Plugged Ducts and Mastitis
A plugged or clogged milk duct usually feels like a hard, tender swelling in the breast which can vary in size from a pea to a peach and may feel painful while breastfeeding. The skin over the affected area may be red and the area around the plug may feel full even after a feeding. Sometimes a small whitish-yellow milk plug can be seen at the opening of a duct on the nipple. Plugged ducts occur when milk flow is restricted, or there is a delay in removal of milk from the breast resulting in poor drainage of the breast. Contributing factors may include:
- Missed or irregular feedings and/or an unusually long interval between feedings (a sudden long sleep stretch).
- Pressing the breast to provide nostril space for the baby.
- Wearing a tight or poorly fitting bra that impedes milk flow.
- Having an overabundant milk supply and insufficient breast drainage.
- A plugged nipple pore/nipple bleb (looks like a white head).
- Rapid weaning.
- Practicing vigorous upper arm exercise.
- Extreme exhaustion.
An untreated plugged duct can quickly lead to a painful bacterial infection in the breast called "mastitis." The suggestions below will hopefully help you clear the plug and avoid mastitis. If there is no change in your breast in two days or you begin to notice signs and symptoms of infection, notify your physician. Antibiotics may be indicated.
Treatment suggestions for a plugged duct; follow this plan every 2-3 hours until the plug is relieved:
First: Use moist heat and try to loosen the plug.
- Apply moist heat to the breast for 15-20 minutes prior to feeds, or take a hot shower allowing the hot water to pour over the affected breast. A warm compress can be easily made by pouring water into a paper diaper and heating it in the microwave.
Be careful not to burn yourself with an overheated compress.
- Massage the breast while in the shower or between compresses, pressing with your thumb from behind the plug toward the nipple. Also try "clearing a path" by massaging from the front edge of the plug toward the nipple.
- Use vibration over the plug. The handle of an electric tooth brush or any hand held massager will work
Second: Nurse the baby.
- Nurse more frequently than usual, every 2 to 3 hours.
- Do not miss any feedings.
- Make sure the baby is deeply latched (Info on Deep Latch Technique).
- Start each nursing on the affected breast. If using only one breast at a feeding, nurse on the side with the plug at each nursing and pump the other breast as frequently as you would have nursed on it.
- Pump the affected breast for 10-15 minutes after nursing. A hospital grade pump may be more effective especially if the baby does not nurse well or you cannot tolerate feedings
Additional Strategies to help relieve the plug:
- Vary nursing positions. Have the baby's nose or chin pointed toward the plug.
- If a plug appears at the nipple (looks like a cheesy whitehead), soak the breast in warm water and Epsom salts. Then place a cotton ball soaked in warm olive oil against the nipple bleb for 5 minutes to soften the plug. Gently rub the plug to remove the top layer of skin, and then try to force the plug out.
- Use gravity to help move the plug by nursing on all fours with the baby on pillows below you.
- Increase your fluid intake.
- Increase your intake of Vitamin C rich foods and juices (citrus, cantaloupe, strawberries, dark greens)
- A homeopathy remedy may be helpful: Phytolacca 30 C and Silicea 10 C
- Consider acupuncture/acupressure or Chinese herbology.
- Therapeutic ultrasound can be helpful in breaking up the blockage. One treatment is usually sufficient but occasionally a second visit is required. Dr, Jack Newman suggests that if two treatments on two consecutive days have not resolved the blockage, more treatments will not be effective and you should see your physician.
- Castor Oil compresses can relieve pain, reduce inflammation, and aid in removing persistent plugs (do not use on broken skin).
- Use a high-quality, cold-pressed Castor oil (available at Whole Foods).
- Take a flannel cloth sized to cover the plug. Fold three times for thickness.
- Saturate flannel with Castor oil and warm in microwave—beware of hot spots—wring it out so that it remains wet
but not dripping.
- Apply the cloth to the plugged area of the breast.
- Cover with Saran wrap and then apply heat (a hot cloth, heating pad, hot water bottle, etc.).
- Keep in place for 20 minutes.
- After treatment, rinse the breast so the baby does not ingest the castor oil, then pump or feed the baby while
massaging plug toward nipple.
- Repeat treatment 2-3 times a day. Plug often resolves within 24 hours.
- The flannel pack can be reused several times. Place it in a ziploc bag for future use. No need to wash—it can be used
as is. If it dries out, more castor oil can be added.
- For repeated plugged ducts, some women find that lecithin is helpful in lessening the liability of a reoccurrence. Soy lecithin
is a naturally occurring fatty acid. It is available in capsule or liquid form from health food stores and pharmacies.
The dose is 1 tablespoon, 3-4 times/day; or 1 capsule (1,200 milligrams each), 3 to 4 times/day
Mastitis: When Mastitis develops, the woman’s symptoms worsen. The plugged area of the breast becomes hot and the redness increases. The mother usually feels very sick and has a fever with body aches, chills and a headache, very similar to the flu.
Treatment suggestions for mastitis:
- Continue following the suggestions listed above for a plugged duct.
- Call your physician immediately and take the prescribed antibiotic for the duration required by your doctor. You should start to feel better within 24 to 48 hours. If not, call your doctor. He/she may want to change your medication.
- Mother and baby should both take probiotics while mother is taking antibiotics. Probiotics help maintain a healthy intestinal
flora and lessen the chance of developing a yeast infection.
- Most physicians agree that acetaminophen (Tylenol 650-1000 mg) and Ibuprofen (Advil or Motrin 400 mg) are helpful for
reducing pain, fever and inflammation. Try alternating these medications every 3 hours; for example: take acetaminophen at
6-12-6-12 o’clock and Ibuprofen at 3-9-3-9 o’clock.
Always check with your doctor before starting any medications.
- Because the breast is hard, hot and swollen, some babies struggle to latch on and become frustrated during feeding. If this
happens, pumping is a necessity. A hospital grade, electric breast pump is suggested and may be more comfortable than
breastfeeding. Other pumps might feel "jerky" and painful during this time.
- Mastitis can occasionally lead to a breast abscess. This is a pocket of pus that forms within the infected area of the breast.
Abscess formation is actually the body’s defenses at work to localize an infection and keep it from spreading.
Let your physician know if the lump in your breast does not go away, even if your other symptoms are improving.
Copyright© 2001 by The Pump Station & Nurtury™. All rights reserved. No part of this handout may be reproduced or transmitted in
any form or by any means, electronic or mechanical, including photocopy, without permission in writing from The Pump Station &
Nurtury™. This article has not been prepared by a physician, is not intended as medical advice, and is not a substitute for regular
medical care. Consult with a physician if medical symptoms or problems occur. (Revised April, 2012)
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