Many new mothers experience sore nipples and breasts at some point in their breastfeeding journey. While there are certainly women who have pain-free breastfeeding, studies suggest that a lot of mothers in the United States and other countries experience some kind of nipple pain.
The Centers for Disease Control and Prevention found that 3% of breastfeeding mothers experienced agonizing pain the first time they nursed their babies, while 26% reported no pain at all. Research also shows that breastfeeding pain is one of the main reasons why women give up breastfeeding within a few weeks or months.
While nursing is different for every mother, it’s undeniable that some mothers do experience pain while breastfeeding. This is why it’s not right to dismiss women’s complaints of breast pain as “normal.” They may be suffering in ways that no non-breastfeeding women and men would ever understand.
In general, breastfeeding is not supposed to hurt, but in reality, it can. When this happens, it usually means that something needs to be fixed so that mother and baby can be more comfortable. Remember that if you’re experiencing toe-curling pain and it doesn’t go away after 15 seconds, there might be a problem that you need to address.
Sometimes your breasts may feel full and a little painful during the first few days of breastfeeding; for most mothers, it subsides. If the pain is excruciating and it continues, that doesn’t mean that you should stop nursing. This is all the more reason for you to keep going and find a solution. With some help from time-tested advice from mothers and experts, you should be able to eliminate the pain and breastfeed your baby in bliss.
Here are some of the common breast pain problems during breastfeeding. You’ll find tips on their symptoms, causes, and possible methods of treatment:
This page talks about
- General guidelines on breast pain
- Full breasts
- Sore or cracked nipples
- Blocked milk ducts
- Latch problems
- Oversupply of milk
- Overactive letdown
- Mastitis or breast infection
- Breast abscess
- Nipple vasospasm
- Mammary constriction syndrome
- Baby biting
- Nipple bleb
- Other possible causes
- Oversupply of milk
- Referred pain
- Inverted nipples
- Wrong-sized breast pump
- HIV-related mastitis
- Inflammatory breast cancer
General Guidelines on Breast Pain
Before you start thinking that every pain entails something serious, it’s important to know that there are cases of typical nipple pain that don’t necessarily mean there’s a problem. Here are some cases of breast soreness that passes:
- If the pain is experienced on the third day after giving birth but not after
- If the pain goes away in one to two weeks
- If your nipple looks okay before and after each feeding. It doesn’t look creased or flattened.
- If there is no blister, blood, or broken skin on the nipple
- If the pain doesn’t last more than 30 seconds after your baby latches on and it causes only mild pain or some degree of discomfort.
- If the pain doesn’t stay for the duration of the feeding
- If there is no pain between feedings
Consult a doctor or a lactation consultant if you experience any of these:
- Bleeding, blisters, or cracks on nipple skin
- Pain throughout a breastfeeding session
- Pain between breastfeeding sessions
- Pain that lasts the first few weeks
- Severe, agonizing pain
Make sure that you talk to a health professional if you experience any of these symptoms. Do not think for a minute that they are part of ‘normal’ breastfeeding. If you feel pain or notice damage in your nipples, it could be a sign of an underlying condition in your breasts. This needs to be checked ASAP. Seeing an IBCLC or any breastfeeding specialist should help you sort out the problem and try out solutions—some of which are described below.
Most Common Problems of Breastfeeding Breast Pain
While it’s definitely possible for a new mom to experience pain while breastfeeding, this should not be seen as acceptable or normal. Even a brief period of pain can cause damage to your breast and nipples and lower your milk supply. It can also take away the joy of breastfeeding for you and your baby.
It’s important to know the most common problems associated with breastfeeding and understand the reasons why they occur and, most importantly, what you can do to resolve the issue. Usually, this kind of breast pain can be treated moderately quickly. This is why you should never put off finding remedies or asking someone for help.
Ignoring the pain only makes it worse and most of the time these problems could be prevented with proper care and regular breastfeeding. With this guide, you will be able to watch out for the signs of a breastfeeding problem and seek appropriate treatment.
Symptoms: You may feel uncomfortable. Your breasts may feel hot, heavy, and even lumpy. Milk would even leak involuntarily from your breasts.
