Frequently Asked Questions - Breast Pain

A plugged duct is when one of the ducts (tubes) that carries milk from the “milk factory” in your breast to the nipple is blocked in some way—usually by a thick clump of milk. It might be tender or feel bruised, and you may be able to feel a lump.

Plugged ducts either result from milk not being taken out (baby sleeps through the night, misses a feeding or changes how he nurses) or pressure on a milk duct (tight bra/clothing, straps from a baby carrier or bag, how you sleep). Very often two causes happening at the same time creates the problem.

Nurse frequently on the affected side.  Nurse in different positions. One position that mothers find especially helpful is the all-fours position. (To use this position lay your baby on his back.  Get on your hands and knees or elbows and knees. Gravity will help get the milk out as baby sucks on the breast hanging down.) Whatever position you use, it is especially helpful to have your baby’s nose and chin in line with the hard area. A few minutes of heat applied to the tender area before nursing can also be helpful. Gently massage or apply pressure to the hard area after applying heat or while nursing to help dislodge the plug.

With a plugged duct, there is a hard, tender area (about the size of a pea, sometimes larger) in one breast that may hurt when you press on it; you do not feel sick, just uncomfortable in that specific area. With mastitis on the other hand, a larger part of the breast is painful and tender to touch, will feel warm or even hot, and may look red and swollen. Most mothers will have a fever and feel achy and sick, like when they have the flu. Many mothers will feel sick enough that they will want to be in bed.

No. In fact, you will want to nurse more often on the affected side. A breast infection may require treatment with antibiotics (see next FAQ).  Most antibiotics are compatible with continued breastfeeding. Your baby will not get sick from drinking milk from your affected breast.

A common cause of a breast infection is normal bacteria from your skin entering the milk ducts through a crack on, or other damage to, your nipple.  Most likely this crack is from a shallow latch. Sometimes a breast infection follows a plugged duct and can be caused by the same things: irregular feeding patterns or missed feedings, tight clothing (bras, bathing suits, etc.), pressure on the breast from a baby carrier, heavy purse or diaper bag, sleeping on one’s stomach and unusual stress or fatigue.

Nurse frequently on the affected side, get extra rest and drink plenty of fluids.  Many mothers also find heat on the sore breast helpful. Drop any activities except for breastfeeding to lie down and rest. If you are doing all of this and are the same or worse after 24 hours, contact a health care provider. If your fever or pain is worsening rapidly then see your doctor the same day. You may also wish to discuss pain relief options with your health care provider.  Many mothers find that pain relievers which have anti-inflammatory effects are the most useful. Antibiotics may be required to treat the infection. Most antibiotics are compatible with breastfeeding.

There are many kinds of heat sources you can use. Many mothers find that moist heat (wet washcloth) is more effective than dry heat (heating pad). It is most important that the heat source to be not too hot or it might cause minor burns to the skin. Heat is required for 10-15 minutes at a time to be effective. Some commonly used safe heat sources are:

  • A washcloth soaked in hot tap water (Wring out excess liquid, re-soak as required.)
  • A (clean) disposable diaper soaked in hot tap water (stays warmer longer than a washcloth)
  • Soaking affected breast in a bowl of hot water
  • Soaking in a hot bath with the affected breast under water
  • Allowing water from a hot shower to flow over your breast. You may be most comfortable with your back to the shower, so that the water is not directly hitting the breast.
  • Magic Bag™ or similar bag which can be heated
  • Hot water bottle (Be sure to place cloth between bottle and skin.)
  • Re-heatable gel packs (There are some made specifically for use by breastfeeding mothers.)
  • Heating pad, set on low

Yes. Because the breast is hot and inflamed, some mothers find that cold or cool compresses applied between feedings (not during as it constricts the vessels) makes them feel more comfortable.

Use heat or cold, whichever works best for you.

While many mothers can completely avoid mastitis without extra thought, a few mothers have to be more careful. First, make sure your baby is latched on well so that you avoid cracked nipples and there is no way for germs to get in. Mastitis is much less prevalent when mothers feed their babies as frequently and for a long as the baby wants, i.e. on cue. If your baby suddenly changes his sleeping and eating pattern, your breasts will need to adjust to longer stretches without being emptied. Listen to your body: express a little milk, or wake the baby, if needed. Your body will figure out a balance with time. Avoid unnecessary activities and listen to your body’s signals that you may be doing too much. Rest when your baby naps.  Eating nutritious whole foods can help you stay healthy.  Make sure that your bra and other clothing are not too tight, especially when your breasts are full of milk.

To encourage, promote and provide breastfeeding, chest feeding and human milk feeding support and educational opportunities as an important contribution to the health of children, families and society