Compression Garments for Lipoedema
Expert advice on how compression garments can help people with Lipoedema, plus advice on sourcing, fitting and applying them.
Compression garments are medical garments made from firm, elasticated fabric designed to improve circulation and apply pressure. Compression garments will not change the size or shape of the areas affected by Lipoedema. However, compression garments can help manage symptoms of lipoedema. For people with Lipoedema, compression garments can:
- Help reduce discomfort and heaviness, and in turn improve mobility
- Support tissues and joints, providing a more even shape/silhouette over the limbs
- Reduce swelling in cases where there is fluid retention or secondary lymphoedema present
- Form part of conservative (i.e. non-surgical) treatment
For some patients who also have varicose veins, venous insufficiency, a history of venous leg ulceration, or a secondary lymphoedema, wearing compression garments can be helpful in improving vascular and lymphatic function and prevent a worsening of these conditions.
Compression garments come in many styles – including tights, knee-high socks, closed-toe and open-toe designs, stockings, wraps, sleeves and dedicated night-time compression – and in different materials. Flat-knit garments are made from flat-knitted fabric, whereas circular knits are seamless, tube-shaped garments knitted on a round knitting cylinder. What is best for you will depend on your symptoms.
Some compression garments are available ready made (i.e. off the shelf), but often made-to-measure garments are required in Lipoedema management. This means that the garments are specifically made for individuals and should be a perfect fit and comfortable. Patients should be measured by an experienced professional.
In the early stages of Lipoedema, circular, round-knit garments may be suitable for some individuals. These should generally be in a tights or legging style, but be advised by a specialist trained in compression therapy who can also measure and either prescribe or request a prescription from the GP. Once measured correctly, some individuals may want to purchase directly from the compression garment companies but the made-to-measure (MTM) form must be signed off by a competent trained therapist/clinician.
Circular-knit garments are highly elastic and therefore prone to cutting into certain parts of the body if the shape is irregular, for example if you have fat pads around the ankles, knees or thighs. They are therefore not suitable for later-stage Lipoedema or people with high levels of sensitivity and pain. In the later stages of Lipoedema, where there may also be skin folds or ‘ankle cuffing’, it is important that a made-to-measure, flat-knit garment is provided.
Other types of compression include:
- Inelastic garments made from non-stretch material, which wrap around the body
- Micro-massaging garments, made from a textured knit, which are designed to stimulate the lymphatics through the skin. These are highly elastic, low-level compression but may be useful in the early stages of lipoedema.
- Night-time garments are designed to complement the daytime garments rather than to replace them. However, for some, maybe those with restricted mobility or who struggle with conventional compression, these garments may be a solution to wear at home during the day as well. These are usually made of a thicker, lower compression material that has breathability and can sometimes be ribbed in design.
Wearing a medically prescribed compression garment should improve symptoms of pain and heaviness and be comfortable to wear. For some individuals with very sensitive skin, wearing compression may be challenging. Supportive and sports wear (‘active wear’) is generally less compressive than a prescribed compression garment. Non-medical garments offer a lighter support and may be helpful for some people, especially those who cannot tolerate medical compression or people who are in the earlier stages of Lipoedema.
Compression optimises lymphatic flow and encourages the drainage of the inflammatory interstitial fluid. This is beneficial even in the early stages of Lipoedema, because studies have shown that oedema or extracellular water increases with each stage of Lipoedema.
Compression garments are available on prescription in the UK. Measuring and fitting should be done by a trained nurse, therapist, lymphoedema clinic, private clinician or pharmacist. It is important that any compression requirements are backed by a healthcare provider (a GP, practice nurse or specialist practitioner) who is aware of any relevant medical history, because sometimes compression is contraindicated.
Some people struggle to find a suitable professional to measure them. In this instance, it can help to first get a diagnosis from your GP, who should then be able to refer you.
For made-to-measure options, numerous length and circumference measurements will be recorded on a form, and this will be sent away with the prescription. As a patient, you can research compression companies before your appointment. Many compression suppliers offer measurement training to practice nurses and therapists – you could ask the person measuring you to liaise with suppliers for advice and training on measuring and fitting. It’s useful, too, to keep track of your own measurements. If you don’t change shape, it can make it easier for you to replace old garments in the future. However, you should be reassessed at least every 12 months. This is so that measurements can be repeated in case of weight gain or loss, change in shape or to check for any new contraindications.
When you collect your garment, always check that it corresponds to the item on your prescription and has not been substituted with an item from a different manufacturer or by a garment with a different code. The first time you put on a compression garment it may be a challenge and there are various ‘donning and doffing’ appliances available to make it easier which may be recommended by your trained therapist. You might also find that a pair of rubber gloves designed to help apply the compression, or ordinary rubber gloves, can help gripping the fabric and making it easier to pull garments up and smooth them into place (as well as preventing snagging and prolonging the life of the garments). It’s important to take your time to ensure the garment and material are pulled up and that there are no folds or creases in the material.
Ideally, your measurer/prescriber will check the fit of your garment and ensure it is comfortable. It’s important to feed back to your clinician or therapist if it’s not comfortable, and to work with them to find something suitable that fits properly and lasts well. Always follow the manufacturer’s care and washing garments. Frequent washing keeps the garments in shape and maintains their effectiveness.
If you are purchasing extra garments following assessment, the price of made-to-measure garments will be more expensive. It is useful to check eligibility for VAT exemption with your GP, specialist nurse/therapist.
