Plugged ducts (or mastitis) are the main cause of breast pain for nursing mothers. Thankfully, many breastfeeding women never experience them, and others only go through these challenges once or twice. But for some women, they are ongoing and recurring.
Read more: Breastfeeding and pumping primer >
What’s a plugged duct? When one of the milk ducts becomes inflamed or constricted, milk can back up behind that point, causing swelling and discomfort, even pain if it isn’t resolved. After the milk has been backed up for awhile, it can become thicker (like toothpaste) and it becomes harder to get it flowing again. To the mother, this often feels like a tender lump in one part of the breast (or under the arm where the milk ducts extend).
In some cases, bacteria will grow in the backed-up milk (or bacteria may have caused the initial inflammation of the duct and then proliferated in the milk). Then the plugged duct can progress to mastitis.
With mastitis, the infected area of the breast becomes more swollen, looks red and often feels hot to the touch. The mother may feel feverish, nauseated and tired—like having the flu.
Not all cases of mastitis are related to plugged ducts, though. In some cases, bacteria gets into the breast through cracks or other damage to the nipple. If not treated, mastitis can sometimes turn into a breast abscess, which may need to be drained by your doctor.
That’s the technical side. Here’s what you can do to prevent and treat plugged ducts and mastitis:
1. Plugged ducts are often caused by pressure on some part of the breast that stops the milk from flowing through the duct. A poorly fitting bra (especially an underwire one), sleeping on your stomach, or a baby carrier with tight straps across your chest are things to watch out for.
2. Ducts can also get inflamed or plugged up when your breasts become too full because the milk isn’t being effectively removed. If you need to be separated from your baby, or if he suddenly sleeps all night without nursing, make sure you hand express or pump some milk to keep it flowing. This can also happen when you’re in the process of weaning your baby and is one reason that gradual weaning is usually recommended.
3. When you detect a plugged duct, encourage your baby to feed frequently on that side. Try different positions in case one is more effective in getting the milk to flow through that particular duct.
4. Use gentle massage or pressure on the part of the breast where the milk is backed up as the baby is nursing. Applying heat between feedings can also help. Taking over-the-counter anti-inflammatory medication may make you more comfortable and reduce the swelling.
5. Responding to a plugged duct quickly will help to prevent it from turning into mastitis.
6. If you have repeated plugged ducts, sometimes taking lecithin (a food supplement) can prevent them from returning. Also, see if there are ways you can get some extra help: being stressed and busy can be a risk factor for plugged ducts.
7. Some massage therapists are skilled at treating plugged ducts and reducing the risk of them returning.
8. If you have cracked or bleeding nipples, keep them clean to prevent infection. The best protection: your own milk, which has antiseptic properties. Express a little milk after each feeding, drip it onto your nipples, and let it dry there before putting on clean nursing pads. When you shower, use plain water on your breasts and nipples, then use milk on the nipples again.
9. If mastitis does develop, use the same strategies as with a plugged duct: keep the milk flowing, use gentle massage and pressure, try different positions and apply heat. Rest in bed as much as possible.
10. Even with mastitis, your milk is not harmful to the baby, and it will help you recover more quickly if you continue breastfeeding. Occasionally a baby won’t like the slight change in taste of the milk on the affected side. If that’s your baby, keep breastfeeding on the unaffected breast and pump the breast with mastitis, using heat and massage and hand expression to keep the milk flowing. (If you’re pumping, you may see some of the thickened milk come through, or you may see small amounts of pus or blood in the milk. These are not harmful to the baby.) You may need to supplement temporarily.
11. If the mastitis doesn’t improve or seems to be getting worse after 24 hours, see your doctor. You may need antibiotics. If the infection progresses to an abscess, your doctor may need to make an incision to drain it. You can continue breastfeeding while on antibiotics and after the abscess is drained.
While mastitis is not much fun while you have it (to put it mildly), recovery is usually quick – you’ll notice a big improvement within 24 hours of taking antibiotics. And, in most cases, you simply continue breastfeeding and the problem never returns. If it does become a recurring problem for you, talk to a breastfeeding expert such as a Lactation Consultant or LLL Leader who can help you sort out possible causes and solutions.