Breastfeeding Issues: Cracked Nipples, Clogged Ducts, and Mastitis | Kristen Sorondo, RN, IBCLC
Thanks for tuning in to this episode of MomTalks with Christa. We have Kristen Sorondo back today who is a lactation consultant from Florida. And each month we've been covering all kinds of topics to help you out in your breastfeeding journey and so on from that, and so today we're talking all about issues you might come across in your breastfeeding journey. So today we're talking about cracked nipples, clogged ducts and mastitis. So excited to dive right in. Thanks for coming back. Kristen.
Kristen: Hi, everybody. Thanks for having me. I am Kristen Sorondo, lactation consultant out of Orlando, Florida. And the company's name is Orlando Lactation.
Christa: So first question is should there ever be nipple pain when breastfeeding? And how can you tell if it's something that needs to be addressed.
Kristen: So we've been talking all about the normal for over the last several months, but really wanted to tone into a lot of the abnormal things that would be happening at home, because that's really when we know if there is something going on? That's not correct. So when we talk about nipple pain, you might have some tenderness and just generalized tenderness because you're not used to having somebody stuck on you 8, 10, 12 times a day or being pumping like that, you're just not used to having that stimulation. So maybe just some generalized tenderness, soreness, just from all this stimulation is normal and to be expected, what we don't want is pain, discomfort, toe curling uncomfortable, you're sweating, you're dreading your next breastfeeding session. Any of that would be abnormal. So there's a few different things that you know, let me know pretty much right off the bat, that the baby is not latching properly, maybe you're not having a great position and return that causes the baby to not latch on adequately. And that's usually in the beginning. Usually in your breastfeeding journey. As you go on, you're really not going to have any of that discomfort anymore. So if you're having it in the beginning, it's usually positioning in a latching issue. However, everything's going really well and all of a sudden, you start to have pain or discomfort, then that's really when we look at, you know, possibly do you have an infection as a blood bleb or a blister or milk clogs behind one of the pores of the nipples? Usually that would be what you're looking at, at that time frame if it's not within the initial first couple of days. So to answer your question, should you have pain with seating at any time? And the answer is no, if you are having pain with feeding you or baby or both are not doing something properly, and definitely would want to seek out some professional help because we don't want your breast journey to be painful.
Christa: So when it comes to correct nipples, a lot of moms said that you know, happened to them, or they're currently going through it. So what are the best ways to deal with cracked nipples?
Kristen: So again, cracked nipples, very similar to pain or discomfort, really should not be having it. If you're having it, again, lets me know that baby's not latching properly, mom's not doing something right. Or if you're pumping, that you're not using the proper flange sizes. Okay, so when you guys are pumping, and we've talked about this in our pumping videos, they do come in different sizes, so you want to make sure you've been properly fitted because if you're using too big of a flange, the Ariel is actually going to be drawing in, which can cause a lot of cracking at the base of the nipple or around the areola. If you're using a size that's too small, you're going to have a lot of crack cracking, rubbing kind of like chasing in the middle or to the tip of the nipple. So again, it's not normal. So you want to make sure that you reach out and people say, Well, what can I do for? Well, the biggest thing is to determine what the culprit is the when we're looking at the flange sizes. If it's too small, you're going to have a lot of rubbing and chafing there at the tip of the nipple along the sides. Using products to help with discomfort definitely will help ease some of that pain that you're having. However, we're just putting a band aid on the bigger problem. So you want to make sure that If you are having soreness, cracks, bleeding, blisters, anything like that, that you're actually getting help to find out specifically what's going on, and in return, that will help decrease your pain, it'll decrease all that cracking. So things that you can do, tons of over counter different types of products, nipple creams from nipple butters to lanolin to any different types of products. Pretty much all of them are bees wax based or based from, like an olive oil or petroleum jelly, you want to be really careful with lanolin is made from sheep's wool. So if you have sensitivity to sweaters, animals, different things like that with a lanolin cream, I recommend just putting it on the inside of your arm, and testing it out for a day or so before you put it on your aerial or your nipples. Okay, so any of those type of nipple creams will help relieve just some of that natural discomfort that you're having making sure that you find the culprit. There are a couple of other different products, they have breast shells or now the big thing on the market are these little silver cups that go over the nipples. Basically what those are dealing is really providing a barrier between the nipple and your clothing or your bra to prevent anything from rubbing against it. If you don't want to go down that rabbit hole of buying a bunch of different products, one of the best things that you can do is just leave your breasts open to the air in between feedings if you have that availability to prevent anything from rubbing it but also the oxygen from the air will help kind of heal some of that