Reason: New mothers experience full breasts 3 to 5 days after birth. The first volume of breast milk is produced during this time, and it’s normal to feel the fullness.
What you can do: As you feed your baby, the fullness naturally decreases. Make sure that your baby is latching properly and breastfeed him frequently to remove the excess milk. Your milk production will eventually adjust to your baby’s demand so patiently wait for a few days and your milk supply should be normal.
For some women, breast fullness lasts a day or two and is considered mild. For others, it may be more intense, leading to engorgement that can persist for several days or weeks.
Symptoms: The breasts get very full. They may feel tight, hard, and painful. A little fullness may be normal, but when it causes discomfort and happens for an extended amount of time, it becomes a problem.
Reason: Breast engorgement usually happens when you stop feeding your baby as often. It causes some fluid to build up in the breasts. Here, lymph (white blood cells), blood, and other fluids are stored. It may also be caused by excess IV fluids while on labor.
Engorgement may also be due to latch problems. If your baby is not attached properly, he won’t get as much milk as he should and the nipple ends up a little stretched and flattened and the milk isn’t drained.
What you can do:
- Before feeding: Wear a well-fitting bra. Make sure it’s not too tight or restricts your breasts in any way.
- Feed your baby whenever he wants to be fed. This should be as often as possible.
- As a guide, feed your baby every hour or every two hours during the day and at least 2-3 hours at night. Do this until engorgement subsides.
- Try expressing some milk by hand before feeding. This softens the areola and makes it easier for your baby to attach and drink as much milk as he can, lessening the engorgement in the process.
- Apply warmth to help milk flow. Take a hot shower and let warm water run over your breasts. This makes your milk leak and relieves some pressure in the breast.
- You can also buy hot and cold packs from your local pharmacy. Use hot and cold washcloths as an alternative.
- While breastfeeding: Make sure your baby is in a comfortable position. He should also be attached to your breast properly.
- You can assist your baby by compressing or massaging your breasts while breastfeeding.
- Between feedings: Express milk between feedings to further reduce the volume of milk.
- After feedings: If your breasts are still full, drain milk completely using a hand or electric breast pump after each feeding.
- Apply a cold pack for 10 to 15 minutes. You may use frozen peas with a piece of cloth or buy gel ice packs.
- A lesser known remedy is to apply chilled cabbage leaves to the breasts to reduce swelling.
- Talk to your doctor about taking paracetamol (for the pain) or ibuprofen (for the swelling). They’re generally safe for breastfeeding moms.
To prevent engorgement:
- Feed a newborn 8 to 12 times in a day. If necessary, use a breast pump to remove the milk in case the baby doesn’t want to feed that often. Try to complete the suggested 8-12 times.
- Unless advised by your doctor, avoid bottles and pacifiers. This helps your baby adapt to breastfeeding.
- Start breastfeeding immediately after birth so your breasts will not get too full.
- Check if your baby latches well. This prevents any pain for you and ensures that your baby sucks more efficiently. One indication it’s a good latch is if most of the areola is inside his mouth and his lips are curled out like a fish.
- If the latch is causing some pain, consult a lactation professional as soon as possible to solve the problem.
- If you miss a feeding, express some milk by hand or use a breast pump. Don’t let your breast feel too full.
- If you want to wean your baby, do it gradually so your milk supply will slow down before you stop breastfeeding.
Sore or cracked nipples
Many new mothers report nipple soreness. It’s a common condition for breastfeeding moms but it’s usually temporary and goes away after a few days. However, when the pain is persistent, it’s also a common reason why new moms give up breastfeeding. When the pain lasts more than the normal soreness, it can lead to mental distress and disrupt the mother’s everyday activity and relationship with her baby.
Symptoms: There may be a bloody discharge from your nipples, especially during the first week. The nipple may look pinched, flat, or creased after a feeding. You might also see a white line across the nipple. The broken skin may also take some time to heal because the wound opens every time your baby feeds.
