Mastitis

Having a sore breast can be a painful and alarming experience and can occur when the milk flow in your breast is blocked. Your breast may feel tender, there may or may not be redness or a hard spot or sore lump in your breast. Treat any engorgement promptly to avoid developing blocked ducts or mastitis.

Whether you have a sore breast, a blocked duct or a breast infection, the initial care is similar: nurse frequently, rest and apply heat to the tender area.

Blocked Ducts

Milk flows through a duct system in your breasts. Sometimes an area of the ducts becomes blocked and milk stops flowing well. A section of your breast may or may not be red. If you have a plugged duct, your breast will usually be tender though the pain will be localised. If the blockage is not treated, the area may become infected.

You may also hear people refer to clogged or plugged ducts.

Treatment for blocked ducts is similar to that for mastitis. Try the following ideas:

  • Apply wet or dry heat to the affected area, and remove any dried milk secretions on your nipple by soaking with plain warm water.
  • Fill a basin with warm water and lean over to soak your breasts. Massage the area gently while warm, and then see if your baby will nurse.
  • Use gentle breast massage on any hard lumpy areas while your baby feeds.
  • Massage gently above the blocked duct and then hand express behind your nipple.
  • Try to feed your baby on the affected side frequently, changing positions so that his chin and nose are alternately pointing in the direction of the plugged duct. Experiment with positions including kneeling on all fours and dangling your breast above your baby while he lies flat on the floor.
  • If possible, loosen constrictive clothing or go bra-less for a few days.
  • A more unusual treatment which is successful for some mothers is to hold the flat end of an electric toothbrush against their blocked duct, and use the vibrations to clear it.
  • Ensure your breasts are soft and comfortable at the end of feeds to avoid further engorgement which can lead to blocked ducts.
  • Check your positioning and attachment (latch) to help with optimal draining of your breasts and to stop the problem happening again.
  • Applying cabbage leaves is often recommended as a treatment for mastitis – it is not recommended as treatment for blocked ducts.

If you have recurrent blocked ducts that are not helped by adjusting positioning and attachment (latch), try reducing saturated fat in your diet and take one tablespoon per day of lecithin. You can also reduce sodium (salt) intake (sodium can cause fluid retention, which can make women susceptible to infections of any kind, including mastitis).

Blocked ducts can occur when your baby’s ‘schedule’ becomes less predictable due to illness or life changes, meaning he isn’t emptying your breasts as often as usual. If your baby has recently started to sleep for longer periods at night, or is nursing less due to teething, this can also leave you with overly full breasts. If this is the case you can help by ensuring you feed or express a little to avoid further problems.

Milk Blisters (Blebs)

A milk blister (or bleb) is usually a painful white dot on the nipple or areola. Thickened milk may block milk flow near the opening of the nipple, or sometimes a tiny bit of skin overgrows a milk duct opening and milk backs up behind causing the blister. They can be associated with mastitis.

A milk blister is not the same as a blister caused by friction, either from incorrect latch or a badly fitting nipple shield or breast pump flange. Milk blisters do not always hurt and may resolve over several weeks without any treatment. If you have a painful milk blister:

  • Apply moist heat using warm compresses and then feed your baby—suckling may open the blister.
  • Soak your nipple in warm water.
  • Wear a cotton ball soaked in olive oil in your bra to soften the skin and then attempt to peel away the thickened layer of skin.
  • Compress your nipple behind the blockage to try and express the blockage. Sometimes it is possible to express a thickened string of milk, which helps open the duct and keep it open. Work back from the nipple to make sure there isn’t a blockage further back.

If these don’t work, ask your healthcare professional for help. Avoid opening the blister yourself; it may bring relief but could also result in infection. Once a blister is open, help prevent infection by washing the wound with mild, unperfumed soap and rinsing well once a day.

Mastitis

Mastitis (inflammation of the breast)can occur when a blocked duct doesn’t clear, or more generally when the build up of milk in your breast causes swelling and inflammation.  As well as having a tender breast, you are likely to feel achy, run-down and feverish; you may have flu-like symptoms.

Mastitis is usually caused by backed up milk in a section of the breast. This can progress to an infection if not treated. Delayed nipple wound healing, stress, chronic engorgement and persistent breast pain increase the risk of mastitis. Areas of the breast that remain undrained or that experience blocked ducts may be focal points for bacteria to take hold and start an infective process. Milk production may drop from your affected breast for a few days during the worst of the symptoms, but it is important for your baby to continue breastfeeding from that side to help prevent the infection from turning into an abscess. The milk from the affected breast will not harm your baby.

If you have mastitis you can try all of the treatments listed in the section on blocked ducts, as well as the following care plan.