discomfort as well. They make gel, these really great gel products to where you can put them on top of your nipple. And basically what those are, is you can get them in different companies make different ones but they're all like a gel base. You can get them cold in the refrigerator or the freezer. And then after you get done feeding you can put that on top of your nipple again that coldness will take that like burning stinging sensation out of the nipple, but also the coldness just really provides moms with a lot of comfort. And then again, it provides something over top of the nipples to where the nipples not actually rubbing against your clothes or a bra if you have an on when that coldness wears off. You can take those off, put them back in the refrigerator the freezer and then that's when you can use whatever type of nipple cream that you want. My go to nipple cream is all purpose nipple ointment it is expensive. It's prescription based you can get it at a compounding pharmacy, which is the downfall, a lot of people don't have compounding pharmacies. So the easy thing is just to make it yourself so if you just Google all-purpose nipple ointment, it'll tell you what is actually made up and you can just go to the pharmacy, a Walgreens, whatever next to you and buy the ingredients and mix it yourself and use that. It has different things in it that will help anytime you have cracked nipples, you are at increased risk for other things which we'll talk about like mastitis or thrush if you have a yeast infection so the all-purpose nipple ointment has different ingredients to kind of help all of that it has cream in it to help with yeast something to help decrease the swelling it has a steroid and then it has your antibiotic ointment. So when you mix all three of those together it definitely helps more with the healing aspect than just a comfort measure and that will help long term, prevent some of those other things.
Christa: You said a lot of the reason that there's cracked nipples is because of latching issues, so do you recommend like after that kind of treat it but then also like make an appointment or kind of figure out where the issue is coming from so they don't keep getting the cracked nipples?
Kristen: You're going to kind of be doing it in collaboration together. So say if you know, oh my gosh it was the middle of the night I turned the pump on the wrong setting and all of a sudden I got a huge crack and you know it was from that, then probably not needing to reach out to somebody or say the baby didn't latch great that first one or two times in the hospital and you have some damage but is doing great now then not necessarily but if you're consistently every time you're feeding, you're having pain or discomfort the area's not healing with what you're doing then absolutely. And I'll tell moms a good analogy is think about if you were to suck on your arm, or if you've ever had a hickey one good suck tug or pull, pops those blood vessels. So think about a baby actually feeding for 10, 15, 20 minutes not doing it properly, and all the damage it will do to the breast tissue and unfortunately that one feeding could take two or three days to get the nipple to heal just for one. So it could just be just one time and you had a bad latch. But overall things are going well and you're not having any problems. But if you are consistently having a lot of soreness, cracking, any type of issues, you're going to be treating it but while you're treating it, you're going to go ahead and reach out to somebody and let them know this is what's going on. And your kind of doing those interventions until you can meet up with somebody to kind of figure out ultimately, what's the culprit of the situation, what's been causing it to begin with?
Christa: So now we're going to kind of talk about clogged ducts meet a lot of questions about these two. So first things first, are milk blebs and blisters the same thing as clogged ducts. And if not, what's kind of the category or what makes them different.
Kristen: So a clogged duct is actually inside of the breast tissue. Okay, so a great analogy that I like to use is think about, you have a bunch of straws in the breast, and the straws are very, very small, like smaller than coffee straws, okay? If you are wearing a tight bra, or you lay on that side, or you're pumping, and you're squishing your flanges into the breast tissue, and you can actually see a circle from where you've been pumping, you're pressing in too hard. So what will happen is you just put a little tiny kink in that coffee straw. And what happens is you're stimulating, but nothing's able to come out because you're kinking it and what will happen is behind that you can clog that little coffee straw. We're talking so small, but that's so small is not allowing the milk to get through that coffee straw. So a clogged duct is actually within the breast tissue itself, a blister and a bleb. Very similar, usually blisters just a raised pour coming out of the tip of the nipple, and then like a milk bleb is so one of those ducts is coming down and then it goes through the poor of the nipple. But what has happened is behind there, it has gotten some clogged milk as well. And then every time the baby sucks, it's clogged. So when the baby sucks, that pour will kind of protrude out, kind of think of like a taste bud that you've burned or something like that, and how it just kind of gets a little bit bigger, irritated. So what'll happen is it'll start to slow, but more elevated than the nipple, and you'll actually see white after you get done pumping or you've been feeding the baby because the sucking is trying to pull it out. But maybe now skin has kind of grown over it or still backed up behind there to where it's clogged. So similar but different. They're both kind of the same thing. It's just one is more at the tip of the nipple and one is actually inside of the breast tissue.