Reason: The usual reason for this is a shallow latch. Your baby may be chewing instead of sucking the nipple, especially if you see that the cuts are near the areola. Other possible reasons: inverted or flat nipples, improper positioning, wearing tight bras, or abruptly ending a feeding without breaking the suction first.
What you can do:
- Begin a feeding on the side that feels less sore.
- Express some milk from your breast so your milk lets down before your baby latches.
- Relax your shoulders and take deep breaths.
- If the baby starts to fall asleep and is just nibbling, take him off that breast and try the other one. The fresh let down from the other breast should encourage him to start drinking again.
- When ending a feeding, put your finger in the corner of your baby’s mouth until he stops sucking. Don’t abruptly pull him off to avoid damage to the nipple.
- Spread some milk on the nipple after a feeding. This serves as a natural moisturizer.
- Air-dry your nipples instead of wiping it with a cloth.
- Use purified lanolin on your nipples. This could help heal them.
- After a feeding, don’t wear your bra yet.
- Use hydrogel pads or discs, which are available at the pharmacy. If it feels like your nipples are too moist after using the discs, don’t use them again.
- If you’re wearing nursing breast pads, make sure they’re always dry. Change often to keep them that way.
- Make sure your bra doesn’t rub against your nipples. They may be too tight.
- Don’t use lotions or soaps on your nipples.
- You may want to use breast shields when you’re not feeding. Different from nipple shields, breast shields are round covers that help heal your nipples and stop them from rubbing against your clothes.
- You might also consider using nipples shields. These are used over the nipple while nursing to protect sore nipples. Consult a doctor before using these as they are known to affect the milk supply.
- For some moms, pumping milk for 2-3 days helps the nipples to heal.
- Check your baby’s position. Make sure your nipple touches his soft palate, or what’s called the comfort zone. There shouldn’t be any friction around that area.
- Consider using a laid-back position where your baby lays on top of you. As soon as he feels the contact with your body, your baby will open his mouth and search for your breasts. Gravity will help him reach the comfort zone in this position.
- If you’re not sure your position or latch is right, ask a lactation consultant or a family health nurse to observe a feeding.
- Try breastfeeding your baby as often as possible and for a shorter amount of time. This makes him less hungry and calmer in his sucking.
- Do not treat your nipples with alcohol, perfumes, or anything you find at home that ‘seems’ okay to use. All you really need is clean water to wash your nipples. Your breast milk helps too.
- You can also try a mild painkiller such as ibuprofen or acetaminophen at least 30 minutes before a breastfeeding session.
Consult your doctor or a lactation expert if the sore or cracked nipples persist to check if there are other possible causes for the pain, such as an infection.
To prevent sore nipples:
- Feed your baby as often as you can to avoid getting him hungry and feeding too hard on your nipples.
- Check if your baby has a good latch. Most of the nipple and areola should be inside his mouth.
- Hand express or pump some milk at the start so milk flows faster and your baby won’t have to work too hard.
- Gently break your baby’s latch by putting your finger inside his mouth and between his gums to avoid pulling your nipple.
Symptoms: There’s a tender, hard lump in your breast. The spot may feel hot and look red.
Reason: Narrow tubes or ducts inside the breast carry milk from the glands to the nipples. If one segment of your glands is not drained completely, it can lead to a plugged or blocked duct. This is why it mostly occurs in mothers who have abundant milk and happens more often during the first few weeks of breastfeeding.
Other reasons are irregular feeding schedules and an improper latch or position. Putting pressure on your breasts may also be a factor such as when you sleep on your stomach or place a bag strap across your breasts. The baby himself may change his feeding time because his sleep time changed or he doesn’t feel well like when he has a cold. Over time, your milk production will adjust to your baby’s needs. Be aware, however, that untreated plugged ducts may lead to an infection.
What you can do:
- Frequently feed your baby from the sore breast to clear the plug.
- Ask a lactation expert or a child and family health nurse to check your latch.
- Try various positions to assist feeding. For example, you can try the underarm position if you’re currently using a front hold position.
- Take hot showers or apply hot packs on the plugged breast before every feeding to encourage milk flow.
- During a feeding, massage the lumpy spot.
- After feedings, drain your breast of as much milk as you can.
