Blocked Milk Ducts, blebs and mastitis – what, why and how?
“What are blocked milk ducts?” I hear you say! Or, perhaps you’re here because you’re currently breastfeeding and have found a lump, pain or redness in your breast. It can feel really overwhelming and daunting knowing what to do to manage pain and/or breast lumps when breastfeeding! Hopefully by the end of this article you’ll have plenty of ideas of things to try.
Milk ducts are essentially tiny tubes running from our alveoli (milk producing, tiny balloon-like structures) to and through our nipples. Sometimes, milk ducts clog, causing the milk behind the blockage to build up. This milk build up can result in a lump, pain, engorgement (firmness) and redness, and if not treated, mastitis. So, why does this happen?
Blocked Milk Ducts, blebs and mastitis – The causes…
There are a variety of reasons milk ducts can get blocked, including (and possibly not limited to!):
- Latch and positioning not quite right – A well positioned baby will drain the breast, ‘flushing’ the milk ducts.
- Large gaps between feeds – These can result in engorgement and eventually blocked milk ducts.
- Pressure on or damage to the breasts – For some women, wearing a singlet or crop is enough pressure to cause blockages! A change in bra or clothing, sleeping on your tummy or damage to the breast can lead to blockages too.
- Damage to the nipple – Any cracks, grazes, scabs, bites and/or infections can prevent the milk flowing from the nipple.
- Difficulties getting a let down and/or stress – The let down is when breastmilk flows to your baby. Some mums experience a tingling or full feeling to their breasts, will feel really thirsty or have to take a big, deep breath. Others only notice the let down based on a change in baby’s sucking pattern (from suck-suck to the rhythmic suck-swallow) or milk flowing into a pump. Distracted babies and tense or stressed mums can inhibit the let down. You can stimulate this using warmth before and during the feed, gentle massage, focusing on baby (or photos of bub), taking big breaths, or focusing on letting the milk flow. More let downs = more chances to clear a blockage!
Other potential causes less often recognised
- Diet – Avoid eating lots of processed, fatty or sugary foods to help reduce inflammation in the body (and breasts).
- Run down mum – Some women notice being run down or not getting enough rest (laughable with a baby!) predisposes them to blockages.
- Vasospasm – Vasospasm is the sudden contraction of blood vessels. When it happens in our breasts it can restrict the flow of milk from the nipple causing (you guessed it!) a blockage. Using warmth before, during and after feeds, ensuring you’re in a warm space and away from a breeze/air conditioner can help reduce vasospasm.
Treatment of blocked milk ducts
Physical treatment options
There are lots of different options that work for different women, but the top 4 tend to be most commonly suggested:
- Feed, feed, feed – The more you feed/pump and get a let down (see tips above), the better to clear the duct.
- Warmth – Warmth on the breast before and during a feed or pumping can help!
- Massage (GENTLY) – Massage reduces breast pain. However, I suggest always go gently if you massage at all, and do so with the palm rather than fingertips.
- Position changes – Rotate baby so their chin is where the lump sits to help ‘massage’ the blockage out. However, rotating position at all, even if bub’s chin isn’t on the lump, potentially drains the breast slightly differently.
- Reduce the pressure – Any pressure on the breast from a top, crop bra or otherwise can inhibit drainage from the breast. I suggest sitting in your dressing gown and feed, feed, feed. Likewise, try not to sleep on your tummy or in positions with pressure on your breasts.
- Dangle feeding – As in the image on the left above, dangle feeding, using gravity, can help clear those milk ducts!
- Check baby’s latch (or your pump setup) – If bub isn’t latching well, or your pump isn’t quite right for you, this influences drainage. Give the ABA or an IBCLC a call, or contact me!
- Vibration and/or therapeutic ultrasound – ‘Vibrating’ the blockage (electric toothbrush, vibrator etc) can help break apart clogs. Therapeutic ultrasound apparently does this whilst also dilating milk ducts. Many women’s health physios offer therapeutic ultrasound.
- Five Step Systematic Therapy (FSST) – A therapy for treating blocked ducts involving laser therapy, pumping, massage, magnesium sulfate and education.
Other options (these are sometimes a little harder to arrange!)…
- Rest – Rest not just yourself (yes, go to bed!) but also your breasts! Constantly feeding and pumping can cause swelling, bruising and/or localised oedema in your breast tissue. So feed frequently and well, but give yourself breaks in between feeds to recover too.
- Eat well – Cut out the crap to reduce inflammation (I know it’s hard on no sleep!). Processed foods, dairy, sugar and gluten (and others) increase inflammation in the body.