Christa: So treatment wise, how would you treat each one of these?
Kristen: Again, milk bleb, milk blister, usually from not doing something right with a baby as far as latching so we'll come back to that. a clogged milk duct. Usually there's some type of issue whether you've pressed too hard when you are pumping, you slept on that side, maybe you wore an underwire bra for a long period of time, and it just prevented the milk from flowing down through those straws nice and easily so it's backed up a little bit. Anytime you have any breast discomfort, whether it be swelling, mastitis, a clogged duct, anything like that, you typically use the same regimen. So what I always tell moms do warm compresses before. So warm compresses could be a huge gamut, whatever you can put warm on to the breast tissue. So whether it be a shower, bend over and put your breasts in a basin of warm water, a warm compress, like a heating pad or a warm washcloth. There are a couple companies that make gel pads that you can get hot and cold, you can put those on the breast tissue. What those do is when you provide warmth to the breast, it swells those straws and opens them up and makes them bigger. So that way so it dilates the ductal system to help be able to push things out from there. So do warm before and then when you either feed the baby or pumping and while you're feeding or pumping, you're really massaging that so I've got the ducks that are open and dilated. I got the baby feeding so they're sucking but the work has opened it up and then I take my hand or anything that vibrates at home. vibration is really great because it'll kind of break up the clog but massaging or vibrating and then between all of that it will help kind of draw that milk down through the ductal system and relieve it. And you just want to keep doing that until it does get you relief. So the warm compress, feed or pump, whichever you're doing at home, and then afterwards, do ice. So pack of frozen vegetables, ice pack. What that does is it'll help decrease the swelling and provide you some comfort. Usually if you have a clogged duct one or two feedings, you should be able to get relief from. Now a blister again, a blister is going to be more from the baby not latching on properly or coming back off of the nipple and taking the great big suck and really pulling that out. So making sure that you're following up with somebody, sometimes moms will get milk blebs if they have an abundance of milk, and it just kind of gets clogged up behind the nipple, that's a little bit different of a regimen again, warm compress to the tip of the nipple, get baby to feed by doing that and baby feeding, it still doesn't work, you can do some like sailing soak. So warm water and salt or Epsom salt and soak the nipple in it. Sometimes you might have to see the obstetrician and they might lance it. So just puncture the tip of it to be able to pull the milk out. Usually we'll have a little bit of discomfort after that they do that. But once they do that, and they relieve that and you're able to get like the thick milk that has been stuck behind there. Usually it'll kind of filter itself out and will heal.
Christa: So let's talk myositis. What causes mastitis? And how can moms treat it?
Kristen: So it's going to be it actually just continues to go on from the conversation that we just had. So a lot of time mastitis is a cause from a clog milk doesn't say, clogged, pour a blister or breakdown on the nipple. Okay, so usually you have something that has disrupted the milk flow that has caused it to kind of get angry inside of the breast tissue. And then with some type of breakdown at the nipple, it is allowed bacteria to get in causing an infection. So it's kind of the worst of both. So you have the infection, but you have kind of a clogged duct or some type of nipple issue that they're both compounding each other. And moms will say, Well, how do I know that I have it, trust me, you will know you actually feel sick. If moms truly have mastitis, you have body aches, you don't feel good, typically fever the breast might be definitely you're going to feel a hardened area, a lot of times it'll be red, it'll look very angry. You know, definitely not the color of your skin at all, it's going to be really red, sometimes little spider out. So it can be like red, centrally located. But then like veining that spreads out that's all red and irritated as well. Pretty much, definitely antibiotics. There are some physicians that will say, as long as you continue to do the warm compresses and the massaging of the breast or using a breast massager of some type, and you're able to kind of get that clogs and get the infection out that you might not have to use antibiotics. But I do find that a lot of my local OBs will just go ahead and put moms on antibiotics as a prophylactic why they're trying to get it out just to prevent any major complications. So if you guys are having any of that, definitely you're going to want to call your OB but again, try to touch bases with a lactation consultant, because again, there could be some underlying reason that you aren't catching again, normally you get mastitis because there's some type of breakdown, whether it be cracking or bleeding or blister or you know, scabbing something at the breast tissue. So that has to get fixed or why that's happening, then you won't have the breakdown anymore, which in return won't cause you to have the clogged ducts or the mastitis. So unfortunately, it's kind of like this whole little domino effect, you get one and then it just continues to aggravate based upon things that you're dealing. So again, going back to like the nipple creams, find one that has a lot of different properties in it like an all-purpose nipple ointment, because it'll be kind of your preventive measure to help prevent yeast or mastitis. If you're having that but ultimately we got to figure out the culprit. Okay, so if we're having that continued breakdown, we got to figure out why and if we get to that point, then a lot of those issues will resolve.
