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Mastitus... I need help.

Posted by on Feb. 12, 2012 at 5:10 PM
  • 9 Replies

I think I have mastitus. I woke up this morning with a pretty bad headache and i also didnt get much sleep last night with LO. I forgot about not sleeping on my chest and i did that the last 2 nights but now i have this killer headache. my left breast hurts all the way back to under the underarm. what do i do?

by on Feb. 12, 2012 at 5:10 PM
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Replies (1-9):
Daynaof3
by on Feb. 12, 2012 at 5:22 PM
1 mom liked this
Nurse more often if and when possible, especially dangle nursing. Massage your sore breast while nursing, express milk on that side while massaging also. Warm compresses will help and ibuprofen. If it doesn't improve by tomorrow I would see your doctor. Epsom salt soaks in a basin are really helpful also.
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maggiemom2000
by on Feb. 12, 2012 at 5:35 PM

Plugged Ducts and Mastitis

By Kelly Bonyata, BS, IBCLC

How do I know if I have a plugged duct or mastitis?

PLUGGED DUCTA plugged (or blocked) duct is an area of the breast where milk flow is obstructed. The nipple pore may be blocked (see Milk Blister), or the obstruction may be further back in the ductal system. A plugged duct usually comes on gradually and affects only one breast.
Local symptomsMom will usually notice a hard lump or wedge-shaped area of engorgement in the vicinity of the plug that may feel tender, hot, swollen or look reddened. Occasionally mom will only notice localized tenderness or pain, without an obvious lump or area of engorgement. The location of the plug may shift. 

A plugged duct will typically feel more painful before a feeding and less tender afterward, and the plugged area will usually feel less lumpy or smaller after nursing. Nursing on the affected side may be painful, particularly at letdown.
Systemic symptomsThere are usually no systemic symptoms for a plugged duct, but a low fever (less than 101.3°F / 38.5°C) may be present.

 

MASTITISPer Maureen Minchin (Breastfeeding Matters, Chapter 6), mastitis is an inflammation of the breast that can be caused by obstruction, infection and/or allergy. The incidence of postpartum mastitis in Western women is 20%; mastitis is not nearly so common in countries where breastfeeding is the norm and frequent breastfeeding is typical. Mastitis is most common in the first 2-3 weeks, but can occur at any stage of lactation. Mastitis may come on abruptly, and usually affects only one breast.
Local symptomsLocal symptoms are the same as for a plugged duct, but the pain/heat/swelling is usually more intense. There may be red streaks extending outward from the affected area.
Systemic symptomsTypical mastitis symptoms include a fever of 101.3°F (38.5°C) or greater, chills, flu-like aching, malaise and systemic illness.

 

Common (and not-so-common) side effects of plugged ducts or mastitis

Plugged duct

  • Milk supply and pumping output from the affected breast may decrease temporarily. This is normal and extra nursing/pumping generally get things back to normal within a short time.
  • Occasionally a mom may express "strings" or grains of thickened milk or fatty-looking milk.
  • After a plugged duct or mastitis has resolved, it is common for the area to remain reddened or have a bruised feeling for a week or so afterwards.

 

Mastitis

Side effects may be the same as for a plugged duct, plus:

  • Expressed milk may look lumpy, clumpy, "gelatin-like" or stringy. This milk is fine for baby, but some moms prefer to strain the "lumps" out.
  • Milk may take on a saltier taste due to increased sodium and chloride content - some babies may resist/refuse the breast due to this temporary change.
  • Milk may occasionally contain mucus, pus or blood.

 

What are the usual causes of plugged ducts or mastitis?

Plugged ductMastitis

Milk stasis / restricted milk flow 
… may be due to:

Stress, fatigue, anemia, weakened immunity

Milk stasis (usually primary cause)

  • Same as for blocked duct.
  • Blocked duct is also a risk factor.

