Pain while breastfeeding: Explanations and Solutions

Pain while breastfeeding: Explanations and Solutions

Are you experiencing pain while breastfeeding? While some nipple pain is common during the first few days of nursing, breastfeeding is supposed to be a natural and pain-free experience for moms.  

Why do some nursing mothers experience breastfeeding pain while breastfeeding? Apart from the initial discomfort when you start breastfeeding there are other reasons why you will feel pain after this time. This includes engorged breasts, vasospasm, a painful let-down, inverted or flat nipples. It can also be due to thrush, blebs, post a frenectomy procedure, oversupply or cracked nipples. Mothers who have fibrocystic breasts or fibroadenoma to their breast may also experience pain while breastfeeding. Breastfeeding pain can be relieved by medication, nipple creams, nipple shiels, gel pads, homeopathy or a cabbage leaf compress.

Sometimes we only think of breastfeeding pain as something that occurs in the first few days of nursing. But what if you experience something beyond what is considered normal? If the pain persists after the adjustment period of breastfeeding, we have to take a look closer as to why this is happening. I have looked more in-depth at some of the reasons why you may feel pain while breastfeeding your baby and what can you do to alleviate your discomfort.

Reasons for Breastfeeding Pain

Engorged breasts

During the first few days of breastfeeding, colostrum is produced in small quantities. When your milk comes in at around day 2 to 5 of breastfeeding, your breasts will start to feel fuller and heavier. This happens not only due to the increased milk production but also due to the increased blood supply and lymph fluids in your breasts. Most mothers get through this time without any problems by continuously nursing their babies. However, some mothers may experience severe fullness and firmness of their breasts. This condition is called engorgement. 

Engorged breasts may feel lumpy, tender, and hot. The surrounding skin will look shiny, reddish, and stretched. It can also be accompanied by low-grade fever (37.5 to 38.3 °C). It is a common reason why breastfeeding can be painful for the first week of breastfeeding. Because the breasts become firmer, it will also be more difficult for the baby to latch on effectively. Engorgement usually subsides with frequent and effective breastfeeding, but pain can last for around one to two days.

Vasospasm

Vasospasm often results when the baby has a shallow latch. As the baby only latches onto the nipple, the tiny blood vessels found inside are squeezed, leading to the interruption of the blood supply to the area. This makes the nipple appear white and deformed. After the baby has released the nipple, the blood supply will go back to the pinched area. This is often accompanied by throbbing or a burning pain sensation.

Let-down breastfeeding pain

Let-down, also known as the milk ejection reflex (MER), is the automatic response of a mother’s body when the breastfeeding hormones, prolactin, and oxytocin, are released. These hormones are released every time the baby latches or during pumping. It can also occur when your baby cries, or if you feel warm. Let-down is often accompanied by a needle or pin-like tingling and burning sensation that subsides after a few seconds. This usually happens coming up to feeding time or when your breasts are full of milk. 

Inverted nipples/ flat nipples

A mother who has flat or inverted nipples may experience some nipple pain after a few days of nursing. This might be due to a couple of reasons:

  • The skin covering the nipple stretches as the baby breastfeeds.
  • As the skin retracts back after nursing, some moisture can become trapped. This can lead to skin chapping.
  • The adhesions in the skin do not stretch while breastfeeding. When skin remains tight, it may cause blisters or cracks to a particular area of the nipple. 
  • If a mother’s nipple is deeply inverted, her baby may squeeze the inverted nipple while breastfeeding, instead of compressing the milk ducts of the breast. If this happens, breastfeeding will be painful.

Thrush

A breastfeeding mother can get a thrush infection if there is a crack on her nipple (source). Cracks to the nipple skin can be a point of entry for the fungus that causes thrush. You are also at an increased risk of getting thrush infection if you or your breastfed baby is taking antibiotics.

If the thrush infection enters your nipple and breast, you may suddenly feel pain after breastfeeding even if you haven’t experienced it before. Severe pain may last up to an hour after you finished nursing.

Bleb or white spot

A white spot or bleb to the nipple is due to a blockage within a nipple pore. This blockage may be caused by thickened milk or skin that overgrows on the pore. The skin that surrounds the white spot appears reddish. Blebs can cause nipple pain, especially while you breastfeed your baby. This article explains more in-depth on how to deal with a nipple bleb/blister while breastfeeding.

After a frenectomy

A frenectomy is a procedure carried out to correct tongue tie in babies. Tongue-tied babies have difficulties latching on to the breast and feeding effectively. This article gives some tips on breastfeeding positions when nursing a baby with a tongue-tie. A shallow latch from a tongue-tied baby will often result in breastfeeding becoming painful. 

