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Recurring mastitis

Posted by on Feb. 5, 2013 at 6:02 PM
  • 9 Replies
Can mastitis go away on it's own and keep coming back if you don't get abx? I woke up with a sore breast again, massaged, nursed, it felt a little better. Now a few hours later I'm chilled and feel a headache coming on. I need to find my thermometer... This is the third time in two months it's happened and I get really sick for a few days. I can't take it any more!
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by on Feb. 5, 2013 at 6:02 PM
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Replies (1-9):
MusherMaggie
by Platinum Member on Feb. 5, 2013 at 8:42 PM
I would say always go for the abx and probx when you have mastitis.
K8wizzo
by Kate on Feb. 5, 2013 at 10:05 PM

Recurrent Mastitis or Plugged Ducts

JULY 27, 2011. Posted in: BF CONCERNS: MOTHER

By Kelly Bonyata, BS, IBCLC

  • Treatments for recurrent plugged ducts or mastitis
  • References and additional information
  • Risk factors for recurrent plugged ducts or mastitis

    Most mothers do not have repeated bouts of mastitis or plugged ducts, but when there is a history it’s always a good idea to look at additional risk factors. Make sure that you are aware of the symptoms of plugged ducts and mastitis so you can start treatment immediately. See Mastitis and Plugged Ducts for more information.

    Risk factor: Inadequate treatment of previous mastitis

    • A major risk factor for recurring mastitis is failure to completely recover from a previous bout of mastitis due to slow treatment, incorrect treatment (wrong antibiotic, for example), or treatment that was not long enough. Has the treatment of previous bouts of mastitis been delayed, inadequate or incomplete? If you were treated for a previous bout of mastitis, did you take a complete course of antibiotics? Have you had repeated prescriptions for the same antibiotic? Amoxil is often ineffective against the bacteria that causes mastitis. Some of the drugs “of choice” for treating this are Keflex, Dicloxacillin, and Erythromycin. Treatment should continue for 10-14 days. See the links below for additional information.
    • In addition, some moms get recurrent plugged ducts due to inflammation from an ongoing subclinical case of mastitis.
    • A related risk factor is a previous plugged duct. The duct can be deformed (“stretched out” a bit) at the location of a previous plug, which can put that particular area more at risk for plugging in the future. To reduce this risk, be vigilant about keeping the milk flowing well after a plugged duct is resolved.

    Risk factor: Poor milk drainage

    • Are latch-on and positioning optimal? Problems with either can affect milk drainage, and whenever the milk flow is hindered you are at risk for plugged ducts and mastitis. Always go back to the basics when you are having problems.
    • Are you supporting the breast from underneath? This is not always needed, particularly after the first few weeks. However, if you are having problems with plugged ducts or mastitis, lifting the breast from underneath can increase milk drainage.
    • Are you interrupting feedings or cutting them short (due to outdated advice to limit nursing duration, a busy schedule, taking care of other children or family members, etc.)? This can lead to a backup of milk in the breast and thus increases the risk for engorgement, plugged ducts, or mastitis.
    • Do you press down on the top or side of your breast to make extra breathing space for baby? This should not be necessary (baby’s nose is designed so baby can breathe while nursing) and can cause plugged ducts and/or sore nipples.
    • Look for anything that results in consistent pressure on the breast tissue — this can block milk flow and lead to plugged ducts. See if you can associate any of the following things with the location of the plug(s): Are you sleeping on one side or on your stomach a lot? Do you carry a heavy purse or bag on one side? Are you carrying the baby in a front carrier or sling? Do you wear an underwire bra that presses in one area? Are you wearing any type of bra that does not fit well? Do you wear a sleep bra that stays pushed up or to the side for much of the time at night? Are you wearing constrictive clothes?
    • Are you having problems with oversupply or engorgement? Do you feel that you have too much milk? Does your baby choke, gag, strangle when nursing because of a fast milk flow? Do you leak a lot? Remedying the oversupply will help to reduce your risk for plugged ducts and mastitis.
    • Do you use a nipple shield? Use of a nipple shield can result in poor milk drainage from the breast.
    • Sometimes moms who pump often (to replace missed nursings) are more prone to plugged ducts because a breastpump simply cannot drain the breast as effectively as the baby. You might try slightly moving the breastshields around to different quadrants of the breast so that these areas will be softened more efficiently.
    • Any kind of exercise that involves repetitive motions of the upper arm may lead to plugged ducts or mastitis.
    • Have your breasts been operated on, scarred, bumped, handled roughly, or otherwise injured? Any breast surgery can cause scarring and/or pressure on milk ducts. Other things that can cause plugged ducts/mastitis are an anatomical problem or variation in a particular duct, breast lumps or cysts, past injuries. In any of these cases, mastitis will recur in the same area of the breast. Recurring mastitis in the same location is one of the warning signs of a breast tumor (but this is rare cause of recurring mastitis).

