If you’ve got pain, redness or swelling in your breast, it could be engorgement, a plugged duct or possibly an infection. Here’s how to ease common pains and when to see the doctor.

Engorgement

Fullness is different from engorgement. Breasts normally become full two to three days after birth. Engorgement is caused by increased blood supply, fluids and milk in the breast tissue and is usually painful. Normal fullness decreases within the first two to three weeks if your baby is nursing regularly. But if your baby doesn’t remove enough milk because of a skipped or limited feeding time, your breasts may become tender and engorged. An engorged breast may flatten your nipple and make it harder for your baby to latch on.

If breasts continue to be full and uncomfortable, here’s how to ease engorgement:

• Apply cold compresses to both breasts as needed between feedings. The cold will feel good and decrease the swelling.(Baggies of frozen peas work as well as cold compresses.)
• Try a warm shower or hot washcloths on your breasts, or lean over a sink to let your breasts rest in warm water before nursing.
• Massage your breasts to promote milk flow.
• Use hand expression to soften the areola before latch-on.
• Nurse often (at least 8 to 12 times in 24 hours).
• Don’t skip feedings.
• Wear a supportive bra and get in a comfortable and supported position for feedings. Avoid underwire bras.
• Consult a lactation consultant for additional help.

Plugged Ducts

Sometimes milk ducts become clogged due to incomplete emptying or continued pressure on one or more ducts. If this happens, you may feel a hard, lumpy, painful area on your breast. To treat a plugged duct:

• Apply warm, moist towels to your breasts before feeding.
• Massage your breasts down toward the nipple, paying special attention to the painful area.
• Nurse your baby more often: every one and a half hours if possible.
• Breastfeed on the side with the plugged duct first. (Babies suck hardest on the first breast.)
• Breastfeed in different positions, placing your baby’s chin in the direction of the plugged duct.
• Put a little lotion on your thumb and apply steady rolling pressure from behind the outer lump toward the nipple while your baby breastfeeds.
• Get plenty of rest and fluids.
• Avoid tight clothing. Look to see if your baby carrier or bra is rubbing the painful area.
• Avoid sleeping on your stomach or the side with the plugged duct.

The area may still be tender once the plug is gone. Continue to examine your breasts daily to check for plugged ducts. If the plug doesn’t go away in several days, contact a lactation consultant or your healthcare provider.

Contact your healthcare provider immediately if you develop fever and flu-like symptoms. The plugged duct may have turned into mastitis.

Mastitis

Mastitis usually shows up as a red, hard, hot and painful area on the breast. You may also have a fever greater than 100.4 degrees and feel as if you have the flu.

Fatigue is a leading cause of mastitis. Sometimes a plugged duct will become infected or bacteria will enter the breast through another route, such as an open sore on the areola or nipple.

If you suspect you have mastitis:

• Don’t wait for it to go away. Contact your healthcare provider immediately for treatment with antibiotics that are safe for you and your baby.
• Continue nursing! Your milk is not infected and will not harm your baby.
• Complete the entire treatment of antibiotics (7 to 10 days) so the infection doesn’t come back.
• Contact a lactation consultant to teach you how to prevent mastitis from happening again.

Thrush

The candida (yeast) organism is normally present in the mouth, gastrointestinal tract and vagina. Typically, your body’s “good” bacteria prevent an overgrowth of candida.

Candida overgrowth causes a fungal infection called thrush, which grows in warm, moist conditions. This yeast overgrowth can affect any part of the body, including the breasts and nipples in breastfeeding mothers.

You may be at risk for thrush if you have:

• Taken or are currently taking antibiotics.
• Cracked nipples from poor latch-on or positioning.

Thrush symptoms include:

• Pain! This may be the only symptom. Pain may indicate thrush especially if pain continues after correcting poor latch-on or positioning, even after several weeks or months after successful breastfeeding. You may feel a burning, shooting or stabbing pain in the nipple, breast tissue or both, either during and after feedings or pumping. Sometimes pain between feedings is stronger.
• Nipple itching, flaking, redness, shininess or sometimes white patches.
• White patches on the baby’s tongue or inside the mouth.
• Diaper rash, gas and fussiness in the baby.

If you suspect thrush, contact your healthcare provider. It’s wise to treat both you and your baby at the same time, even if breast pain is the only symptom. Treatment should continue for two weeks, even if symptoms disappear.

Any items that come in contact with your baby’s mouth or your nipples can contain yeast. Follow these recommendations while treating thrush and to prevent its return:

• Boil all items that come in contact with your baby’s mouth for 20 minutes every day, including toys, pacifiers, bottle nipples, etc.
• Replace pacifiers and bottle nipples weekly.
• Any breast milk that was expressed and then frozen during a thrush outbreak may re-infect your baby later. To avoid this, boil the milk to destroy the yeast.
• Keep the breasts as dry as possible and exposed to air whenever possible.
• Use disposable bra pads.
• Use hot, soapy water when washing bra pads, bras or diapers. One cup of bleach in the wash water or one cup of vinegar in the rinse water can be effective. Line-dry all items thoroughly in the sun or in a hot dryer.
• During an outbreak, use paper towels for hand drying. Use bath towels only once before washing.