After a frenectomy, many mothers find that their baby’s latch improves and the pain they previously felt while breastfeeding is often relieved. However, it may take some time for a baby to figure out how to breastfeed effectively after having a frenectomy.

Fibrocystic breast breastfeeding pain

Fibrocystic breast condition is a term used to describe a group of symptoms involving the glands and tissues of the breast. The symptoms may include solid lumps, cysts, and pain. Though it may be a source of some pain, the fibrocystic breast is often benign and is not a reason to interrupt breastfeeding.

Fibroadenoma breastfeeding pain

Fibroadenoma is a solid cyst that may be found within the breast tissues, which are responsible for milk production. Usually, fibroadenomas do not cause any pain. However, since they react to hormonal changes, fibroadenomas may increase in size and feel tender when you are about to get your period. 

The main problem with fibroadenomas is that they may impede a specific area of the breast and interrupt the flow of milk. If it blocks the area where milk needs to get drained, this area could also become painful.

Oversupply

An oversupply of breast milk will make your breasts feel full, firm, and tender. It may also be a cause of painful and forceful let-downs. Since milk comes forcefully similar to a “spraying” effect, babies often gag or get irritated and refuse to continue breastfeeding. 

Cracked nipples

Another common cause of breastfeeding pain is cracked nipples. Cracked nipples might be caused by excessive dryness or prolonged moisture on the nipples. It might also be due to improper positioning or a poor latch. 

What Part of the breast Hurts While Breastfeeding

Locating the area where the pain originates may help you and your health care provider determine the best intervention to relieve the pain while breastfeeding. Here are the most common areas where nursing moms can feel pain while breastfeeding.

Montgomery glands

These are the small glands found on the areola or the dark pigmented area surrounding the nipples. Montgomery glands often become more prominent during pregnancy and while breastfeeding. This is because it is responsible for discharging the natural oils that moisturize and lubricates the nipple. This lubricant also has natural antibacterial properties and a unique scent that draws your baby to the breast.

Though these glands can release fluids with antibacterial effects, they can also be irritated at times. In some other cases, they get infected. Breastfeeding can be painful if the Montgomery glands are swollen. Once you notice that they turn red and painful, contact your doctor for evaluation.

Base of the nipple/ around the nipple

Pain at the base or around the nipple while breastfeeding is an indication that your baby is not taking in enough breast tissue while nursing. Instead of latching onto the breast, your baby might be latching on at the nipple only. His gums will rub on the base of your nipple. This can lead to painful breastfeeding.

Breast Tissue

Typically, your breasts will feel larger, fuller, and tender when your milk comes in at around 2 to 5 days after giving birth. This is called engorgement that usually subsides after a couple of days of effective breastfeeding. You may also have engorged breasts when you delay or skip a feeding.

Other than engorgement, breast tissue pain may be triggered by any of the following reasons:

  • Plugged milk ducts
  • Mastitis or the infection of the breast tissues
  • Vasospasm or Reynaud’s phenomenon – these conditions can trigger deep breast pain
  • Oversupply
  • Mammary constriction syndrome- a group of symptoms where the tightening of chest muscles results in decreased blood flow to the breast and nipples
  • Poor-fitting bra
  • Tight straps of the baby carrier
  • Premenstrual symptom
  • Very large breasts

Side of the breast

Pain, redness, and a small lump on one side of your breast might be an indication of a clogged milk duct in that area. This happens when milk has not been effectively drained from the ducts, causing inflammation to the surrounding area and blocking the ducts. 

Armpit

Engorgement or mastitis can cause pain and lumps on the armpit. This is because the breast tissues extend to the lymph nodes in the armpit area. These lymph nodes swell and become painful as a reaction to an infection or inflammation in the breasts. 

Other Reasons for Breastfeeding Pain

After pumping

Pain after pumping can be related to the frequency and duration of using the pump. Most moms at some point express their milk while also breastfeeding their baby. Pain can also be associated with the type and size of the breast shield that you use. Poor-fitting breast shields may irritate and tear the skin of your nipples and breast as the pump suctions back and forth. Some nursing moms may also prefer going back to exclusively breastfeeding their baby after having expressed milk at first.

Baby teeth

Once your baby begins teething, he may bite on anything to experiment or give comfort to his sore gums. A newly erupted tooth will feel sharp and may also scrape the skin on your nipple while breastfeeding. A bite or scrape on the nipple will be painful, but will the right adjustments this can be rectified. You can try different breastfeeding positions to prevent your sore nipples from touching your baby’s tooth. This article gives some tips when breastfeeding a teething baby.

Twins

Sore nipples while breastfeeding twins is usually related to a poor latch and positioning. It takes time, guidance, and experience nursing and correctly positioning two babies at the same time. However, once you have it figured out, pain while breastfeeding should gradually disappear. Seek help from a lactation consultant or experienced health professional to assist in latching and positioning your twins. This article gives advice if you may be pregnant while also nursing twins.