    Risk factor: Nipple problems

    • Look for dried milk secretions on the nipple. If you notice this, apply a warm cloth to the nipple until the dried milk peels off and then try to express some milk. Sometimes this can cause a plugged duct because the duct cannot empty well through the nipple.
    • Have you had any nipple damage? Sore, cracked, or bleeding nipples can offer a point of entry for bacteria. Secondary staph infections may be responsible for delayed healing.
    • Milk blisters can cause repeated plugged ducts.
    • Secondary infections such as thrush (yeast/fungal infection) can cause inflammation within the milk ducts which increases the risk of plugged ducts or mastitis. Moms who are experiencing recurrent plugged ducts or mastitis due to thrush may benefit from taking an anti-inflammatory medication (like ibuprofen) to reduce the inflammation.

    Risk factor: Mother’s overall health

    • Have you been very tired or busy, worried or stressed? Many times mothers who have recurring bouts of mastitis are not getting enough rest or are trying to do too much. Mastitis is often the body’s way of telling Mom to “slow down.”
    • Have you been ill? Might you be anemic? Lowered resistance to infection or anemia can cause or contribute to recurrent plugged ducts. A blood test for anemia is a good idea when there is a history of repeated mastitis. Increasing foods containing natural sources of iron (or supplemental vitamins with iron) and a Vitamin C supplement may be helpful.
    • Are bouts associated with hormonal changes (ovulation or menstruation)?
    • Do you have food allergies? According to La Leche League’s Breastfeeding Answer Book, food allergies occasionally result in plugged ducts that occur either premenstrually or before ovulation:
    • In her book Breastfeeding Matters, Maureen Minchin theorizes that if a mom has allergies, recurring mastitis/plugged ducts might be caused by the “complex immune responses” that occur when she is exposed to an allergen. In a group of food-intolerant women, Minchin observed that their plugged ducts, “which rarely progressed to overt infection and which often recurred either premenstrually or before ovulation,” were “often accompanied by other symptoms of allergy intolerance.”

    • Do you smoke? Smoking can lower your resistance to infections.

    Risk factor: Mother’s diet

    • Are you eating regularly, and eating plenty of fresh food and vegetables? This will help to increase your resistance to infection.
    • Are you drinking to satisfy thirst? Lack of sufficient fluids can contribute to plugged ducts. Make sure you are drinking something each time you sit down to nurse or pump.
    • Too much saturated fat in the diet can be a problem. Reduce animal fats / limit your fat to polyunsaturated fats and take one tablespoon of lecithin (a dietary supplement available at most pharmacies, health foods stores, etc.) Adding lecithin to the diets of moms with recurrent plugged ducts has been shown to be very effective.
    • Either too much salt or too little salt in the diet has been linked to this problem.

    Risk factor: Baby’s health

    • Has your baby been ill? Occasionally, baby can have the bacteria in the back of his throat and be reinfecting mom with mastitis. This can be determined by swabbing the baby’s throat. If the culture is positive, then baby should be treated along with mom. A culture of your milk can also help your health care provider better determine the best treatment (antibiotic-wise).

    Treatments for recurrent plugged ducts or mastitis

    These treatments should be used in addition to your efforts to find and remedy the source of the problem. Keep in mind that if the source of your recurrent plugged ducts or mastitis is something fixable (for example: oversupply, infrequent nursing, too tight bra, etc.), then solving the underlying problem is the most effective thing you can do.

    Treatments: Dietary supplements and diet

    A Vitamin C supplement can be helpful for any mom suffering with recurrent plugged ducts or mastitis.

    Many moms have found that taking lecithin (a dietary supplement) can help to resolve and prevent recurrent plugged ducts.

    It is also helpful to make sure that you’re getting enough liquids, and to reduce the amount of saturated fat in your diet.

    Treatments: Homeopathic remedies

    Some moms with recurrent plugged ducts or mastitis have also had good luck with the followinghomeopathic treatment — 2 doses Hepar Sulphur and 2 doses of Phytolacca (allow pellets to dissolve in mouth). The doses are to be taken as follows:

    First, take Hepar Sulphur 30C – 3 pellets; 
    3 hours later, take Phytolacca 30C – 3 pellets;
    3 hours later, take Hepar Sulphur 30C – 3 pellets;
    3 hours later, take Phytolacca 30C – 3 pellets.

    Treatments: Acupuncture

    Acupuncture has also been used successfully for recurrent plugged ducts or mastitis.

    Treatments: Long-term, low-dose antibiotics

    If you follow the complete course of treatment with an appropriate antibiotic and the mastitis continues to recur, Dr. Ruth Lawrence (Breastfeeding: A Guide for the Medical Profession, page 281) suggests long-term, low-dose antibiotics for 2-3 months or even the duration of lactation. This type of treatment has broken the cycle of repeated mastitis for some women. If this treatment is chosen, it’s also a good idea to have an antifungal medication prescribed along with the antibiotic and/or to supplement the mother’s diet with acidophilus to lessen the risk of thrush.

    Treatments: Time

    If you are relatively early postpartum and your recurrent plugs/mastitis seem to be tied to an overabundant milk supply, a little more time may be the best remedy. Hormonal changes occur by about 12 weeks (give or take a bit) that make milk supply more stable and you may notice less of a tendency to get the plugs.