Referral to a specialist Lymphoedema Clinic
NHS Clinics
Individuals with Lipoedema may be referred by their GP to a local Lymphoedema Clinic as there are no specialist Lipoedema clinics in the NHS. It is important to be assessed and treated with appropriate non-surgical treatments, such as the right compression garments and advice. Your GP can also refer you to other services if appropriate, such as weight management or psychological services. The GP may make a referral to the practice nurse to measure and fit for compression, but this is dependent on what training and skills the practice nurse has in this area.
The British Lymphology Society (BLS) holds a list of UK Lymphoedema Clinics, but not all accept patients with Lipoedema. UK lymphoedema services are inconsistent, and many parts of the UK have no provision at all. A number of lymphoedema clinics accept out-of-area and private patients for diagnosis and treatment.
Out of Area & Tertiary Clinics
The UK has two outstanding Lymphoedema specialist hospitals – St George’s University Hospitals NHS Foundation Trust and The University Hospitals of Derby & Burton NHS Foundation Trust. Your GP cannot refer you directly to either of these specialist services unless you fall into their locality catchment areas, but they will accept a referral from a hospital consultant. Most specialist Lymphoedema Clinics do not routinely recommend and prescribe compression garments without evidence of oedema. However, your GP can refer you to a service that accepts out-of-area lipoedema referrals, such as Accelerate in East London and LymphCare in Dudley.
Private Therapists & Clinics
There are some private therapists and clinics that may be able to diagnose and offer advice and support, such as measuring for compression and providing pre and post operative liposuction treatments. Most are also qualified in manual lymphatic drainage (MLD) and other therapies which may relieve some of the symptoms of Lipoedema. The MLD UK website’s ‘Find a Therapist’ page has a search function to enable you find your nearest therapist. Please check the individual therapists’ credentials and that they are qualified, and experienced, to treat lymphoedema and lipoedema.
Expert advice to get the most out of your GP visit
Some people report feeling uncertain about how to ask their doctor for compression garments. In our special feature on compression, published in Living With Lipoedema in December 2024, Mark Hudson of Daylong Direct offered advice for anyone unsure about how to approach their GP for compression.
1) When you visit your GP or healthcare provider, state clearly that you have suspected lipoedema, and then outline your symptoms – for example, your legs bruise easily, are painful and swollen. Explain if these symptoms affect your Quality of Life (QoL) and how they prevent you from doing everyday things.
2) Ask your doctor how they can help you manage your pain and improve your QoL and limb mobility.
3) Ask your doctor if they can order you the product you want. Manufacturers use different measuring guides (you can see different companies’ guidelines online).
4) If you can’t get a diagnosis, ask for ‘suspected lipoedema’ to be written on your file and request support for your symptoms.
5) If your GP doesn’t agree with you, you can – and are entitled to – ask for their recommended care plan to improve your QoL. You can also enquire who they recommend within their surgery to give you a second opinion.
What our members tell us about their experiences with compression garments
- When you receive your compression garments, check that the packaging has the correct information regarding the company, style, size and class of compression. If you collect them from a pharmacy, it is important to check you have the right garment before you walk out of the door.
- A garment applicator (donning and doffing aid) can make the application of the stockings easier and some can help you get them off, too. Ask your GP for a prescription for a suitable device, although you may want to research online and purchase your own through a compression-garment supplier’s website.
- Specially designed gloves are available from compression companies to help with getting your garment on – but a pair of rubber washing-up gloves can also help!
- Long fingernails can easily go through the expensive garment material, so gloves can be helpful to prevent this, too.
- Check the fit and feedback to your specialist who recommended or prescribed them. Quite often initially only one pair will be requested to ensure that the fit is good and comfortable prior to ordering the second pair.
- Garments are usually applied first thing in the morning and taken off in the evening.
- According to the NHS, anyone prescribed with compression stockings should have their legs re-measured and garments replaced every four to six months.
- It’s time to get a replacement if you find loose threads or holes, or if you have lost or gained weight, and if the garments feel too loose or too tight. Do not wear your hosiery if it is causing your skin to mark excessively or is causing any numbness or is uncomfortable.
- Two garments will be required – one to wear and one to wash. Always check the manufacturer’s washing instructions, which usually recommend a lower temperature and hand-wash cycle with no fabric conditioner. The compressive properties of the garment can be altered if incorrectly washed.
- There are different specialist postal prescription services which stock various garments in an array of colours. If you choose to use one of these companies, they can explain how to set up repeat prescriptions to enable you to have compression delivered to your home.
- Compression should be snug without causing any discomfort or other issues, such as excess bunching. Numbness, tingling, bruising, blistering and rubbing are common complaints of ill-fitting garments and among the warning signs to look out for. In this case, remove the garments immediately and get in touch with your GP or the healthcare professional who recommended or prescribed them as soon as possible.
- If the weather is hot, wearing compression can be a challenge – but try keeping your spare pair in the fridge or freezer so they are nice and cool to apply!
Lipoedema UK is grateful for the support of the companies listed below, which provide professional-grade medical products that are suitable for patients with Lipoedema. Following a diagnosis, these products can be obtained through prescriptions issued by a qualified healthcare professional, your GP or your practice or community nurse, and are often available on the NHS. Some of these companies also provide made-to-measure or standard-size compression products via their online shops, and have helplines to offer support relating to queries regarding their products.
