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Subject:Hot Tubs

I've gotten differing opinions regarding the ability to sit in a hot tub if you have lymphedema.  Is there any amount of time or water temperature which is "safe" for someone with lymphedma?

Posted: 04 Jun 2012 05:33 PM
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Subject:Hot Tubs

We are concerned about individuals with lymphedema going into a hot tub for several reasons.

One is the accumulation of body heat that is produced by sitting in a hot tub. Hot tubs are often factory programmed to maintain a water temperature of approximately 104º F. When a person gets warm, the body tries to dissipate heat by venous dilation. When veins dilate they tend to leak more fluid, therefore producing more fluid into the tissue. This gives a larger volume of fluid for the lymphatics to remove. Individuals with perfectly functioning lymphatic systems can handle the extra volume. Individuals with lymphedema don't have perfectly functioning lymphatic system, so this puts more stress on their system. It gives the dysfunctional system more work to do. It can cause a worsening of the lymph accumulation.

Second is Infection.
Individuals with lymphedema have increased risk of infection in their lymphedematous body part. Hot tubs, even when chlorinated, may act as a source of germs. Bacteria such as mycobacteria, E. coli, and pseudomonas aeruginosa can live in the slime found on wet surfaces and in pipes. Hot tubs have wet surfaces that remain continually wet and a system of pipes. These organisms can all cause infection. One study( *) looking at the background prevalence and antimicrobial resistance profile of Pseudomonas aeruginosa in swimming pools and hot tubs,found twenty-three of 108 samples (21%) positive for P. aeruginosa. Of these, 96% of the P. aeruginosa isolates tested were multidrug resistant.
An infection of particular concern is "Hot tub folliculitis," typically caused by bacteria, such as pseudomonas, that can live in hot tubs. Infection of a person's hair follicles results in red, itchy bumps or pustules. These may go away on their own without treatment, or may require further treatment or progress into cellulitis.
Individuals with lymphedema are more susceptible to infection and cellulitis in their lymphedematous body part.( **) Once infected, the infection progresses very rapidly and they may require intravenous antibiotics for treatment.

There no controlled studies on this subject to dictate absolutes.
Cooler water would more likely be better tolerated.
Infection could be avoided if skin integrity is not compromised and one had an absolute meticulous assurance of sterile aqueous environment.

The National Lymphedema Network's "18 Steps To Prevention" suggest that lymphedema patients avoid hot tubs.

*[Lutz JK, Lee J. Prevalence and antimicrobial-resistance of Pseudomonas aeruginosa in swimming pools and hot tubs. Int J Environ Res Public Health. 2011;8:554-64]
**[Woo PC, et al. Cellulitis complicating lymphoedema. Eur J Clin Microbiol Infect Dis. 2000;19:294-7.]

Posted: 18 Jun 2012 09:25 AM
Originally Posted: 18 Jun 2012 09:28 AM
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