- Acupuncture – In dairy cattle, acupuncture reduces the incidence of mastitis (and can increase milk supply). Low level research supports the same effect in women.
- Cabbage leaves! Or cold compresses – After the feed, using cold cabbage leaves or compresses helps reduce inflammation, pain and hardness of the breasts.
- Drink lots of water – Staying well hydrated is important, especially if you end up with a temperature or fever! So drink lots of water, often, to support your body.
- Myofascial release – This is one that isn’t often suggested, but can be SO amazing! I encourage you to give it a go! By releasing fascia restrictions the milk ducts are free to flow. For a discussion of these techniques from an Osteopath, check out this link!
Supplements and other things that might help…
The research is limited in this area. If there is a highlighted, linked item it’s because there is some research to support it. I include all methods I know of as anecdotes can be helpful too! Sometimes anecdotes are just responses that we dont yet have data to back up; worth keeping in your arsenal, ready.
- Lecithin – Many IBCLCs and women note that lecithin reduces the ‘stickiness’ of milk, helping it flow freely. There is no research to support it to my knowledge.
- Probiotics – This is a review on the research behind probiotic use for mastitis; we need more research. However, some studies report a correlation between probiotic use and reduction or prevention of mastitis. If you’re going down this route Lactobacillus fermentum and L. salivarius are the bacteria you need.
- Magnesium, calcium and Nifedipine – Magnesium, calcium and Nifedipine reduce the incidence of vasospasm, a causative factor for blockages (see above). There is no research on magnesium use for women without vasospasm, so it’s unknown whether it would help.
- Vitamin B6, Fish Oil and Nifedipine – These are again supplements or medications that can reduce the incidence of vasospasm, a causative factor for blockages.
- Ibuprofin – Ibuprofin reduces inflammation in the body (and breast tissue), reducing pressure on milk ducts. This can allow the milk to flow more easily.
- Magnesium sulfate soak – Magnesium sulfate (epsom salts) soaks supposedly reduce inflammation and get the milk flowing. Some research supports its use.
- Homeopathics – Many women swear by Belladonna, Phytolacca and Poke Root for relieving mastitis. I suggest speaking with a homeopath/herbalist directly.
What about recurring blocked milk ducts!?
Recurring blockages, regardless of the type, are painful and so upsetting! If you can’t find the cause and you’ve tried the ideas above, seek additional help. Please reach out to an International Board Certified Lactation Consultant for help or contact me for a lactation consult!
Mastitis? What is it? What do I do?
Mastitis is breast inflammation, not infection, though it can sometimes occur due to an infective agent (typically the bacteria, Staphylococcus aureus). The key difference between mastitis and a blocked milk duct is the systemic signs of illness, including:
- Headache or body aches
- Feeling ill
- Shivers/lack of temperature control
Mastitis caused by a blocked milk duct is treatable as described above, without antibiotics. However, if you find you’re struggling to treat the blockage and/or you’ve had systemic illness signs for 24 hours without improvement, it’s worth following up. Many GPs will prescribe antibiotics for mastitis. While sometimes useful, clearing the blockage is still necessary. The reason GPs are cautious and prescribe antibiotics is to avoid mastitis developing into a breast abscess. These are uncommon, but it’s worth being aware that they do occur sometimes, particularly when mastitis isn’t treated appropriately. Some GPs are really knowledgeable about breastfeeding and will give fantastic advice, but this isn’t the common experience. Please reach out to an International Board Certified Lactation Consultant for help or contact me for a lactation consult if you need.
What happens after I clear the blockage?
Just keep on feeding! Some women will notice a huge increase in milk supply and engorgement following blocked duct treatment. If this is the case for you, progressively cut back feeds/pumping until it is just as much as your baby needs. You can use cold cabbage leaves as noted above to help curb the milk supply and reduce any engorgement/inflammation too. I typically suggest listening to your breasts and pumping whenever you feel engorgement or lumpiness to the breasts.
Reach out for help!
If you need any help at all, please let me know! I have been assisting mums through issues, like blocked milk ducts for years, and will soon qualify as an IBCLC (I may already be one depending on when you read this!). Furthermore, I have personal experience with navigating the hurdles of recurring blocked milk ducts and mastitis. I’m here for you!
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Who am I?
Hello, I’m Aimee! I support women and their families through pregnancy, birth, postpartum and breastfeeding. I am a qualified and experienced Doula and breastfeeding counsellor, providing support in the Blue Mountains and surrounds. I’d love to meet you for an obligation free catch up! Contact me here.