- Drink plenty of fluids. Drink more if you have a fever.
- Don’t sleep on your stomach. Sleep on your side or back instead.
- Use a castor oil compress to relieve inflammation and remove the plug. Don’t use on broken skin though.
- Apply a cold pack after feeds.
- Take a paracetamol if needed.
Get enough rest. If possible, ask someone for help around the house. Occasionally, when the plug clears, you may see a spaghetti-like strand of milk come out of your nipple. It’s just a milk secretion from the plug and okay for your baby to swallow.
If you observe that the lump is getting bigger, more tender, and looking red, it may have developed into a breast infection or mastitis. See a doctor as soon as possible.
Symptoms: Breastfeeding causes discomfort and your nipples hurt. They may look sculpted or squeezed after a feeding. They may also have blisters. Problems with latch may also make your baby fussy or underweight. He may also bite the nipple if he’s not getting enough milk.
Reason: The baby uses his tongue to get the milk out and if the nipple isn’t far back, the tongue rubs or puts pressure on the nipple and causes pain. A good latch means that the nipple is inside the mouth fully and touches the back (the soft part of the mouth).
Another reason is engorgement as it makes latching difficult. A baby who’s used to bottle-feeding may also have a shallow latch at the breast.
What you can do:
It primarily depends on improving the latch. You usually just need a minor change in positioning to make a huge improvement.
- To get a good latch, support your baby’s weight and put your hand between his shoulder blades.
- Use your elbow to tuck your baby’s body in. His head should fall back a little.
- Support your breast with your fingers under the breast and the thumb close to the nipple. This lifts the breast up and makes it easier for your baby to feed.
- Align your baby’s mouth with the breast’s underside.
- Aim your nipple at his nose. Encourage your baby to latch by stimulating his lower lip.
- Prompt your baby to open his mouth wide, much like a yawn. Then, make sure his lower lip and tongue will take in a large part of the breast. Your baby’s mouth should cover most of the bottom of the areola and even some of the topic—not just the nipple. This stimulates the milk-making glands better.
- If the position is okay but the pain persists, check if your nipples are dry. Apply lanolin-based creams on your nipples between feedings.
- Wear loose clothing to avoid abrasion.
If it still hurts, don’t try to solve it on your own. Ask a lactation consultant or find any La Leche League leader in your area to help you.
Symptoms: These vary between mothers. Some women experience mild pain, while others may have a slight tingling sensation. Usually, the breast pain happens at the start of a feed when the baby starts sucking. There are others who don’t feel anything at all. The symptoms are usually temporary.
Reason: The hormone oxytocin is responsible for stimulating your letdown, or milk ejection reflex. For milk to get into the ducts and towards the nipple, oxytocin fires up the engine surrounding your milk-producing cells which contract and squeeze the milk out.
During this time, studies show that the milk ducts are stretched to let milk out. Mothers experience pain and discomfort the wider the ducts are stretched. Usually, this doesn’t last through the whole session and voluntarily disappears after the first month or so.
What you can do:
- Feed your baby longer on just one breast. Switch to the other breast when needed.
- Breathing techniques help mothers relax and ease the pain.
- A side-lying or laid-back position helps babies handle the milk flow.
- If the tingling sensation escalates to something more severe like having sharp breast pain while breastfeeding, you need to have yourself checked for a possible breast infection.
- If it’s an infection, you’ll have to take antibiotics. Note that it’s generally safe for your baby if you take antibiotics.
Mastitis or breast infection
Symptoms: There are several symptoms of mastitis—among them:
- Feeling like you have the flu
- Your breast feels hot and somewhat tender
- A fever (temperature over 100.5 degrees Fahrenheit)
- A painful red spot on your skin
- Feeling tired and tearful
If you have at least two of these symptoms, you may have mastitis. This can develop suddenly and get really bad quickly so get yourself checked.
Reason: Around one-third of new mothers will experience mastitis sometime in the future. It is especially common during the first few weeks of breastfeeding, but it can also happen while you’re weaning your baby off your breast.
