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nipple thrush | nipple bleb | nipple vasospasm

Nipple pain is not normal

Too many women put up with nipple pain when breastfeeding or breast pain thinking it’s just part of the journey. Unfortunately, this can result in a want to end breastfeeding due to the ongoing nipple or breast discomfort. Nipple or breast pain should always be investigated to determine why there is an issue. Nipple pain while breastfeeding can result from several factors including poor latching, biting from the baby, and potentially nipple vasospasm. We can also see conditions like thrush and infection on the nipple which is also very painful.  

Regarding breast and nipple pain, you don’t need to be breastfeeding to experience it! The pain can be related to breastfeeding conditions such as mastitis, blockages, blebs or engorgement. However, when we have breast or nipple pain we also must consider if the pain is referred pain, where the cause of the problem is somewhere else in the body. As the nerve supply comes from T4, we might even look there to see there’s something going on.  

Nipple Pain Causes

A number of conditions can affect the nipple which can cause a mama to stop breastfeeding. You may experience burning pain, sharp-shooting pain, bleeding and even pus coming from the nipple. Some conditions can be so intense and ongoing that you may feel like you want to stop breastfeeding altogether. the important thing here is to work out the exact cause of the pain. Latching of the baby if first-and foremost for direct breast feeders, whereas pumpers will really want to check they have the right flange size for their breast to reduce unnecessary trauma.

Nipple blebs 

Nipple blebs are a common issue during breastfeeding. They are simply put a milk blister. Essentially there is a bit of skin at the surface of the nipple that is blocking the exit of the milk duct.  

They tend to look like small white dots on the nipple, you may notice after a feed or pumping session it looks even whiter than before. This is because as the baby or pump is sucking it’s drawing more of that milk to the surface.  

There are a couple of tricks you can use to try and open the bleb and remove that blockage in the pathway. You might like to try: 

  • Soaking the nipple in some salt water 
  • Warm compresses 
  • Gently brushing the nipple with a towel or facewasher 
  • Rubbing olive oil into the nipple to soften the skin  

If all else fails, you can book an appointment with a medical professional to get their help in removing the bleb.  

Nipple thrush 

Nipple thrush is a fungal infection caused by Candida albicans. Thrush itself, is a common condition that can happen in multiple areas of the body. It can be extremely painful and if you’re trying to breastfeed or pump that can make it a real struggle to deal with.  

What you might experience if you have nipple thrush is:

  • An intense burning like pain of the nipple(s), you might have tried different techniques to get a better latch and avoid the pain but this usually doesn’t give much relief.  
  • The colour of your nipple may change, look for bright pink or red changes. The skin may also change in look becoming shinier or dry and flaky.  

If you have a thrush infection while breastfeeding, it’s likely your baby will also have an infection. Typically, you can see this as a white film or patches in and around the mouth, but they can also get thrush on their buttocks where you may see nappy rash that isn’t improving.  

As it’s a fungal infection, thrush needs to be treated with antifungals. There are creams that can be applied or oral medications. Keeping up with nipple care during this time is also important, changing out breast pads often and cleaning any surfaces that are coming into contact with your nipple(s) or your baby’s mouth.  

Bacterial infection of the nipple 

Similarly to how you can get a fungal infection of the nipple, you can also get a bacterial infection.  

A bacterial infection can look and feel fairly similar to thrush with burning, sharp, stabbing pains of the nipple. You may also notice skin colour changes like redness. Lastly something else to look for is changes to the skin itself, cracks and sores that may or may not be weeping with pus-like fluid can also be present.  

The treatment for a bacterial infection requires antibiotics, which unfortunately does mean a trip to the doctor. They can prescribe antibiotic creams or oral medications to help treat your infection. 

Nipple vasospasm 

Nipple vasospasm or Raynaud’s phenomenon of the nipple is where the blood flow to the nipple is restricted due to the constriction of the blood vessels. It can be something that happens due to issues with latching, but it can also be unrelated and occur at random. 

What does nipple vasospasm feel and look like? 

What it feels like can range for everyone who experiences it. For some, nipple vasospasm can be extremely painful and can last a few minutes. For others it might only be some minor pain or discomfort that can resolve in a matter of seconds. You may be somewhere in the middle of the spectrum too. While the attack is happening one thing to look for may be a change in the colour of your nipple. As the blood flow is restricted, you might notice some whiteness or blotchiness in the colour of you nipple. In some cases, the colour may deepen turning a red or purple tone.  

