What is a Plugged or Blocked Milk Duct, and how does it feel?
A plugged milk duct (also called a clogged or blocked 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 (bleb) 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, poorly fitting, or underwire 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 tips below will hopefully help you clear the plug and avoid the onset of mastitis. If there is no change in your breast in two days, or you begin to notice signs and symptoms of infection, notify your obstetrician. 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. Our Lactation Experts also recommend Earth Mama Booby Tubes to safely deliver warm, moist heat.
Massage the breast while in the shower or between compresses, pressing with your thumb from behind the plug toward the nipple. Also try "clearing the path" by massaging from the front edge of the plug toward the nipple.
Use vibration over the plug. A personal vibrator or massager provides more vibration than the handle of an electric toothbrush. If the electric tooth brush is your only available tool - use it.
Second: Nurse your baby
Nurse more frequently than usual, at least every 2-3 hours. Do not miss any feedings. Make sure the baby is deeply latched. Our lactation experts recommend Luna Lullaby Nursing Pillow & The Pump Station's own Back Pillow to get your little one in the proper position and make the latch on process easier. 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 like The Medela Symphony (usually available for rental) may be more effective than your personal breast pump, 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 bleb/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 massage the plug out.
- Use gravity to help move the bleb/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 homeopathic 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 or more is required. Dr. Jack Newman of the International Breastfeeding Centre 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 also relieve pain, reduce inflammation, and aid in removing persistent plugs (do not use on broken skin):
- Use a high-quality, cold-pressed Castor oil.
- 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 plastic 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 re-occurrence. Sunflower lecithin is a naturally occurring fatty acid. It is available in capsule or liquid form at The Pump Station, 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.
MastitisWhen 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.