily noticed?
Symptoms of lipedema often appear gradually. A picture that the patient has thought "this is how my legs are" since childhood, adolescence, pregnancy or weight gain may become painful, sensitive and more prominent over time. Therefore, lipedema can be easily overlooked in the early period.
The situation we see frequently in the clinic is this: The patient diets for years, does sports, loses weight in his upper body, but does not see the change he expects in the hip, thigh, knee circumference or calf area. Moreover, there may be pain to the touch, easy bruising, a feeling of heaviness at the end of the day, and discomfort when moving in these areas. The problem is not just the image. Lipedema is a chronic condition in which adipose tissue behaves differently in the body and progresses with pain and tenderness.
In the main guide we published before, we explained the general definition, stages and diagnostic approach of lipedema. For those who want to see the general framework , what is lipedema? Symptoms, stages and diagnostic guide will be a good start.
In this article, we will discuss the symptoms in particular. Because most of the patients first try to understand: "Is the condition in my legs normal overweight, cellulite or lipedema?"
"Why do my legs hurt when I touch them?"
One of the most bothersome symptoms in lipedema is pain and sensitivity to touch. The patient sometimes describes this as "my legs are bruised", sometimes "as if there is internal pressure", and sometimes "it hurts immediately when I press with your hand".
This pain is not the same in every patient. Some people have a slight sensitivity. In some patients, standing for long periods of time, wearing tight clothing, climbing stairs or applying pressure to the legs cause significant discomfort. There are also patients who describe extreme sensitivity during massage.
In the 2024 S2k lipedema guide, pain is central to the definition of lipedema. The guideline states that painless and symmetrical adipose tissue increase should be considered as lipohypertrophy rather than lipedema. Lipohypertrophy is a disproportionate increase in adipose tissue without pain. In other words, not every leg thickness is lipedema; pain, tenderness, and other accompanying findings should be evaluated together (Faerber et al., 2024 [2]).
The message given to the patient is important here. Saying "my leg is thick" alone does not diagnose lipedema. However, if leg thickness is accompanied by pain, tenderness, easy bruising and typical fat distribution, it should be evaluated for lipedema.
How is pain felt in lipedema?
Lipedema pain is not uniform. Some patients describe pain as a feeling of pressure. Some describe it as burning, stretching, heaviness or fatigue. Sometimes the pain increases at the end of the day. In some patients, complaints of menstrual periods, hot weather, standing for long periods of time or intense physical activity may become more pronounced.
The source of pain cannot be reduced to a single mechanism exactly. Adipose tissue increase, connective tissue changes, microcirculation, tissue fluid balance, inflammation and sensitivity of nerve endings may play a role together. The word "inflammation" here describes a low level of inflammatory activity in the tissue. This does not mean infection; It means that the body's immune and tissue responses work differently in that area.
The presence of pain in a patient with lipedema does not mean that the patient is exaggerating. This sentence should be made specifically. Because these patients often get the answer "you are overweight, that's why it hurts". Excess weight can increase pain; However, lipedema pain may not be explained only by excess weight.
Can easy bruising be a sign of lipedema?
Yes, easy bruising is one of the frequently described findings in lipedema. The patient may bruise with a small blow, or sometimes he does not even remember what he hit. Bruises can be seen especially around the thighs, knees and calves.
The reason for this situation cannot be explained exactly with a single title. Capillary fragility, connective tissue properties, microcirculatory changes, and tissue pressure may contribute to this trend. What we call "microcirculation" is the exchange of blood and fluids by the small vascular network in the tissue. In lipedema, the relationship between this small vessel and tissue circumference may be more sensitive.
Still, caution is required here. Not every bruising is a sign of lipedema. The use of blood thinners, coagulation disorders, liver diseases, some vitamin deficiencies and hematological diseases can also cause easy bruising. If bruising is widespread, has just started, is accompanied by bleeding from the nose or gums, or is thought to be related to the medications used, a physician's evaluation is required.
How is the fat distribution in lipedema?
In lipedema, adipose tissue is not evenly distributed throughout the body. It is most common in the hips, hips, thighs, knee circumference and calf area. In some patients, the arms are also affected. A significant disproportion may occur between the trunk and the legs.