Women around 30 to 34 years old experience this the most, along with women who keep a job and women spending the winter months. They usually experience unusual episodes of extreme tiredness, stress, or a cracked nipple (especially during the early breastfeeding weeks) right before they got mastitis. Commonly, women get mastitis because of the pressure from breast engorgement, external pressure built up from tight clothing like a bra or a swimsuit or a bag strap that squeezes the breast and a break in the nipple’s skin where bacteria could enter.
What you can do:
- Keep breastfeeding your baby. This is how your breasts are drained of the extra milk.
- Breastfeed as often as you can. Ideally, you should nurse every 1.5 to 2 hours in the daytime and every 2 to 3 hours at night.
- Avoid long gaps between feeds.
- Remember that milk from the infected breast is not harmful to your baby.
- For 10 to 15 minutes every day, apply a warm compress to the tender part of the breast at least 3 times in a day. You should feel less swollen if your condition is improving, but it may take up to a week to completely subside.
- Do not let your breasts become engorged and try to avoid having hurried and interrupted feedings.
- Express some milk in case you miss a feeding.
- You can use all the same methods for mastitis as you can do for blocked ducts.
- You may need to take analgesics like ibuprofen or paracetamol to help with the swelling.
- You should get enough rest. Eat healthily and drink lots of fluids.
The main treatment for mastitis is to take antibiotics. Your doctor may prescribe them if you have the following:
- A fever of 101 degrees (Fahrenheit) or 38.4 degrees Celsius or higher
- The swelling is getting worse and the red spots are feeling hotter
- Not feeling better after a day or two
- You feel extremely tired and have chills
You most likely need to take antibiotics for 7-10 days, which you should always finish. It’s important to finish the prescribed number of days even when you feel better in a day or two. This reduces the chances of the infection coming back later. Not finishing the course of antibiotics is the usual reason why some cases of mastitis recur after a few weeks. If your mastitis keeps going back, you may need to take antibiotics for a longer period of time. Talk to your doctor about it.
Some studies have found that a change in the mother’s diet such as reducing saturated fats and adding at least a tablespoon of lecithin can help avoid chronically blocked ducts which lead to mastitis. Do not ever stop breastfeeding during an episode of mastitis as it may worsen your symptoms and lead to a breast abscess.
Symptoms: There’s a painful swelling in your breast and it feels full of fluid. There may also be discoloration at the swollen spot.
Reason: This usually happens when mastitis is not effectively managed even after frequent feedings and a course of antibiotics. A breast abscess needs an operation to drain the fluids.
What you can do:
- Have the abscess drained and treated with penicillinase-resistant antibiotics.
- Drainage should be done either by catheter or by needle aspiration.
- Drainage should be guided by ultrasound to avoid making a large incision that could damage the milk ducts.
- You may continue feeding on the affected breast, but if it’s too painful (e.g. the baby has to suck on or near the incision) you can pump and resume feeding when the pain subsides, typically in 2 to 3 days.
- Continue to feed using the other breast.
- Once the drain is completed and the stitches are removed, you can feed on the affected breast again.
Symptoms: Thrush is a yeast infection that affects the mother’s nipples and the baby’s mouth and diaper area. A pink rash appears on the nipples, which may feel itchy. This could be the reason why sore nipples don’t get better, but some women with a thrush infection may feel a sudden or burning pain in their breasts even when the nipples are not sore.
When a mother has a thrush infection, the baby is usually infected too. Here are some symptoms to check in a baby:
- White spots on the tongue or inside the cheeks of the mouth. These look like milk curds but hard to remove.
- A red rash in the baby’s diaper area
- Some babies feed a while but pull away
- Some babies reject the breast, while others may seem in pain when trying to attach.
Reason: There’s a certain amount of yeast in our bodies but when it gets out of control, it can cause infections. This particular infection is caused by the fungus Candida albicans and it usually follows antibiotic treatments or if the level of iron is too low.
What you can do:
- You have to see your doctor for advice on how to treat a thrush infection. If you have the symptoms, both you and your baby need to be checked. If it’s just your baby, then you don’t normally have to be treated.
- Usually, treatment involves gentian violet paint or nystatin.
