Could you have a breast or nipple infection?
Like any other part of our body, breasts and nipples can experience injury, inflammation and infection. Nipples are particularly at risk in the early days of breastfeeding as mother and baby learn to breastfeed together. The highly sensitive skin of the nipple and areola helps the baby find the breast and signal milk release. But just as our heels and toes are vulnerable to damage from new or ill-fitting shoes our nipples are vulnerable to new or ill-fitted babies!
Most mothers will experience an element of discomfort or short-term pain when their baby is learning to attach well. Like anything, it takes practice to get it right every time. When a baby is consistently attaching incorrectly though, the delicate skin can be grazed or even split due to pressure, leading to sore or cracked nipples. With skilled help to help your baby take a good mouthful of breast tissue, the nipple is positioned further back and damage will not occur.
Thrush and other nipple infections
Damaged skin is at risk of infection from both fungus (known as thrush, due to the bug Candida albicans) or bacteria (due to the bug Staphylococcus aureus) or … both!
If you are reading this before you have your baby, try not to freak out! Not everyone experiences this.
Mothers who have damaged nipples that are not healing despite improved attachment should seek help from their doctor or IBCLC lactation consultant sooner rather than later. It is not normal to experience pain which makes you cry, avoid feeding your baby or hurts even when your baby is not at the breast. Women tend to use similar words to describe their pain when infection is present: stabbing, burning, sharp, itching, shooting … you get the picture!
It used to be presumed all patients presenting with “thrush” had a fungal infection. However, research showed a significant number also or actually had a bacterial infection. If your doctor is unfamiliar with this and treatment for candida doesn’t improve your symptoms then seeking a second opinion might be helpful. This fact sheet is a useful guide for management by health professionals:
Royal Women’s Hospital Clinical Guidelines Breast and Nipple Thrush
Mastitis and breast infections
Some breastfeeding mothers experience mastitis and/or blocked (plugged) milk ducts in their breasts. These usually occur if something has interfered with effective drainage of the breast during feeding or pumping. If you are sick or run down you can be prone to developing infection in the breast so it is important to be familiar with how your healthy breasts feel and look out for any signs something is different.
A blocked milk duct might feel like a distinctly firm or hard section of the breast. The most common part affected is near your armpit but blockages can appear in any lobe of the breast. There might be pain or redness or just a hard, full area. The breast might feel slight relief after feeding or expressing but not complete draining. Sometimes there might be a blockage at the very tip of the nipple, what is known as a white spot or milk bleb or blister. Here there is an overgrowth of skin tissue sealing the milk duct and preventing milk to flow. There are many ducts in each breast so milk will continue to flow to the baby during feeds even if one section is blocked.
Mastitis is an inflamed area of breast tissue. This might be after pressure or injury causes swelling or if a blocked duct puts pressure on surrounding tissue, having the same effect. Sometimes this might develop an infection, if bacteria has become involved. You can have mastitis without infection and without a blocked duct. And you can have a blocked duct without having mastitis. Because infection can be rapid when conditions are right, its a good idea to consult your doctor if basic management techniques don’t improve things quickly. A course of antibiotics might be prescribed even if measurable signs of infection aren’t present. Your body’s response to inflammation can be similar to that with infection. You might experience “flu-like symptoms” including aches and pain, fever and fatigue.
In the 20th century, doctors were taught to instruct women to cease breastfeeding immediately if they experienced mastitis. This often led to complications like severe infection and breast abscesses. Better knowledge about lactation led to a significant change in clinical management of mastitis and now we advice frequent and effective removal of milk from the breast by breastfeeding and/or expressing. Application of warmth can help a painful breast let-down the milk and cold after feeding or pumping can ease discomfort and reduce swelling. Although chilled cabbage leaves were popular in the past when gel cooling packs weren’t easily available, these are more hygienic and easier to keep on hand at home. Talk to your doctor or pharmacist about the best pain relief and rest as much as possible to help your body heal. Recurrent mastitis can be a problem for some women and an IBCLC lactation consultant can help identify potential triggers and create a personal management plan for you.
Mastitis where bacterial infection is present is effectively treated with antibiotics which are safe to use while breastfeeding. However, treatment of mother or baby with antibiotics can lead to infection on the nipples caused by thrush (due to the bug Candida albicans) so you might like to talk to your doctor about that possibility during your consultation.
Royal Women’s Hospital Clinical Guidelines - Mastitis and Breast Abscess