This disproportion may be one of the earliest findings noticed by the patient. The upper body appears slimmer, while the lower body is noticeably wider. The patient has difficulty choosing trousers, cannot buy top and bottom clothes of the same size, and is uncomfortable with narrow-legged clothes. Some patients say that their legs have been thick since childhood; others find that it becomes evident after puberty, pregnancy or menopause.
In lipedema, adipose tissue is usually bilateral and symmetrical. So the right and left legs are affected similarly. This point is important. Unilateral sudden swelling may suggest vascular occlusion, infection, or another emergency rather than lipedema.
"My upper body is thinning but my legs are staying, is this lipedema?"
This sentence is heard very often in patients with lipedema. The patient loses weight, his face becomes thinner, his waist circumference decreases, but there is no change in the legs at the same rate. Sometimes the scale falls off, but the trouser size remains almost the same. This can be demoralizing.
It has long been clinically known that areas with lipedema can be more resistant to weight loss. This resistance does not mean that the patient does not make an effort. Lipedema tissue may behave differently from classical adipose tissue. Therefore, weighing alone is not sufficient in lipedema follow-up.
Waist, hip, thigh, knee circumference and calf measurements should be evaluated together for more accurate tracking. The fit of the clothes, the level of pain, the feeling of heaviness at the end of the day, the comfort of walking and the capacity to climb stairs also tell the patient a lot.
Nutrition is still at the heart of the process. Because insulin resistance, excess weight, tendency to edema and inflammatory load can increase lipedema complaints. However, telling the patient to "just lose weight" is an incomplete approach. Nutrition, exercise, manual lymph drainage, compression and follow-up should be considered together in lipedema.
Why is the preservation of the feet an important finding?
In classic lipedema, the feet are usually preserved. The increase in adipose tissue may appear to be cut at the ankle level. This appearance is sometimes described as a "cuff look" or "cut at the wrist".
This finding may help in differentiating lipedema from lymphedema. Lymphedema is swelling that develops when lymph fluid accumulates in the tissue. In lymphedema, the back of the foot and fingers may be affected more frequently. In lipedema, painful adipose tissue increase is at the forefront and the feet often look more normal.
Still, diseases can be mixed together. In the future, lymphedema may be added to lipedema. This is called lipo-lymphedema. In this case, swelling may begin on the back of the foot, and edema may become more permanent. For this reason, sharp comments such as "my feet are not swollen, then it's okay" or "my feet are swollen, it's definitely not lipedema" are not true. Inspection is required.
How to recognize swelling and heaviness in lipedema?
In lipedema, patients often use expressions such as "my legs are getting heavier", "they are swelling towards the evening", "it is as if they are filling up". Here, the swelling may not always be a swelling that leaves a pit when pressed with a finger, like classical edema. Sometimes the feeling of fullness, tension and heaviness is more at the forefront.
Standing for long periods of time, hot weather, long travel, inactivity and menstruation can increase this feeling. Some patients wake up more easily in the morning and feel heaviness in their legs as the day progresses. This picture may also be associated with venous insufficiency or lymphatic overload. Therefore, the vascular system should also be evaluated in the patient with suspected lipedema.
"Venous insufficiency" is the difficulty of the veins in carrying blood up the legs. It can manifest itself with heaviness in the leg, swelling at the end of the day, varicose veins, itching and skin changes. It can be found together with lipedema. In such a case, the treatment plan should be established more carefully.
Do lipedema symptoms change during the day?
Yes, some symptoms may change throughout the day. In particular, the feeling of heaviness, fullness, tenderness and swelling may increase towards the evening. In hot weather, complaints may become evident when standing for a long time or sitting for a long time.
This variability can confuse the patient. If the legs, which are better in the morning, become more painful and fuller in the evening, the patient sometimes interprets this as "I have edema". Sometimes he thinks, "So it's not lipedema, because I'm better in the morning." In fact, the increase in fat in the tissue in lipedema is permanent; To this can be added the fluid load and circulatory effects that change during the day.
For this reason, it would be more accurate to measure at the same time in patient follow-up. If the measurement is taken one day in the morning and another day in the evening, the results may be misleading. The same time, similar conditions and the same measurement points should be used in weekly follow-up.