- Gentian violet paint involves applying 0.25% solution to baby’s mouth daily for 5 days, or until 3 days after lesions heal and, for the mother, applying 0.5% solution to the nipples daily for 5 days.
- Nystatin treatment includes nystatin suspension of 100,000 IU/ml (international units per milliliter) and applying 1 ml to the baby’s mouth using a dropper 4 times daily for 7 days after each feeding, or as long as the mother is being treated.
- The same amount of time is usually required for treating the mother’s nipples with nystatin cream.
To prevent nipple yeast from returning:
Yeast can grow anywhere. You could do the following while getting treatment for thrush:
- Wash your and your baby’s hands as often as you can.
- For around 20 minutes, boil anything that your baby may suck on. This may include teething toys, bottle nipples, pacifiers, and breast pump parts that come into contact with the milk.
- Replace nursing pads with disposable ones.
- Follow the prescribed treatment time to the finish.
Symptoms: A vasospasm happens when blood vessels suddenly constrict or narrow. The nipples become sensitive to cold and appear white after a feeding and then transition to blue or purple—usually with some stinging pain involved. Vasospasm is a rare cause of breast pain and sore nipples.
Reason: What causes a vasospasm is usually a shallow latch. It’s more common for women who have Raynaud’s Disease, or when someone experiences cold, white fingers and toes during winter months. Women with circulation problems may also be susceptible to this.
What you can do:
- Keep yourself warm, especially while breastfeeding.
- Take hot showers between feeding times.
- Make sure the baby is latching well. See that he doesn’t squeeze the nipples to hard as it may worsen the pain.
- After a feeding, place a hot towel or hot pack over the nipple. Offer your other breast to the baby. Apply a hot towel to the other one as well.
- Avoid drinking caffeine products like coffee and tea.
- Avoid smoking as it could make vasospasm worse.
If symptoms of vasospasm persist, consult your doctor about other possible treatments.
Mammary Constriction Syndrome
Symptoms: Mammary constriction syndrome (MCS) is a new term coined by Edith Kernerman, IBCLC to explain deep breast pain while breastfeeding. It’s a collection of symptoms stemming from a nipple vasospasm that happens deep in the breast and causes deep stabbing pain in the chest. It’s possibly responsible for shooting breast pain breastfeeding that isn’t thrush.
Reason: MCS is caused by tension in the muscles of the shoulders and chest, which then leads to pectoral muscles pressing on blood vessels and disrupting blood flow and oxygen. This, in turn, results in a wide array of painful sensations that could be constant, knife-like, tingling, burning or freezing, sharp or dull, or a combination of these.
The muscle tension may be attributed to the way a mother sits or the act of breastfeeding for a long time or even simply tensing the shoulders whenever the baby’s latch is painful. Difficulties during pregnancy and labor may also contribute to the tightness in the shoulders and chest, which leads to MCS.
What you can do:
- Kernerman recommends doing pectoral muscle massage in which the chest muscles are massaged or gently stretched to relieve the tension before a breastfeeding session.
- For 45 to 60 seconds, rub the chest muscles of the affected side and not the breast. You may massage the area above the breast against the wall of the chest, between your breasts, under the breast against the rib cage, or on side of your body, against the rib cage.
- Also, avoid hunching over your baby. Get back support (e.g. pillows) and avoid carrying heavy objects like grocery bags or car seats.
Symptoms: Your baby may bite your nipple during or towards the end of a feeding.
Reason: It may be caused by discomfort in the gums while they are teething. Older infants may feed more quickly and they may only suck for 5 minutes. If left on the breast, they may start nibbling rather than sucking, which eventually leads to biting.
What you can do:
Telling your baby ‘no’ after he bites will not work because they cannot associate the biting with the act of saying ‘no.’ There are other alternatives you could try:
- Give them chewing toys before feeding time.
- You can also give their gums a rub with your fingers before feeding.
- You can also use teething gel on your baby’s gums.
- Your baby may also bite to get your attention or to tell you they’ve had enough, so make sure to watch your baby’s feeding cues.
- Try not to scream when the baby bites as he may associate feeding with something negative or he might think it’s a good thing and do it again.
