A blocked duct causes a red, tender lump that may progress to a local area of inflammation (mastitis) that makes you feel flu-like and achy.
A duct becomes blocked plugged either because of pressure from a badly fitting bra, or from engorgement with inadequate emptying of one particular duct. Milk builds up in the duct behind the blockage, causing a lump.
If you treat a blocked duct early, the lump should subside with no further problem. If you do nothing, the surrounding breast tissue will probably become inflamed. This inflammation results from fluid and certain constituents of dammed-up milk escaping, makes the overlying skin redden, and increases your body temperature. Inflammation from a blocked duct alone has been known to make a woman's temperature rise as high as 104ÂºF (40ÂºC)!
Treatment is urgent because stagnant milk - in the blocked duct and the glands supplying that duct, and in the surrounding breast tissue - can easily become infected. Simple measures started at the first suspicion of anything wrong put things right almost every time.
10 steps for treating a blocked duct:
1. Empty your breast thoroughly each time your baby feeds, since the lower the pressure of milk in the breast, the better your chance of clearing the blockage. Check your baby is well positioned, let him feed as long as he wants, and express the milk remaining after a feed. 2. Vary your feeding position at each feed. This simple tip is one of the most helpful. If possible, position your baby with his chin over the block; the milking action of his tongue and lower jaw then have a better chance of clearing it. 3. Feed your baby more often if your breasts - or part of a breast - feel lumpy after a feed. This ensures frequent drainage of the ducts. Fit in as many extra feeds as you can, even if you're already feeding on demand. 4. Offer the affected breast first to ensure best possible emptying, and either return to it later in the feed, or express it afterwards. 5. Gently but firmly massage the lump towards the nipple during a feed (and after if it's still there) in an attempt to release the block and its dammed-up milk. 6. Check your bra isn't pressing anywhere and causing the block, especially if you wear one that leaves a band across the top of the breast when its flap is open, or you pull the cup of an ordinary bra down to feed, or your bra has an underwire that presses on your breast because it doesn't fit well. 7. Relieve pain by applying a hot wet compress every hour, or putting a covered hot water bottle over the area. Immersing the breast in a basin or bath of hot water for five to 10 minutes before a feed may help too. 8. Take antibiotics if the lump persists after 24 hours. This will prevent infection, and your doctor can prescribe ones suitable for a breastfeeding woman. Don't stop feeding. Eating some bio yoghurt twice a day, or taking probiotic capsules (from a health store), will help prevent the antibiotics causing diarrhoea and, perhaps, thrush. 9. Get plenty of rest and relaxation. Go to bed - even if only for one day it will make you feel better and may boost your resistance. This wil help prevent any local inflammation spreading. 10. Take more exercise - as this may help dislodge the block. Do whole body exercise to boost your general circulation, plus shoulder, arm and upper-body stretching exercises.
Check your sleeping position Some women find that sleeping on their front can result in a blocked duct!
This means the breast is inflamed. Many people assume every inflamed breast is infected, but studies show that of every two women with mastitis, one has engorgement or a blocked duct, the other has an infection. It's important to recognise a breast infection because this is potentially serious and needs antibiotics. Mastitis is most likely to begin in the upper part of the breast, in the side nearest the arm. If left untreated, local inflammation can spread.
Breast infection (mastitis with infection)
Breast inflammation due to infection can be called mastitis with infection, infected mastitis or simply breast infection. It happens to around one in 40 breastfeeding women, most often between two and five weeks after childbirth. Infection may affect just one part of the breast, or the whole of it. The infected area is red, swollen, hot, painful and tender, the overlying skin is shiny, and the woman feels shivery, ill and achey, as if she has flu with a high fever. She may feel sick or be sick, and sometimes it's possible to squeeze pus from the nipple. If only a part of the breast is involved, the symptoms are like those of a blocked duct, but worse. If the infection involves the whole breast, it may look as if it's badly engorged, but unlike severe engorgement, which nearly always affects both breasts, mastitis due to breast infection usually affects only one.
If you have obvious signs of infection, and initial tests suggest you need an antibiotic, your doctor will prescribe the one he thinks most likely to help.
What to do if you have an infection
Take antibiotics early. Flucloxacillin (500 milligrams four times a day) is best to start with, as long as you aren't allergic to penicillin. (If you are, you can take 500 of erythromycin twice a day). Neither will harm your baby. (Tetracycline, ciprofloxacin and chloramphenicol are unsuitable, as they can harm a breastfedbaby). Check your feeding technique and in particular keep your breasts frequently emptied by your baby and/or by expression or pumping. This maintains your milk supply and helps healing. If you let your breasts remain too full - or try to let your milk dry up - you run the serious risk of getting an abscess. Rest more. One study showed that women with mastitis due to a breast infection had had fewer hours of sleep at night than other women, and were less likely to be taking daytime naps. Look after yourself! Treat the pain with hot flannels. Find effective ways of managing stress, as high stress levels can lower your resistance to infection. Check you are eating a healthy diet with plenty of fresh fruit and vegetables. Try gently smoothing in some vitamin E cream, or a simple cream scented with three drops of geranium oil to each tablespoon.
Causes of breast infection
Breast infection can occur any time in breastfeeding women. Some women have been breastfeeding successfully for several weeks or months. However, certain breast infections follow poor or delayed treatment of engorgement, a blocked duct or a cracked nipple. Other infections are thought to enter the breast via the nipple from the baby, who is likely to have picked them up in hospital and been carrying them in his nose without symptoms.
And remember, it's almost always better to go on breastfeeding: better for the baby and better for you.