 

Infection

  • Sore, cracked or bleeding nipples can offer a point of entry for infection.
  • Hospital stay increases mom’s exposure to infectious organisms.
  • Obvious infection on the nipple (crack/fissure with pus, pain) is a risk factor.
  • Past history of mastitis is a risk factor.

 

Stress, fatigue, anemia, weakened immunity

 

What is the usual treatment for plugged ducts and mastitis?

It's always best to treat a plug immediately and aggressively to avoid escalating into mastitis.

 

CAUTION: Do NOT decrease or stop nursing 
when you have a plugged duct or mastitis, 
as this increases risk of complications (including abscess).

 

GENERAL SUPPORTIVE MEASURES

Plugged Duct

  • Rest
  • Adequate fluids
  • Nutritious foods will help to strengthen mom's immune system

Mastitis

  • Bed rest (preferably with baby)
  • Increase fluids, adequate nutrition
  • Get help around the house

 

BREASTFEEDING MANAGEMENT
-- SAME for plugged duct or mastitis
-- important to start treatment promptly
 
"Heat, Massage, Rest, Empty Breast"
General
  • Nurse frequently & empty the breasts thoroughly. 
    Aim for nursing at least every 2 hrs. Keep the affected breast as empty as possible, but don’t neglect the other breast.
  • When unable to breastfeed, mom should express milk frequently and thoroughly (with a breast pump or by hand).
  
Before nursing
  • Use heat & gentle massage before nursing 
    Warm compress. Try using a disposable diaper: fill the diaper with hot water (try the temperature on your wrist first to avoid burns), squeeze the diaper out a bit, then put the inside of the diaper toward the breast. This will stay warm much longer than a wet cloth.
    Basin soak. Fill sink or bowl with hot water and submerge breast in water while massaging the plugged area toward the nipple. Some report better results when epsom salts are added to the water -- add a handful of epsom salts per 2 quarts (2 liters) of water. Rinse with fresh water before nursing, as baby may object to the taste.
    Hot Shower. It can be helpful to massage in the shower with a large-toothed comb. The comb should be drawn through a bar of soap until it is very soapy and then used to gently massage over the affected area in the direction of the nipple.
  • Loosen bra & any constrictive clothing to aid milk flow.
  
While nursing
  • Nurse on the affected breast first; if it hurts too much to do this, switch to the affected breast directly after let-down.
  • Ensure good positioning & latch. Use whatever positioning is most comfortable and/or allows the plugged area to be massaged. 
    Note: Advice to point baby's chin (or nose) toward the plugged area is not necessarily going to be helpful as it is based on the idea that the milk ducts take a nice, direct route to the nipple - recent research tells us that this is not true, and that a particular duct might begin in one area of the breast but can "wander" in many different directions before terminating in any area of the nipple.
  • Use breast compressions.
  • Massage gently but firmly from the plugged area toward the nipple.
  • Try nursing while leaning over baby (sometimes called "dangle feeding") so that gravity aids in dislodging the plug.
  
After nursing
  • Pump or hand express after nursing to aid milk drainage and speed healing.
  • Use cold compresses between feedings for pain & inflammation.
  
 

 

MEDICATION *
Plugged ductMastitis

Analgesia

  • Pain reliever/anti-inflammatory 
    (e.g., ibuprofen)
  • Second choice – pain reliever alone 
    (e.g.,acetaminophen)

Analgesia

  • Same as for plugged duct

Antibiotic?

  • No

Antibiotic?

  • No: If symptoms are mild and have been present for less than 24 hours.
  • Yes: If symptoms are not improving in 12-24 hours, or if mom is acutely ill.
     
  • Most common pathogen is penicillin-resistant Staphylococcus aureus.
  • Typical antibiotics used for mastitis:
    - Dicloxacillin, flucloxacillin, cloxacillin, amoxycillin-clavulinic acid
    - Cephalexin, erythromycin, clindamycin, ciprofloxacin, nafcillin
  • Most recommend 10-14 day treatment to prevent relapse. Do not discontinue treatment earlier than prescribed.
  • Consider probiotic to reduce thrush risk.
     