     

    References and additional information

    Mastitis and Plugged Ducts @ 

    Lecithin treatment for recurrent plugged ducts @ 

    Breastfeeding and breast abscess @ 

    LLL FAQ: Repeated Cases of Mastitis

    Ultrasound for persistent mastitis and plugged ducts. Question answered by Debbi Donovan, IBCLC

    Prone to mastitis – How much milk should I express? Question answered by Debbi Donovan, IBCLC

    Weaning and repeated mastitis. Question answered by Debbi Donovan, IBCLC

    Reasons for recurrent plugs by Kathy Kuhn, IBCLC

    PoodleMum
    by Silver Member on Feb. 5, 2013 at 11:02 PM

    I pretty much have all the triggers for recurring mastitis :/  I never had this issue with Pippi!  I'm afraid to stop taking dom because I don't know how well Evie is doing, we keep having to pop open the revision site and she always seems sooooooo hungry. I feel like she drains me well for the most part, I think it's just an overnight problem.  She doesn't take that side as often during the night

    Quoting K8wizzo:
    K8wizzo
    by Kate on Feb. 6, 2013 at 8:21 AM

    Could you try to pump it well before you go to bed maybe?  And, have you considered taking lecithin granules?  If you can't do soy, they also make sunflower lecithin.

    Quoting PoodleMum:

    I pretty much have all the triggers for recurring mastitis :/  I never had this issue with Pippi!  I'm afraid to stop taking dom because I don't know how well Evie is doing, we keep having to pop open the revision site and she always seems sooooooo hungry. I feel like she drains me well for the most part, I think it's just an overnight problem.  She doesn't take that side as often during the night

    Quoting K8wizzo:


    PoodleMum
    by Silver Member on Feb. 6, 2013 at 12:06 PM
    I already pump right before bed and make sure to nurse her well from that side after as well. I will look for the other lechitin, I had a horrible reaction to soy milk :/ Soy sauce is fine though, but I'd rather not risk it

    Quoting K8wizzo:

    Could you try to pump it well before you go to bed maybe?  And, have you considered taking lecithin granules?  If you can't do soy, they also make sunflower lecithin.

    Quoting PoodleMum:

    I pretty much have all the triggers for recurring mastitis :/  I never had this issue with Pippi!  I'm afraid to stop taking dom because I don't know how well Evie is doing, we keep having to pop open the revision site and she always seems sooooooo hungry. I feel like she drains me well for the most part, I think it's just an overnight problem.  She doesn't take that side as often during the night

    Quoting K8wizzo:


    Posted on CafeMom Mobile
    K8wizzo
    by Kate on Feb. 6, 2013 at 12:09 PM

    lecithin doesn't contain soy protein, so it's safe for most people with soy allergies (unless they also have issues with soybean oil).  Amazon has a bunch of sunflower lecithin.

    Quoting PoodleMum:

    I already pump right before bed and make sure to nurse her well from that side after as well. I will look for the other lechitin, I had a horrible reaction to soy milk :/ Soy sauce is fine though, but I'd rather not risk it

    Quoting K8wizzo:

    Could you try to pump it well before you go to bed maybe?  And, have you considered taking lecithin granules?  If you can't do soy, they also make sunflower lecithin.

    Quoting PoodleMum:

    I pretty much have all the triggers for recurring mastitis :/  I never had this issue with Pippi!  I'm afraid to stop taking dom because I don't know how well Evie is doing, we keep having to pop open the revision site and she always seems sooooooo hungry. I feel like she drains me well for the most part, I think it's just an overnight problem.  She doesn't take that side as often during the night

    Quoting K8wizzo:



    Char07
    by on Feb. 6, 2013 at 2:06 PM
    Hugs, I've had mastitis 4 times so far with Robbie, never really bad and not lately but ive never even had a clogged duct with the girls so...
    Posted on CafeMom Mobile
    gumeshoe
    by on Feb. 6, 2013 at 2:29 PM

    I seem to be getting clogged ducts about once a month, same duct on the left. Thankfully it has not gone to mastitis. And it seems like it is also connected to overnight. Nights that he doesn't wake up and I didn't feed on that side last seems to be the trigger. The dangle doesn't seem to work for me. What I tried today was lay on my right, flip baby around so I am looking at his feet and the tilt over him and he can get the left from there. I got the idea and had nothing to lose. Hubby told me last night man that looks painful. Yea thanks hun it is. Sent him to CVS for lecithin and took that too. I'm desperate. Also baby has been not feeling well, so its pretty rough over here. I was also wondering if part of the problem is how the duct goes. It goes from the top outside armpit area to almost my nipple then it goes around the nipple to the inside center circles twice then finally to the nipple. I had been trying to see if i could massage the clog out and I can't because of the circling. Pumping mine only seems to make the situation worse.

    Hope you feel better and figure out what works for you, this stuff is no joke.

    aehanrahan
    by Group Mod - Amy on Feb. 6, 2013 at 2:41 PM

    Kate gave all of the information that I was going to. I think the lecithin might help you. (((HUGS)))

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