What you can try 

Unfortunately, there’s not a lot of advice out there! If you’re struggling, look for what triggers your episodes. A common one is the cold so keeping your nipples warm is a good place to start, and if it’s a latching issue perhaps it’s a good time to adjust and get advice on your technique. You might even consider things like massage as this can stimulate blood flow.  

Eczema and dermatitis of the nipple 

Common conditions like eczema and contact or allergic dermatitis can also happen at the nipple and areola . If you’ve already had a skin condition like eczema or dermatitis before – even elsewhere on the body – you are more likely to get a reaction on your nipple.  

Treatment for these sorts of skin conditions on the nipple typically comes in the form of topical creams. You might also like to try finding your triggers, for example changing soaps, detergents or other products that come into contact with your nipple.  

What do I do if I notice blood in my breast milk?  

Blood in breast milk occurs more commonly than you would think. It can present as a pink, bright red or a brown colour tinting the milk. There are several reasons it may occur. The simplest reason is damage to the nipple which causes surface bleeding and therefore may be seen in the milk during feeding or pumping. Another reason it can happen is due to mastitis, which you can read more about HERE. If you do notice blood in your breast milk, you can usually continue to feed as normal. If you’re worried, it’s always best to seek advice from a health professional. 

Blood-stained colostrum or milk in the first days after giving birth is also commonly noticed. This is referred to as ‘rusty pipe syndrome’ and is thought to be as a result of the growth of the ducts and milk-making cells in the breast but usually doesn’t persist past 7 days after birth. 

A less common condition that we have also seen in clinic that can cause blood in breast milk is an intraductal papilloma. This is a small benign wart-like growth on the lining of a milk duct, that bleeds. This not breast cancer and usually resolves in a few days. It is still a good idea to see a medical adviser to get this checked out. 

Attachment problems and nipple pain or damage 

A common trend in the conditions we talked about above is how a latching problem during breastfeeding can lead to nipple pain. Bubs is spending a lot of time at the breast while feeding, and if there’s an issue which latch it’s no wonder we see an increase in nipple pain. If bubs can’t manage to get a good latch, not only are they potentially going to have to work harder for the milk, but your nipple is also going to get compressed, irritated, and potentially damaged!  

Seeing a health professional in the case is going to be very helpful in finding a solution that works for you and bub. It might be a simple fix of how you hold them. If not, you’ll have someone to help you get to the bottom of the issue, it might also be a good idea to have bubs assessed for tongue or lip ties as this can lead to breastfeeding problems.  

Nipple pain with pumping  

Nipple pain due to poor attachment is not exclusive to breastfeeding parents, it can also happen in those that choose to express. In the same fashion, it’s a good idea to assess the fit of your pump with your breast. A good place to start might be the flange – is it comfortable, does it pull, hurt, or compress the nipple? You could also ask yourself how the setting feel, adjusting the strength of the sucking motion might be needed.  

Can nipple damage cause mastitis 

If you do have nipple damage, you may be wondering what this means for you while breastfeeding. Rest assured you can still breastfeed as normal. Something you may need to be more aware of though is that your risk for mastitis may be increased.  

The nature of nipple damage is that there is an opening of the breast tissue to the outside world that normally wouldn’t be there. This is a gateway for bacteria to get into the breast and cause mastitis.  

Something else you may want to consider is if due to your nipple pain and damage you’ve adjust how and when you breastfeed or pump. If it’s different to normal, perhaps you’re not draining the breast as well. This can lead to blockages which can progress to mastitis if not addressed.  

Nipple care tips! 

If you’re having nipple pain at the moment or if you want to try and prevent nipple pain here are some tips you might like to try! 

  • Be gentle, your nipples especially when breastfeeding are sensitive. Use soaps sparingly and be gentle when drying.  
  • If you are using breast pads change them regularly. Moist areas are where bacteria and fungus thrive, keeping your nipples dry is a great way to minimise your risk of infection.  
  • You might like to try topical creams for damaged or cracked nipples, your local pharmacy will be able to help you in finding the right one for you!  
  • Cooling pads; when we have red, hot, inflamed nipples sometimes a cool pack is just the right thing we need, you can find gel ones or you might even use a cold facewasher.  
  • If you’re worried, get it checked out. There’s never any harm in getting a professional opinion. If something feels not quite right its best to get some help! 

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