Infection by various organisms are fairly common causes of breast and nipple pain. Most of these are as a result of poorly managed minor causes of breast and nipple pain. Their presentation and management are discussed below and include;
This refers to the inflammation (soreness and redness) of the breast during lactation. Though common during the first six weeks of delivery, it can occur anytime during breast feeding. It is often divided into infected and non infected mastitis.
Infected mastitis refers to the inflammation of the breast tissue due to infection by organisms migrating from the breast skin into the breast tissue, e.g. following a cracked nipple.
Non infected mastitis refers to the inflammation of the breast tissue due to irritation caused by prolonged accumulation of milk in an unrelieved engorged breast or a plugged milk duct. Because, non infected mastitis will eventually become infected if the irritating milk in the engorged breast is not decongested on time, the management of both types of mastitis is essentially similar, except in the very early mild phase of a non infected mastitis that may resolve with non medical management.
This includes the onset of a firm, red, and tender area on the breast associated with fever, muscle aches and body pains.
Although usually treated with a course of an antibiotic, a mild case may get better by performing the following measures:
1. Before feeding, massage the breast gently; you may apply a warm fabric or take a warm shower to soothe and soften the breast.
2. Continue breast-feeding with the affected breast in other to empty and keep the milk flowing; not doind so will cause accumulation of milk which will worsen the infection.
3. If you are having trouble with breast feeding, learn how to achieve a proper latch; for tips on this, please see BREASTFEEDING; STEPS TO ACHIEVING A PROPER LATCH.
4. While feeding on the affected side to empty it first, be careful not to let the unaffected side become too full of milk; so remember to empty the other breast too.
5. If it is too painful to feed from the affected side, express the milk from that side with a breast pump.
6. Eat well, drink a lot of fluids and you may get more relief with the use of Paracetamol tablets; always confirm from your doctor before the use of any drug while breast feeding.
7. If atfer the above, the symptoms persist after two days or worsens, this may signify a more severe case of mastitis; kindly request for an urgent medical attention, so that a proper clinical assesment and investigations can be done.
1. Continue to feed from the affected breast so as to ensure continuous flow of milk and prevent worsening breast engorgement.
2. Feeding from an infected breast does not harm the baby.
3. Apply cold compress or ice packs to help soothe the pain.
4. If a breast-feeding baby refuses to feed from the affected breast because of a possible change in taste of the milk, feed from the other breast but remember to express the milk (that your baby has refused to take) from the affected breast completely so as to prevent breast engorgement which will further worsen the breast pain. Not expresing the milk can also result in reduced milk production and ejection following recovery.
1. Breast abscess
This refers to the collection of pus in an infected portion of the breast.
It usually presents as a firm, red, tender lump associated with fever and a general feeling of unwell usually more severe than that seen in mastitis. Although, diagnosis is usually clinical after a physical examination by your doctor, the pus can also be easily seen with an ultrasound scan.
This is by a combination of antibiotics and aspiration or sucking out of the pus with a needle and syringe, if the skin over the abscess is intact, or by an incision and drainage (I&D), if the skin over the abscess is broken. In the management of a breast abscess, antibiotics alone is usually not effective and the removal of the pus either by aspiration or incision and drainage is essential in complete resolution of the abscess.
While on antibiotic medication and following the surgical drainage of the pus, it is important that you avoid feeding the baby with the affected breast so as to avoid infecting the baby, unlike in mastitis where breast feeding is allowed, but express and discard the milk in other to avoid the development of breast engorgement.
This is a poorly understood and highly controversial cause of nipple pain in many women. It may present as a deep radiating breast pain associated with a burning nipple sensation in the absence of any sign of mastitis. Usually, the complained pain is out of proportion to any nipple damage seen. Diagnosis therefore, often relies on subjective signs and symptoms of the patient.
1, Breast pain out of proportion to any apparent cause
2, Pain following antibiotic treatment of either the mother or the baby in the absence of other causes of pain.
3, A history of vaginal yeast infections or an infant with a history of yeast infections such as thrush or diaper rash.
4, Shiny or flaky skin on the affected nipple.
5, Positive yeast test from skin scrapings from the nipple or areola or from the breast milk
Use of topical antifungal creams or gels to kill the yeast. Any remnant of the antifungal cream or gel on the nipple must be wiped off before each feed and reapplied after each feed.
Antifungal ointments contain paraffins which may be harmful to the infant and thus are contraindicated for use in breast feeding women.
Gentian violet 0.25% to 1% can be applied to the nipple and areola as well as the baby’s mouth if the baby too has oral thrush. Using it once a day for three to four days is usually enough to complete treatment, although it is a bit messy.
Oral antifungal tablets may be required and prescribed by your doctor if the above measures fail.
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