Breast pain is one of the most common reasons women wean before they had planned. Most of the time, however, breast pain caused by plugged ducts is a temporary event that can be quickly treated for more comfortable feedings and a continued breastfeeding relationship.
What is a plugged duct?
When milk cannot flow from a duct - due to a clog either at the nipple or further back in the breast - a lump can form. This typically causes tenderness, swelling, redness and warmth to touch in the area around the plugged duct. It is typical that only one breast is affected, and the discomfort usually begins gradually. Feeding may make the breast feel more comfortable, but then pain returns as the breast fills again for the next feeding.
What causes plugged ducts?
When milk is not being effectively removed from the breast, it can build up in a particular duct, causing a blockage. This ineffective emptying may be due to:
- prolonged engorgement
- poor latch
- weak suck
- tongue tie
- sleepy baby
- nipple shield use
- limiting feeding length
- scheduled feedings
- skipped feedings or sudden weaning
- baby sleeping longer
- returning to work
- inefficient pumping
If you have nipple damage from a poor latch, your risk of a plugged duct is increased. A milk blister or bleb covering a nipple pore can also cause this problem.
Other outside causes for plugged duct include any pressure on milk ducts from a tight bra or clothing, seat belts, purse or diaper bag straps, or even sleeping on your stomach (which compresses your breasts). Sometimes the way you hold your breast can cause your fingers to keep a duct from emptying adequately.
If you’ve been ill, are extremely fatigued or stressed, or have a bacterial or fungal infection, your risk of a plugged duct is increased.
Treating plugged ducts
The most important treatment is to keep milk flowing. Nurse (or pump) as frequently as possible – aim for every 2 hours. Don’t stop feeding on the affected side. Attempt to nurse on the side with the plugged duct first since your baby’s suck will be strongest when they are most hungry. If it’s too painful to nurse, be sure you are pumping regularly.
If your baby has started sleeping through the night, you may need to wake to pump at least once during the night to avoid engorgement.
Use positioning to your advantage. Your baby’s suck is strongest in line with their nose and chin. If you can comfortably position your baby’s chin toward the plugged duct, their strong suction may dislodge the plug. Try ‘dangle feeding’ – kneel on your hands and knees with baby underneath you, allowing gravity to help.
Massage the affected area. Gently rub the plugged duct before feeding. As your baby is nursing or you are pumping, massage toward the areola and nipple. Some mothers find that a vibrating massager or the back of an electric toothbrush held against the plugged duct helps to break it up a little.
Use a heating pad or a warm, wet washcloth on the breast before feeding, pumping or massaging. This can get milk flowing, and may improve your comfort level. Get in a hot shower and allow the water to spray over your breasts while massaging them to loosen the blockage. Some mothers have found that soaking the breasts in a basin of hot water helps.
Be sure you are getting enough rest. Tuck yourself into bed and do nothing but nurse, nurse, nurse. Get help with childcare and household tasks until you are feeling better. Eat well and stay hydrated.
Don’t be alarmed if your breastmilk looks stringy when you express milk (or if your baby spits out a stringy portion of milk). This is the actual dried milk secretion that was blocking the duct.
Are there complications to watch for with plugged ducts?
Sometimes a plugged duct will progress to a breast infection, called mastitis. If you develop a fever during treatment or the pain increases, speak to your healthcare provider about antibiotics for the infection.
You may notice a dip in your milk supply (or the amount you can pump). This is only temporary. Once the plugged duct is resolved, try to add extra feeding or pumping sessions to give your supply a boost.
It’s not uncommon for the area where the plugged duct was to feel bruised as it heals. It may also continue to look red. This can last a week or so, but should eventually go away.
How can I prevent plugged ducts?
The best prevention for plugged ducts is feeding your baby ‘on demand.’ Frequent feedings will keep milk flowing. Be sure that you are positioning your baby well and that they are latched deeply onto the breast so that they can transfer milk well and won’t cause nipple damage.
Treat any problems promptly. If feedings are painful or you have broken skin on your nipples, get help with positioning and latch. If you have oversupply or prolonged engorgement, work with a lactation consultant to help regulate your supply. If you have a plugged duct, start the feeding-warmth-massage-rest regimen as soon as possible.
If you have persistent, recurrent plugged ducts, you may want to consider taking the food emulsifier, lecithin. You may be able to find lecithin in capsule form or as a powder that can be mixed with food.
Pay attention to your clothing. If you can, go bra-free during treatment, or wear the loosest bra that is supportive for you. Make sure no other clothing or accessories are pressing on your breast.
If you are pumping regularly, make sure you are pumping often enough and using the right sized flange for your nipple size. This will maximise milk removal. Are you using a hands-free bra that might be putting pressure on certain milk ducts? Or perhaps you are pressing the flanges against the breast to keep them in place. These can both lead to plugged ducts.