Christa: And do you recommend people use nipple cream whether they have issues or not just to kind of, you were saying like especially the all-purpose one having different kind of things that can help with is that something like they should do as a preventative measure just to kind of take care of themselves.
Kristen: It's really up to moms, you know, if you're having tenderness and moms will say why use this and I really like it, it just makes me feel so much more comfortable, perfect. Why break anything that's not broken if you find that you really enjoy a particular product, and there's so many on the market, so many different companies offer different things. If you find one, and it's working well for you great. One of the things that moms might find just in general, kind of like if you haven't used lotion on your legs, after you shave them or your skin is super dry, that that's kind of when you tend to do it. But if you're using it on a regular basis, that kind of stays moist with a nipple, kind of the same thing you're having something's sucking on it all the time, it's going to be you know, a little bit dry a little bit more sensitive, you can just use your breast milk, express it, put that on there. Because one of the things is you don't want to constantly be lubricating it so much to where you provide a warm, moist area to where you're going to allow bacteria or yeast to possibly grow. So you know, use your breast milk, see how that does. But if you want to use the cream then just small portions, I'll tell you, usually just like a pea sized drop, my mom is pouring a whole bunch out like she went on her leg and put it all over the breast tissue way too much. Okay, so if it looks still greasy Vaseline look and like when you go to feed the baby that lets you know that you're using too much. So it should absorb just like you would if you were putting lotion on your body, if you do happen to go to feed the baby. And it does kind of still look a little greasy. Just take a warm wash rag and kind of wipe it off, but it is safe to ingest for baby.
Christa: At what point you know, in these different cases, when should they see a professional? If at all in some of these.
Kristen: Really kind of go with your instinct, I recently had a mom that ended up having an abscess, because constantly had a clogged milk duct consistently being put on antibiotics, but really never got to the reason why it was happening. So just be really cautious. You know, if you call the OBs office, a lot of times they'll just call you in an antibiotic. But if it is not getting better with that, make sure that you go in to see your provider, because long term, if that particular antibiotic or whatever you're doing is not working, it can continue to get worse and worse. And ultimately lead to an abscess or an open wound, which is horrible. You know, we're talking like surgery and you know, just really a lot of pain and discomfort for moms. So if you don't feel like things are getting any better, then definitely you're going to want to reach out. So these things should not take long term. If you have mastitis and you start doing the regimen that they tell you, you start taking antibiotics, you should be feeling significantly better in like 24 to 48 hours. Granted, this stuff is still going to be there. You might have some tenderness, but it is definitely getting better. Same thing with a clogged duct, you get it out, but it just keeps coming back, it keeps coming back. Okay, well, let's look into this a little bit further. Try not to treat yourself at home and doing a lot of googling and things like that, you know, if you've given it a good shot, you've done the things that you've read about, or we've talked about. And in a day or two, it is not getting any better. definitely reach out because we don't want that extreme situation to happen.
Christa: Awesome tips. You know, a lot of women go through at least one of these in their breastfeeding journey. So it's great to hear tips and treatment as well. So that's all the questions we have for today. But I know we talked about doing kind of like a part two for next month. So everyone that's listening, we do these interviews with Kristen the last Wednesday of every month, or they come out the last Wednesday of every month, I should say. And so if you guys have any questions while this is out, feel free to post your questions in the comments. And we'll address them in the next interview as well. All kinds of issues. And Kristen, do you want to let everyone know where they can find you and all that good stuff?
Kristen: Yeah, absolutely. On Facebook and Orlando Lactation. My website is www.orlandolactation.com, you can always reach out with any questions or concerns that you might have.
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