Symptoms: You may have a white spot or a blister containing milk on the tip of your nipple. It can be painful to touch.
Reason: Nipple blebs or milk blisters happen when a pore in a nipple plugged with the skin sealing over it. The area becomes sore because the milk is backed up inside. It can be white or yellowish depending on the number of days. It usually resolves on its own within a few days.
What you can do:
- If it doesn’t go away, try soaking your breasts in warm water and rub with a cloth to remove excess skin.
- Hand-express some milk from the affected area by pressing on the areola near the bleb.
- Just like plugged ducts, you can treat a bleb by breastfeeding as often as you can and using cold or hot packs between feedings.
- If necessary, take an analgesic for the pain.
- If these don’t work, you may need to drain the clog yourself. Use a sterile needle to break the skin over the bleb and then gently squeeze out the clogged milk. Apply hydrogen peroxide afterward or take antibiotics like Neosporin to avoid infections.
- Consult your doctor if you see any signs of inflammation, fever, or pus as it could be an infection. Also, contact your healthcare provider if the bleb keeps on coming back.
Symptoms: Your baby may have tongue tie if your nipples hurt and the tip of the nipple is damaged. There is usually a pinching sensation in the nipple.
Reason: Check your baby’s mouth to see if the band of skin called frenulum under his tongue is too short or tight that the baby has difficulty sticking his tongue out or even lifting it to the upper teeth. This way, the tongue only reaches the end of the nipple and rubs against it, causing you nipple pain.
What you can do:
- A doctor can perform a simple procedure of snipping the extra skin under the tongue.
- After the frenulum is cut, your baby might have some difficulty learning how to properly use the tongue to assist in feeding so you may have to endure the pain a little bit more.
- At other times, the frenulum frees itself up without the need of a procedure, but you may have to experience some pain until this happens.
Other Causes of Breastfeeding Pain
Aside from the common causes of breastfeeding-related breast pain described above, there are less common reasons why you are experiencing pain in your breasts. It might have to do with your milk supply, the shape of the nipples, the size of your breast pump, or pain in other parts of your body. In very rare cases, breast pain may be related to serious illnesses like HIV and an aggressive form of breast cancer.
It’s worth checking out some of the other symptoms you may have missed. Learn some steps that you could take in case you are dealing with the following breast pain issues.
Oversupply of milk
Sometimes the overproduction of milk could be a reason. When a mother makes too much milk, the baby struggles to feed and may spit the milk up. This oversupply could also lead to an overactive letdown and engorgement, which could both be painful.
A health advisor may give advice on how to decrease your supply. Ask them to watch a feeding session as they could determine how long your baby wants to feed at one breast. This prevents you from switching breasts too early, which then leads to oversupply.
When you nurse in an uncomfortable position, it could strain the muscles in your neck, back, and shoulders. This can lead to referred pain in the breasts as they all share the same nerve pathways.
Gently stretch your shoulders and back to loosen tight muscles. Some mothers find relief in leaning forward while holding both sides of a doorway. You can also try feeding in a laid-back position which is considered more natural and helpful in reducing the strain.
Inverted or flat nipples
Inverted nipples turn inward instead of protruding like most nipples. Flat nipples don’t stand when your baby is nursing. Women who have any of these two may have difficulty breastfeeding and may experience nipple pain.
If this is the case, talk to your doctor or a lactation expert about methods to manage the pain and make nursing more possible.
Wrong-Sized Breast Pump
Make sure that you have the right flange size for your breast if you pump regularly. Having the wrong size can cause nipple pain. For one, if your nipple can’t move freely in the flange tunnel, then the flange or breast shield is too small and too tight for your breast, causing the nipple pain. The breast shield is too big if the skin around your nipple is being pulled in when you pump. This causes sore nipples.
Different sizes are definitely available, so ask your manufacturer if you can get a replacement that would better fit your nipples. You can also try to pump on the lowest suction level so it wouldn’t cause pain but still express milk. Find the most comfortable setting for you.
