Ouch! Whichever condition you are worried about, it hurts. It doesn’t look right. It doesn’t feel right. You may be trying to figure out whether you have a plugged duct or a full-blown case of mastitis. You want to find out if there’s anything you can do about it. Your nipple may hurt, and you checked with Dr. Google and think you have a bleb and you want to know more about that, and how to get it to stop hurting so darn much. Mama, you have come to the right place! I can help you with all these questions.

Nipples and breasts should not hurt. After you get through the early nipple tenderness that so many moms experience and after you get through engorgement, they just shouldn’t hurt. I can help you figure out why they hurt and what you can do about it.

A Quick and Painless Lesson on Basic Anatomy

I’ll keep this brief, so it doesn’t get boring.

I couldn’t find the kind of picture that I wanted and was available in my budget. (Do you know how much stock photos cost??? If you are a photographer, it’s worth looking into. It could be a good side gig. ) I had to come up with an image I drew myself. I know, I’m not an artist either. I’m a lactation consultant, and I’m good at that. Know your strengths and weaknesses, I always say!.

My little drawing gets the point across. It is not drawn to scale though.

There are fat cells under the skin. Next, come the glandular tissue and ducts. The milk is made in the grape-like clusters called alveoli. There are a lot more of these in a breast than I show here. The milk drains into the ducts and makes its way down to the nipple where it gets removed with suction from the baby or a pump. There are a lot more ducts than I show here also. The ducts are just like the ducts in a house. Well, not exactly like them, but you get the idea.

The milk cells can collect, get stuck together and cause a back-up of milk. That is a clogged duct.

Clogged duct

The terms “clogged” and “plugged” can be used interchangeably when talking about this condition. I am going to call them clogged ducts. You will know you have a clogged duct if you have a hard area in your breast that is tender. It may be a little red. It may get a little worse before feedings and then a little bit better after a feeding. You will not have a fever with it. The chances are that it will not develop into mastitis.

Mastitis

Approximately 10-20% of breastfeeding moms will get mastitis during their breastfeeding journey. It can start off as a clogged duct, or you might just jump right into mastitis. Usually, it starts with a hard, tender area in one breast. You won’t always have a clearly defined lump with mastitis. The breast may just have a tender, swollen and reddened area. It can also start with a fever and flu-like symptoms. If it starts out as a clogged duct, eventually you will get the fever and flu-like symptoms. That is basically the difference between a clogged duct and mastitis, the temperature and that crummy flu-like feeling. It can really knock you off your feet.

Chances of getting mastitis are highest in the first 2-6 weeks of breastfeeding, but it can develop at any time.

Since I can’t really call this a fun fact, I will call it a fascinating fact: A person who is not breastfeeding can also develop mastitis, including men.

Abscess

A really not at all fun fact is that 3% of mastitis cases will develop into an abscess. An abscess is usually diagnosed by ultrasound. However, I have seen instances where repeated ultrasounds were negative for an abscess, and the decision was made to have a surgeon try and drain it, and it was, in fact, an abscess. My experience has been that an abscess does not always make a mom feel as bad as mastitis usually does. You take one look at her breast though, and you know something bad is going on.

What Puts You at Risk

The most common culprits are:

  • Pressure on your breasts
    • Photo credit: hugabub.com on Visualhunt / CC BY-ND

      A bra that doesn’t fit well, especially if it is an underwire

    • A strap from a purse, diaper bag, backpack or front carrier
    • A seat belt
    • Sleeping on your side
  • Delayed feedings
    • Scheduled feedings
    • Sleep training
    • Baby suddenly sleeping through the night
  • Cracked nipples

Treatments

Clogged ducts

If you have a clogged duct, try massaging it when feeding as soon as you realize that it is there. If that doesn’t make it go away,  you should try a good old fashioned warm compress. Take a washcloth, get it wet with water that is as warm as is safe to put on your skin. If it feels too hot, don’t use it! Let it cool down until it feels comfortable. Put it over the hard area and cover it with plastic wrap. Remove it after 15-20 minutes and breastfeed or pump while massaging the lump towards the nipple. You might need to do all this more than once. I know a lot of women who have used a disposable diaper instead of a washcloth. If you have large breasts, you may find a hand towel covers a larger area.

What I have found even more effective is a warm castor oil compress.

  • I could not find any research on this, but I could personally present many case studies to show that it works.
  • Take a wash cloth and get it damp with water
  • Drizzle a generous amount of castor oil on it
  • Microwave it for 5-second increments until it feels warm but not hot
  • Put it over the hard area and cover with plastic wrap
  • Leave it on for 20 minutes
  • Breastfeed or pump and massage.
  • You may need to do this more than once, just like with a regular compress
  • Wash the castor oil off, paying extra attention to whether any got on your nipple. You don’t want your baby getting any of it when he nurses.

Mastitis

  • If you have a fever or feel like your getting the flu, I don’t advise watchful waiting.
  • Call your healthcare provider.
  • Mastitis requires antibiotics the vast majority of the time.
  • Thorough draining of the breast with regular breastfeeding and additional pumping as needed
  • Rest, rest, rest
  • Fluids
  • Ibuprofen as needed

Blebs

It’s a funny word but doesn’t feel funny at all.

  • White spot on the nipple
  • A bleb may also be called a milk blister.
  • It is a clogged milk pore on the nipple.
  • Usually painful
  • May also have a clogged duct

To get rid of a bleb

  • Warm compress right before nursing on the affected nipple for 15 minutes
  • Scrub your fingernails clean with soap
  • Gently scrape at the bleb with your fingernail
  • You may get a sudden stream of milk
  • If you can’t get it off with your nail, ask your doctor or dentist for a sterile needle and gently try scraping at it with that.
  • A sewing needle that you light a match to is not an acceptable alternative
  • Put some antibiotic ointment or All Purpose Nipple Ointment on the area for the next couple of days

Good Things to Know

For all three, clogged ducts, mastitis and blebs, repeated episodes can be helped by a daily lecithin supplement. Most sources recommend 1200 mg taken 2-3x/day.

I also recommend getting in the habit of feeling your breasts after each feeding to make sure that you are not developing any lumps and if you are to give that area some extra attention at the next feeding with massage. You should also look at your bras and anything that may be putting pressure on your breasts.

You can’t make your baby sick from breastfeeding when you have mastitis.Milk expressed is safe to use. Milk expressed with a clogged duct or mastitis may look stringy and clumpy.

Clogged ducts sometimes, and mastitis almost always will cause a temporary decrease in milk supply. It will usually increase back to normal with good stimulation.

One Final Thought

Clogged ducts, mastitis and blebs are bumps in the road of your breastfeeding journey. Fortunately, they are temporary bumps.

Have you ever had a clogged duct, mastitis or bleb? What helped?

Next Time

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