A blocked milk duct or breastfeeding mastitis – how to tell the difference

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You can get a blocked milk duct when milk is not sufficiently removed from the breast. These hard lumps, also known as plugged milk ducts or clogged milk ducts, form in a woman’s breast’s narrow milk ducts.

Mastitis (breast infection) in breastfeeding women is often the result of a plugged milk duct. Often mastitis is so painful for the breastfeeding mother that she wants to stop breastfeeding altogether. About 20% of women from Western countries will develop mastitis.

This usually occurs in the first 2-3 weeks post-partum, but it can also happen later on, for example, when you start weaning. Mastitis can develop very suddenly, and most of the time, it affects just one of the breasts.

What does a blocked milk duct feel like?

A blocked milk duct is not the same as mastitis, but a blocked duct may become mastitis if not taken care of. How do you know you have a blocked duct or mastitis?

Symptoms of a blocked duct:

• The infected breast is tender or painful
• There may be swelling and redness in the area
• Sometimes you feel a lump in your breast
• The problem is local, only affects the breast
• Body temperature will not be higher than 101.37°F (38.5°C)

Symptoms of Mastitis:

• Pain, redness, and swelling
• Affects the whole system like with a bad flu
• Fever of 101.3°F (38.5°C) F or higher
• Will, most of the time, need treatment with antibiotics

Blocked milk duct causes

• Engorgement (This is the overfilling of the breasts with milk, which can be very painful)
• Inadequate milk removal. (incorrect positioning or latching on, anatomical problems of baby’s mouth, use of nipple shields.)
• Anything that puts pressure on the breast tissue (restrictive clothing, sleeping on your stomach, heavy diaper bag).
• Irregular or missed feedings. (Milk stasis is more likely to happen when you miss a feed). This often happens to women with a busy work schedule.
• Painful or cracked nipples (This can be very painful, and the mother stops feeding before her baby empties the breast.)
• When a baby has a sore mouth and refuses to drink. (This can happen when a new tooth is ready to erupt or with mouth thrush in babies.)

Mastitis causes

• A blocked duct and all the previously mentioned factors that can lead to blocked ducts.
• Nipple trauma allowing bacteria to enter the breast.
• If a mother is stressed, doesn’t sleep enough, and is not eating well, she has a higher risk of infections like mastitis.
• The mother’s hands can transfer bacteria when she is touching her nipples. Hand disinfection before breastfeeding has proven to reduce the chance of developing mastitis.

How to clear a blocked duct?

#1. Frequently nursing your baby in different positions is the most effective way to empty the swollen breasts and clear that blocked duct. Especially the position that is is shown on the right.

#2. By using a warm shower or a warm compress on the painful area. Massaging the breast with some coconut oil or essential oil helps too. Start to massage just before the painful spot towards the nipple. This will help to unblock the ducts so the milk can run freely.

#3. By using a breast pump if nursing is too painful. A breast pump can be useful to take off the pressure initially or empty the breast after nursing. Another possibility is manually expelling milk from the breast.

#4. When the breast is very painful, you can take a pain-relieving medicine like acetaminophen or ibuprofen. Or you can also apply an ice pack right after breastfeeding.

Mastitis treatment

The recommended treatment for mastitis is usually focused on clearing blocked ducts and engorgement. Frequent breastfeeding and varying the feeding position will help the milk flow in the affected area and clear the blocked milk duct. Always try to start feeding the baby on the affected side.

• As with a blocked duct, apply heat and massage before nursing. It also helps to lean over a big bowl with warm water and soak the breasts in their 3 times a day, preferably before nursing.
• Plenty of rest and fluid will boost your immune system.
• If a fever persists for more than 24 hours and you are very sick, you should contact a doctor because you may need a course of antibiotics to fight the infection.

Most breast infections are caused by the bacteria staphylococcus aureus and are treated with penicillins such as flucloxacillin and dicloxacillin. Treatment with antibiotics does not harm the baby, and breastfeeding can continue normally.

For some mothers, nursing is very painful at this stage. Though stopping breastfeeding at this point will increase your chance of developing a breast abscess, which may need surgical drainage.

How do you prevent mastitis?

• You can use a nipple cream to avoid irritation and cracks.
• Be careful when weaning your baby to do this gradually.
• Use different feeding positions. This will help to empty all areas of the breasts.
• Do not miss feedings.
• If more than 4 hours pass, express milk by hand or with a pump.

Do I need a breast pump?

A breast pump can be handy in certain situations when you are a breastfeeding mom. For example, to relieve engorgement and prevent mastitis. It also increases and maintains your milk supply or when you have to go back to work and want to continue breastfeeding.

I would recommend trying the Haakaa Breast Pump, a very affordable manual pump that is 100% food-grade, ever so simple to use, and fits in your diaper bag.

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Frequently asked questions

Getting help

While most health providers know the appropriate treatment for blocked milk ducts and mastitis, there are still doctors that may advise you not to feed on the infected breast or not to breastfeed at all. If given this advice, get a second opinion or contact a lactation consultant in the area.

Lactation consultants can be beneficial when you have breastfeeding difficulties, such as treating and preventing mastitis.

Do not put yourself at risk of complications and unnecessarily deprive your baby of all the nutritional and immunological benefits provided by breast milk.

References:

• Kellymom: Recurrent Mastitis or Plugged Ducts
• International Breastfeeding Center: Blocked Ducts and Mastitis