  • Some mothers also use natural treatments.
* Consult your health care provider for guidance in your specific situation. The medication information is taken from the references listed below and is provided for educational purposes only.

 

Does mastitis always require antibiotics?

No, mastitis does not always require antibiotics.

Mastitis is an inflammation of the breast that is most commonly caused by milk stasis (obstruction of milk flow) rather than infection. Non-infectious mastitis can usually be resolved without the use of antibiotics. However, per the World Health Organization document Mastitis: Causes and Management, "Without effective removal of milk, non-infectious mastitis was likely to progress to infectious mastitis, and infectious mastitis to the formation of an abscess."

Per the Academy of Breastfeeding Medicine's Clinical Protocol for Mastitis:

"If symptoms of mastitis are mild and have been present for less than 24 hours, conservative management (effective milk removal and supportive measures) may be sufficient. If symptoms are not improving within 12-24 hours or if the woman is acutely ill, antibiotics should be started."

If a mom with mastitis has no obvious risk factors for infection (as noted in the box below), it is likely that the mastitis is non-infectious and, if properly treated, will resolve without antibiotics.

When you have mastitis...

Talk to your DR about starting 
antibiotics immediately if:

  • Mastitis is in both breasts.
  • Baby is less than 2 weeks old, or 
    you have recently been in the hospital.
  • You have broken skin on the nipple
    with obvious signs of infection.
  • Blood/pus is present in milk.
  • Red streaking is present.
  • Your temperature increases suddenly.
  • Symptoms are sudden and severe.

 

Follow-up

  • Re-evaluate treatment plan if symptoms do not begin to resolve within 2-3 days.
  • Investigate further if mom has more than 2-3 recurrences in the same location.
  • Consider the possibility of thrush if sore nipples begin after antibiotic treatment.

 

As always, consult your own health care provider to determine how this information applies to your specific circumstances.


Colleen86
by on Feb. 12, 2012 at 5:36 PM

omg that sucks! i remember having it. I got fever and everything! the ladies have wonderful ideas so try those! hope you feel better soon

Rainray2
by on Feb. 12, 2012 at 5:50 PM
I'm so sorry, I jus got over that! What helped me was taking ibuprofen around the clock and nursing on that side first. I also took a diaper and placed hot water in it and wore it as often as I could. I also pumped or fed every 2 hours. It took me 5 days but it did get better.
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comf
by on Feb. 12, 2012 at 5:58 PM
Nurse, take a hot hot shower, hand express in the shower, pump, nurse, rest, repeat :) also eat somewhere in there
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starreyedcutie
by on Feb. 12, 2012 at 6:02 PM
Take a hot shower. And use warm compress. Massage the breast and hand express trying to loosen the clog. Its gonna hurt but it has to be done. Nurse often
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zannahdeux
by on Feb. 12, 2012 at 8:30 PM
They suck...and be careful...once you get them they most often return I. The same place.....nurse on all fours with baby underneath you and or pump with breast dangling down so gravity helps pull it out
FrumpyMama
by on Feb. 12, 2012 at 8:37 PM

REST! Forget the shower. Just rest on the sofa, bed, wherever and nurse lo often, always starting on that side. Knead your breast in a downward motion with your fist and concentrate on any spots that feel firm/hard.  Drink lots of water, apply a heating pad too while nursing.  And just nurse.  It should be better by the next day if you do this religiously. 

louise1212
by on Feb. 15, 2012 at 4:37 PM

Well thank you all for the advice. i did a lot of it but i was so tired with the fever chills and sweats and ended up sleep through the night, my lo has been for a few weeks now and when i woke up my whole breast was rock hard and crazy red and there was no way she could feed on it, so i ended up calling the dr. and they gave me an anti-biotic and now as of noon today she has been feed on my left breast all day great! thank you all for the advice.

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