How to relieve, reduce and soothe breastfeeding pain

There is no doubt it’s a challenging time when a mom is breastfeeding her baby while also experiencing pain. There are some solutions to help relieve pain depending on the cause of the particular pain. These include:

Medications 

Many moms question whether they can take medications while breastfeeding. However, according to the AAP, the most commonly used over-the-counter pain relievers are compatible with breastfeeding. Acetaminophen (Tylenol) and Ibuprofen (Advil) or (Motrin) are safe to use as recommended. 

Your doctor will provide a suitable antibiotic for a breastfeeding mother if required.

When taking medications, here are some tips that can help:

  • If possible, take medicine shortly before feeding your baby.
  • Peak levels of antibiotics will occur 4 to 5 hours after taking each dose. When taking antibiotics, work out an approximate time when your baby will not be nursing.
  • Only take medications when necessary.
  • Observe your baby for any untoward reactions such as excessive sleepiness, irritability, or the presence of a rash. Discontinue the medication and consult your doctor immediately if you notice these signs.
  • Avoid taking long-acting or extended-release types of medications as they remain in the body for a longer period of time.

Creams

There are a lot of nipple creams and ointments available to soothe sore and cracked nipples. When selecting a nipple cream, you may consider the following:

Organic creams

When using a nipple cream, inevitably, some residue can get passed to your baby when nursing even if you wipe your nipple clean. It’s best to choose one made from natural ingredients. Avoid petroleum or alcohol-based creams. Lanolin and creams derived from natural plant oils are the best options. 

Texture

Creams that are thicker in texture can be harder to apply to your sore nipples. Select a lighter textured cream that won’t pull or drag on your skin when applying.

Things to avoid

  • Harmful ingredients- these include parabens, petroleum, mineral oil, alcohol, and triethanolamine.
  • Numbing agents- these can numb your nipple, but it can also numb your baby’s mouth.
  • Artificial Fragrances- babies are attracted to the natural scent of your nipples, so these additional scents may interfere with their eagerness to breastfeed.

Nipple shields

If used appropriately, nipple shields can help mothers with sore nipples to continue breastfeeding. These are silicone nipples that can be placed over the nipple while feeding. 

It is important to remember that nipple shields should only be used if absolutely needed and under the guidance of a lactation consultant. You should wean your baby off the nipple shield once the soreness is relieved. Improper use of nipple shields can lead to reduced milk intake, plugged ducts, mastitis, and dependence on the shield. 

Homeopathy

Homeopathic remedies involve the use of natural substances to relieve the common causes of breastfeeding pain. Many lactation consultants recommend homeopathic treatment for nursing moms. 

Homeopathy uses dilute forms of natural ingredients. This poses minimal to no risk for babies. However, even natural ingredients can cause problems if not used correctly. Make sure to use them under the guidance of a professional who is knowledgeable of homeopathic treatments.

Some examples of homeopathic remedies include the following:

  • For cracked and sore nipples – Graphites, Nitricum Acidum, Phytolacca
  • For mastitis, plugged ducts or breast pain- Belladonna, Bryonia, Calcarea carb, Pulsatilla, Urtica urens

Gel Pads

These are used to cushion and soothe painful breasts and nipples. Gel pads can be stored in the fridge to cool. Then, you can directly place them over your cracked or sore nipples to provide instant cooling relief. Depending on the variety, gel pads can generally be reused for up to 72 hours. 

Cabbage leaves compress

You can use cabbage leaves compresses to help relieve inflammation and swelling caused by engorgement or oversupply. Here’s how to use a cabbage leaf compress:

  • Remove the outer leaves of the cabbage.
  • Store the cabbage in the refrigerator.
  • Once cold, peel off two inner leaves and wash them using cold water.
  • Pat, with a clean towel, to remove the excess water.
  • Cut and remove the stem in the middle of the leaves. Be careful not to cut the leaves in half.
  • Place the leaves over your breasts. Along with some extra cutting, the area where you removed the stem will allow space for your nipples to be exposed.
  • You can hold the cabbage leaves or use a bra to keep them in place.
  • Leave them for 20 minutes or until the leaves are warm.

Always remember that breastfeeding should be pain-free, particularly after the first few days. If breastfeeding pain persists and interferes with your ability to breastfeed, always seek help from a health professional or a lactation consultant.

References:

https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Treating-Breast-Pain.aspx
https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-and-thrush/
https://www.breastfeeding.asn.au/bfinfo/white-spot-nipple
https://www.aap.org/en-us/Pages/Breastfeeding-and-Medication.aspx
https://www.homeopathycenter.org/breastfeeding

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