How are the symptoms of lipedema, cellulite and obesity distinguished?
Lipedema, cellulite and obesity are confused with each other. This is very normal; Because there may be some similarities in the external appearance. But clinically, they are not the same thing.
Cellulite is more related to the cosmetic appearance of the subcutaneous tissue. There may be an orange peel appearance, surface irregularity and dimples on the skin. Pain, easy bruising and symmetrical disproportionate fat distribution are not necessary.
Obesity progresses with a general increase in adipose tissue in the body. The trunk, abdomen, back, arms and legs can be affected together. In lipedema, the lower body is more noticeably affected. There may be a significant difference between the upper body and the lower body.
In lipedema, pain, tenderness, easy bruising, symmetrical leg thickness, relative protection of the feet and regional fat resistant to weight loss are more remarkable. However, obesity and lipedema can coexist in the same patient. Therefore, differential diagnosis, i.e. differentiating similar diseases from each other, requires an experienced clinical evaluation.
What symptoms suggest non-lipedema emergencies?
Lipedema is usually a slowly developing condition. Sudden onset complaints should not be passed off as lipedema.
Urgent evaluation is required if there is unilateral sudden leg swelling, redness and temperature increase in the leg, new-onset severe pain, significant tenderness in the calf, shortness of breath, chest pain, fainting or fever. These findings may be associated with vascular occlusion, infection or other serious diseases.
This point is very important for patients. A person with lipedema may also develop clots, infections, or venous problems. It is not safe to ignore new and sudden symptoms by saying "I already have lipedema".
What should be done if there are symptoms of lipedema?
If there are symptoms of lipedema, the first step is the correct evaluation. The patient's history should be listened to, physical examination should be performed, fat distribution, pain, tenderness, bruising tendency, condition of the feet, venous findings and lymphedema signs should be considered together.
The simplest preparation that can be done at home is to keep a measurement track. Waist, hip, thigh, knee circumference and calf measurements can be recorded under the same conditions. A complaint log is also helpful. On which days does the pain increase, does hot weather affect it, is it related to the menstrual period, what happens when standing for a long time, do dietary changes affect the complaints? This information is very useful in examination.
On the treatment side, the goal is not to condemn the patient to a single method. Nutrition, appropriate exercise, manual lymph drainage, compression, weight management, sleep, stress management and, when necessary, surgical options are considered together. Successful follow-up in lipedema begins when the patient stops blaming his own body and reads the symptoms correctly.
What could be the first symptom of lipedema?
The first symptom is not the same in every patient. In some patients, disproportionate thickening of the legs is noticed earlier. Some have pain to the touch, easy bruising, or a feeling of heaviness at the end of the day. The increase in complaints after puberty, pregnancy or menopause is remarkable in terms of lipedema.
How to distinguish lipedema pain?
Lipedema pain is often described as sensitivity that increases with pressure, bruise-like pain, a feeling of heaviness or fullness. It's not just like muscle soreness after exercise. Standing for long periods of time, hot air or applying pressure to the legs can increase complaints.
Is bruising normal in lipedema?
Easy bruising can be seen frequently in lipedema. However, not all bruising is caused by lipedema. If bruising has just started, is very widespread, is accompanied by bleeding complaints or blood thinners are used, a physician's evaluation is required.
Why do feet usually not swell with lipedema?
In classical lipedema, the increase in adipose tissue mostly stops at the ankle level and the feet are relatively preserved. In lymphedema, the back of the foot and fingers may be more affected. In the future, if lymphedema is added to lipedema, swelling can also be seen in the feet.
I lose weight with diet, but my legs do not get thinner. Could this be lipedema?
This situation is frequently described in lipedema. The fact that the legs do not change at the same rate while the upper body is thinning may be thought-provoking in terms of lipedema. However, the diagnosis is not made only by this finding. Pain, tenderness, bruising, symmetrical fat distribution and examination findings should be evaluated together.
Which doctor should I go to if there are symptoms of lipedema?
Vascular surgery, lymphology, physical therapy, dermatology, plastic surgery and nutrition can play a role together in the evaluation of lipedema. In the first evaluation, it would be correct to consult a physician who can distinguish between lipedema, lymphedema, venous insufficiency and obesity.