Causes of Breastfeeding Pain or Discomfort

November 21, 2009

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Causes of Breastfeeding Pain or Discomfort

by Laura Jana, M.D., F.A.A.P.
reviewed and revised by Marjorie Greenfield, M.D.

Uterine cramping
Engorgement
Blocked duct
Breast abcesses

Uterine cramping
Some women experience cramping each time they nurse for the first week or so. This cramping occurs because the same hormone that stimulates milk to be released from the breast (known as oxytocin) also causes uterine contractions. In general, these cramps are most intense (if they occur at all) in the first couple of days after delivery and can often be treated effectively with over the counter pain medications such as ibuprofen (Motrin®, Advil®).

Engorgement
As your milk "comes in" during the first week of nursing, you may experience a feeling of fullness in your breasts. This is caused not only by an increase in the volume of milk being produced, but also by an increased blood flow to your breasts and some tissue swelling. While for some women this causes only moderate fullness, others become engorged. Engorgement can be uncomfortable and in some cases painful, but generally only lasts a few days.

You can help relieve some pressure and discomfort by nursing frequently, at least every two hours
If your baby has difficulty latching on because your breasts are full and tense, try taking a warm shower or using a warm compress and expressing some milk to soften the breast before nursing. Do not hesitate to seek professional help if your baby continues to have difficulty feeding
Only express as much breast milk as is necessary to relieve the pressure and pain. Overexpressing or pumping large amounts of milk can actually send your body the message to continue overproducing and can exaggerate the engorgement
Ice packs or cool cabbage leaves placed against the breast between feedings can help reduce swelling
Massaging the engorged breast can often offer relief. Focus on gently "kneading" any particular areas with the palm of your hand. This often is offers the most relief when done in the shower
Wear a bra that offers good support but that is not too tight

Blocked duct
Blocked ducts develop when milk is prevented from passing thru the ducts to the nipple. This problem can occur any time during the period when you are breastfeeding. Pain is generally localized to one particular area of the breast and there is often a reddened area of the breast over a distinctly tender lump. When milk is blocked from draining, it is more likely to become infected. Blocked ducts should be treated promptly:

As with engorgement, breast feed more frequently, apply warm compresses before feeding, make sure your bra is not too tight, and massage the sore area
Have your baby nurse on the sore breast first. If possible, position her so that her chin is over the side of the breast that is painful, as this will be where the most "suction" is applied. In general, switch feeding positions from one feeding to the next so that milk is "extracted" more evenly from many areas of the breast
Consult your doctor if you have fever or worsening pain, are unable to breastfeed, or if the lump and/or pain is not improving over 1-3 days. Also seek advice if you are repeatedly experiencing blocked ducts

Mastitis and breast abcess
These infections of the breast can be quite painful. They can involve the entire breast or just a portion of the breast tissue. They can occur as a complication of a localized infection of the breast or appear without any preceeding problems. It is important for you to be aware of mastitis, since its early signs may not always be localized to the breast(s) and can mislead nursing mothers to think that they have the flu. Quite often, mastitis is accompanied by headache, flu-like achy symptoms, and fever in addition to the more expected breast redness and tenderness (which may not show up for a day or two).

Seek medical advice if you suspect mastitis, since antibiotics can help resolve your symptoms within thirty-six to forty-eight hours
If tolerable, have your baby nurse frequently and on the sore side first. The infection does not pose a risk to your baby, and nursing along with warm compresses can help to clear the infection more quickly. If your baby does not like the taste of the breast milk (because it can be saltier than usual), then continue to express or pump milk frequently
Do not use ice packs
Do not stop breastfeeding suddenly, as this can lead to a walled-off infection in your breast (breast abcess)


RELATED INFORMATION

			Breastfeeding: Sore or Cracked Nipples
			Breastfeeding: Problems

Created May 25, 2000
Reviewed and revised September 18, 2004

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