Engorgement and mastitis are both complications to do with breastfeeding. Firstly, there are 2 types of engorgement that will be described below. But the overall picture of engorgement is this: it presents as painful, large, and overall swollen breasts on both sides. You may notice that the engorgement has scattered shiny red areas, with the surrounding skin lacking the normal bounce when your press on it . It almost feels like a stretched-out balloon. You may also find that the milk is not flowing easily or even find difficulty in latching the infant onto the breast to suckle, due to the swelling as they baby will struggle to get their mouth around the areola. Although early engorgement can cause feelings of fullness, it is not to be confused with full breasts. Full breasts present as heavy and hard, as well as easy flowing milk, with the infant able to latch on and suckle with no troubles. A slight fever may also be present with early post-partum engorgement, but usually presents without accompanying symptoms and subsides within 24 hours. However, there are two types of engorgement that can occur, physiological and pathological. Let’s look into each of them now.
Physiological engorgement can occur when the milk first comes in, between two- and six-days post-partum. Which is when there is a substantial influx of blood and lymph fluid (active tissue fluid), as well as production of of milk supply to your breast, more than what the baby can drink. As a result, pressure in the milk-making lobes (of which there are 15-25 in each breast) and milk ducts increase, resulting in painful swelling, hardness, and even taut, flattened nipples. If left untreated, it can lead to latching issues or mastitis.
Pathological engorgement can occur anytime during breast-feeding. It is when there is too much milk in the breast and is swollen, but only from the milk. If left undrained, it can lead to mastitis due to the pressure in the system, & may decrease in milk supply due the effects of supply & demand.
Now that we know a little bit about engorgement, let’s introduce you to some details of how it differs from mastitis, where you may even notice similarities, however symptoms definitely progress with mastitis to another level. Mastitis occurs mainly because of milk stasis and that can be for many reasons (describe in this blog HERE). It’s important to realise that engorgement will ALWAYS affect the whole breast and not parts (whether physiological or pathological) whereas mastitis tends to affect sections of one or both breasts.
Unlike engorgement, mastitis can also occur from nipple pain and damage, leaving an opening for bacteria to enter and progress into an mastitis infection, whereas engorgement is never an infection despite the potential for mild fever. Mastitis can also cause a change in how the milk tastes, which does not occur in engorgement, and may be a flavour deterrent for the baby due to an increase in saltiness. Another similarity to note is that you may notice your breasts feeling painful, swollen and firm, with the addition of having dry or flaky raised skin with localized redness that feels hot and warm. However all of these symptoms are much more severe with mastitis.
It is also important to note that accompanying symptoms of fever can occur in both engorgement and mastitis but once again the fever of mastitis is much higher, whereas engorgement is just a mild rise. Mastitis also has symptoms of chills, aches, and overall malaise that can last days, which doesn’t occur in engorgement.
Although mastitis may occur in both breasts at the same time, early stage (physiological) engorgement always affects both breasts. Pathological engorgement however may only affect one breast, or both simply because it hasn’t been drained and is subsequently overfull.
Now that we have laid out the differences and points of similarities between engorgement and mastitis, you’re probably asking, what do we DO about it? We at Melbourne Mastitis Clinic provide hands-on therapeutic treatment for mastitis, engorgement and blocked ducts which we accompany with giving you self-care techniques and advice, to equip you to continue managing symptoms at home. Depending on what the problem is, depends on what techniques and strategies we use to drain the fluid whether it be lymph, milk or improving blood flow of the breast.
If this sounds like something you need, you can book online via the button below, to come visit us. And if you’re from a different state or live overseas, we now offer virtual consults as well to guide you along your breast-feeding journey.