HIV-related mastitis, abscess, and nipple fissure
In the US, breastfeeding is not encouraged for mothers who are HIV-positive. For its part, the WHO recommends exclusive breastfeeding even for mothers with HIV, especially if there’s no better alternative for the infant.
However, if a mother who has HIV experiences mastitis, breast abscess, and nipple fissure or cuts, it could increase the risk of the baby getting HIV from her. This means she shouldn’t increase the frequency of feeds unlike other cases of these conditions.
An HIV-mother who has mastitis, abscess, or nipple fissure should avoid breastfeeding on the affected side until completely healed of the breast problem. She could instead express milk as part of her treatment but not as food for her baby.
The baby can feed on the unaffected breast if only one has a problem. Breastfeeding on the affected side can resume once the condition is gone. Some mothers stop breastfeeding if they find an effective food replacement, but they should still express milk to help the breast recover.
Antibiotics may be necessary for 10 to 14 days, along with rest and analgesics. For breast abscess, the mother will still need an incision.
Inflammatory Breast Cancer (IBC)
Inflammatory breast cancer is a lesser known, rare form of cancer and can’t be detected by a mammogram. It could be mistaken as mastitis as they have similar symptoms.
Generally, breastfeeding for long periods of time (6 months or longer) reduces the risk of developing cancer. Still, it’s important to know the difference between a breast infection and IBC. Here are some ways it’s different from mastitis:
- IBC: You may experience sudden swelling. Mastitis: There’s some swelling but it commonly starts with a tender lump instead of happening suddenly.
- IBC: You may feel pain all over the breast. Mastitis: There’s pain but the tenderness usually occurs only above the affected area.
- IBC: You see a red rash that itches all over the breast or just a part of it. Mastitis: There may be a pink or reddish rash but doesn’t cover the breast like a rash and doesn’t itch.
- IBC: You may feel swollen lymph nodes under your arm. Mastitis: Swollen nodes may be there but only when the infection is left untreated and spreads out to the milk ducts.
- IBC: Your breast may feel warm. Mastitis: The breast may or may not feel warm.
- IBC: Your breast may have a bruise-like mark that doesn’t go away. Mastitis: The infected area usually has a light pink shade instead of dark.
- IBC: Your nipple may release a bloody discharge. Mastitis: This rarely happens with mastitis although there might be some blood in the mother’s milk due to broken blood vessels or a fissure in the nipples. There shouldn’t be a reason to panic as long as the infection is being treated.
- IBC: The nipple or areola may change its shape such as becoming retracted or inverted. Mastitis: It’s rare to see nipple changes with breast infections.
If you think you have any of the symptoms of IBC, see your doctor. Do this especially if you’re not breastfeeding and not likely to get mastitis. Do not self-diagnose. The only way to know if you have IBC or any type of breast cancer is by conducting a biopsy. If you’re breastfeeding, you should still see your doctor but there’s a big chance that he’ll tell you it’s a breast infection.
Knowing the Signs Helps You Get Treated
Most experts say that breastfeeding is not supposed to hurt at all, but the truth is for some women it could hurt and sometimes it hurts really badly. Telling women that breastfeeding shouldn’t hurt invalidates their experience and makes them feel that they’re doing something wrong when in fact there are factors that are beyond their control.
It’s important that we inform new mothers of the potential pain of breastfeeding. Sugarcoating will just prevent them from getting the right treatment at the beginning as they second-guess what is happening. This is not to say that all women will experience breast pain while breastfeeding as many women do enjoy pain-free breastfeeding, but if you’re among those who experience mild to extreme pain, we encourage you to seek treatment as soon as you can.
Do not think twice about reaching out to an IBCLC certified lactation consultant or a peer counselor who’s trained to speak with breastfeeding moms. It’s best if you can ask them to watch you feed your baby so they can give pointers on how to make you and your baby more comfortable. Breastfeeding pain is almost always treatable, so don’t hesitate to get help as soon as you can.
With the right care, you will learn what feels normal and what isn’t and with enough preparation, you can also prevent pain problems from occurring. Do not let the fear of pain stop you from breastfeeding. Most mothers agree that despite the pain they would breastfeed all over again.