Care Plan for Mastitis

Signs, Symptoms, and Treatment

If you:

  • Can see red patches on your breast
  • Can feel a hard sore lump in your breast
  • Feel achy and run down
  • Have a low grade fever (less than 38.4° C [101° F])

Then:

  • Rest as much as you can
  • Continue to feed your baby 8-12 times each 24 hours from both breasts
  • If your baby does not drain the affected breast, hand express or pump that side to thoroughly drain it
  • Use alternate massage (massage and compress the breast and hard area each time baby pauses between sucks)
  • Apply heat prior to feedings to promote breast drainage
  • Ask your doctor or nurse practitioner if you can use a medication such as ibuprofen to reduce the inflammation

If:

  • You do not see results or feel better in 8-24 hours
  • You continue to run a fever or suddenly spike a high fever (38.4° C [101° F]) or higher
  • Your breast becomes red, hot, and swollen
  • You see pus or blood in your milk
  • You see red streaks on your breast from the areola to the underarm
  • A cracked nipple looks infected
  • You have chills and continue to feel worse

Then:

  • Call your doctor
  • If medication is prescribed, take the full course
  • Rest and drink plenty of fluids
  • Continue to nurse frequently on the affected side (or pump if your baby is unwilling or unable to feed well on that side)
  • Use alternate massage on the affected side to help it drain better
  • Contact your local LLL Leader or group, or find local support here, to help you find out what is causing the mastitis so that it does not recur

Note:
It is a myth that it is unhealthy for your baby to breastfeed when you have a breast infection – the antibacterial properties of human milk actually protect your baby from infection. Continuing to breastfeed when experiencing a sore breast, plugged duct or breast infection will speed recovery.

Nursing frequently helps to provide comfort, reduce inflammation and encourage opening of the blocked area. Many mothers find that varying breastfeeding positions drains all areas of the breast more effectively. For example, if you most commonly use the cradle hold, try the clutch (‘football’ or ‘rugby’) hold or lying down to breastfeed.

Rest is an important component in recovery from sore breasts, plugged ducts or breast infections. Try resting in bed with your baby cuddled next to you. Link safe sleep post This will also encourage frequent breastfeeding sessions to drain your breast. Keep supplies such as diapers, toys, books, your phone, a drink of water nearby to minimize trips out of bed.

Applying wet or dry heat with a heating pad or hot water bottle and gently massaging the sore area of your breast before breastfeeding can assist it in further emptying. Many mothers find that taking showers or baths and gently massaging with a warm cloth on the sore breast is a relaxing treatment during a stressful time. Another technique is to lean over a basin of warm water and soak the sore breast for about 10 minutes three times a day. This will also remove any dried milk secretions that may be blocking the flow of milk out of the nipple. Breastfeed immediately, while your breast is warm, to help unplug the blocked duct.

Sometimes mastitis is the result of poor positioning and attachment meaning your baby doesn’t drain milk from your breast efficiently. An LLL Leader can help you explore improvements you can make to help prevent the condition recurring.  Get local support

Recurring Blocked Ducts and/ or Mastitis

In order to prevent future plugged ducts or breast infections, you may find it helpful to be cautious of sudden long stretches between nursings. When breastfeeding, periodically changing your baby’s position, while maintaining good positioning will help to empty all the ducts around your breast. Maintaining general health through your diet and getting extra rest may help keep your breast from becoming sore again.

Mastitis most frequently recurs when the bacteria are resistant or not sensitive to the antibiotic you have been prescribed, when antibiotics are not continued long enough, when an incorrect antibiotic is prescribed, when the mother stops nursing on the affected side, or when the initial cause of the mastitis has not been addressed (such as milk stasis – ie milk is not removed from the breast). If mastitis recurs, request that your doctor conduct a culture and sensitivity test on your milk to discover exactly what organism is involved and what antibiotic will eliminate it. Many organisms are resistant to common antibiotics and repeated use of ineffective medications increases the risk of an abscess. Mastitis caused by methicillin resistant Staph aureus (MRSA) is becoming more prevalent. Increased risk for hospital-acquired MRSA, a virulent and difficult to treat situation, is seen in mothers with a caesarean delivery, administration of antibiotics in the peripartum period, mothers with multiple gestation, and mothers who have experienced in vitro fertilization. Outpatient infection with MRSA is also becoming more common.

Other Causes of Mastitis

If either of your nipples is sore, cracked or bleeding, this can be a point of entry for infection. If sore nipples are a recurrent problem, be vigilant about positioning and attachment (latch). Contact your local Leader to talk through what might be causing your sore nipples.

Nipple shields can slow down milk flow and encourage infection. Use of pacifiers and artificial nipples can affect how baby sucks and contribute to nipple soreness and development of mastitis.

Some babies are reluctant to breastfeed or refuse the breast periodically, perhaps due to sensitivity or other factors. Irregular breastfeeding patterns may contribute to repeated breast infections. Your local Leader may be able to help you troubleshoot and determine possible causes for this.

Make sure your clothing isn’t too tight-fitting, paying special attention to your bra. Some bras and bathing suits, especially underwire types, may put too much pressure on your breast. Even a heavy shoulder strap purse or frequent use of a baby carrier can cause problems. Frequently changing sides with bags/purses or baby carriers may help.

The shoulder strap of a seat belt can also cause a sore breast. A too tight strap could apply pressure to your breast. Also, the shoulder strap’s pressure from a sudden stop may cause a sore breast. Other types of injuries can result in sore breasts such as a kick or hit from a rambunctious toddler. These may result in blocked milk flow and so should be treated with rest, heat and frequent nursings.

Any history of breast surgery, breast lumps or injury to the breast can increase risk of infection.