-WHAT TO DO IF YOU NOTICE A BLOODY NIPPLE DISCHARGE
Although strange at first, often causing a great deal of anxiety to many women, it is really not uncommon to see blood in the breast milk. Various causes of bloody nipple discharge during breastfeeding are known, most of which are harmless and self limiting usually clearing within a few days. The color may vary from pink to bright red and to rusty brown but essentially, most will resolve completely within a few days. However, any bloody discharge lasting longer than a week, requires prompt attention by the doctor for further investigations and treatment.
RUSTY PIPE SYNDROME
Named as such due to the color of the milk that resembles water from an old rusty pipe, its color may however range from pink to orange-brown. Although it usually occurs during the first few days of breastfeeding, it can also occur in mid pregnancy being more common in first-time moms. It is a painless condition that usually involves both breast but may occasionally involve only one side. Although, quite easily missed, it is often times noticed while hand pumping the breast or when the baby spits up some discolored milk resulting in a sudden cause of anxiety for new moms.
During pregnancy, your breasts go through many changes to prepare for breastfeeding one of which is referred to as vascular engorgement. This refers to a great increase in the blood flow to the breasts as the milk ducts and the glands that produce breast milk grow and develop very rapidly. Some of this blood remains in the milk ducts and makes it way out during the first few days of breastfeeding. Typically cleared within a few days as milk production increases, it totally resolves within the first week of delivery.
This is the most common cause of blood in the breast milk. Commonly as a result of chaffed, damaged, sore or cracked nipples, they are often due to poor breast-feeding positions or wrong techniques of breast feeding.
BREAST OR NIPPLE TRAUMA
Direct injury and trauma to the breast by incorrect use of breast pump, excessive force during hand expression of breast milk, or damage from bra underwires, can result in broken capillaries which can cause leakage of blood into the milk ducts and then into the breast milk.
This refers to inflammation and or infection of the breast which can result in pain, swelling and bloody nipple discharge.
These are small benign or harmless tumors confined usually to one breast that grow in the milk ducts. They are minute and can’t be felt with the hands but may cause bleeding into the milk ducts and hence into the breast milk. These bleeding usually subside on their own, without any need for treatment.
Rarely, a bloody nipple discharge may be caused by a breast cancer.
WHAT TO DO IF YOU NOTICE A BLOODY NIPPLE DISCHARGE
What to do actually depends on the most likely cause of bloody nipple discharge in individual cases. While it’s always ok to contact your doctor right away if you are concerned, you may want to wait a few days to see if it clears up as that too is ok.
If presentation suggests a rusty pipe syndrome, no treatment is required as this normally goes off in a week. Meanwhile;
1. Continue to breastfeed or pump your breast milk for your baby if the blood is minimal and your baby can tolerate it. The blood is not dangerous for your baby and so you do not need to wait for it to clear. You may need to withhold breastfeeding if you have a disease or a condition that is contagious via blood.
2. Monitor your baby for vomiting, stomach upset or jaundice. If there is excessive bloody diarrhea in your baby’s poo, or a significant jaundice, please contact your doctor and discontinue breastfeeding. Pump the breast milk and wait for it to clear before recommencing breast feeding.
3. Keep an eye on the situation to be sure that it’s getting better and resolving on its own.
4. Call your doctor if the blood did not clear up within a few days.
For presentation suggestive of sore or cracked nipple, proper and appropriate breast feeding position will help in breaking the cycle of trauma. See BREASTFEEDIG; STEPS TO ACHIEVING A PROPER LATCH.
If you only see bleeding from one breast and or if there is no improvement after a few days and or you continue to see rusty colored breast milk or blood in your breast milk after a week, please contact your doctor. While Intra-ductal Papilloma is a benign tumor which disappears on its own, breast cancer is a malignant tumor that requires prompt treatment, luckily it is uncommon during lactation. For more information, please CHAT WITH OUR CONSULTANTS.
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Reference and further reading:
1. Lawrence RA. Breastfeeding: A Guide for the Medical Profession, 4th ed. St Louis: Mosby, 1994:473- 540. 5.
2. Virdi VS, Goraya JS, Khadwal A. Rusty-pipe syndrome. Indian Pediatr 2001;38:931-932. 7. Sakorafas GH. Nipple discharge: Current diagnostic and therapeutic ap
3. Cady, B, Steele, GD, Morrow, M, et al. Evaluation of Common Breast Problems: A Primer for Primary Care Providers; prepared by the Society of Surgical Oncology and the Commission on Cancer of the American College of Surgeons for the Centers for Disease Control and Prevention, Publication no. 633-001/20900, US Department of Health and Human Services, 1998. (Available online at: www.utmb.edu/Surgery/clerks/primer.htm) (Accessed on August 8, 2008).
5. American Academy of Pediatrics and the Americal College of Obstetrics and Gynecology. Breastfeeding Handbook for Physicians, Shanler, RJ (Eds), American Academy of Pediatrics, Elk Grove Villate, IL 2006.