Breastfeeding pains – part 2

In the first article, we discussed various problems that can cause pain during breastfeeding. Engorgement, mastitis, blocked milk ducts and abscesses are the topics that we will address this time to help you understand those problems related to breast tenderness.

Engorgement and blocked milk ducts

Breast engorgement and blocked milk ducts are related to an overflow of milk or liquid. This is a common issue, especially during lactogenesis. Those problems often cause swelling. The first thing to do to solve this kind of problem is to get the milk out. It is important to never leave a breast engorged or a milk duct blocked because those issues often cause mastitis. Here is a little checklist to help you out in case of engorgement or blocked ducts.

1- Express breast milk
Express some milk by directly feeding your baby, with a breast-pump or manually. Be careful, you can express milk manually only if your breasts are not swollen. Hot water can also help you get the milk out. Take a good shower or apply warm compresses on the congested area.

Many women believe that the more they express milk, the more they will produce and they avoid using a breast pump in case of engorgement. It is true that if you empty your breast, you stimulate it and that your production will increase depending on the breast pump that you use. However, when breast engorgement occurs, you can use the breast pump to express an ounce or two. It will help you relieve the discomfort caused by engorgement or a blocked milk duct. It will not stimulate the milk production. Word of advice: when you use a breast pump, choose a cup of the appropriate size.

A few suggestions to express milk

  • Breastfeed your baby as often as possible, with efficient feedings while your baby is well awake.
  • Regularly change your nursing position.
  • Express milk manually.
  • Use your breast pump. I suggest consulting a lactation sponsor or consultant to avoid over-stimulating your production.
  • Apply warmth locally, where it is painful and engorged. Heat is applied before or during breastfeeding but it should not be applied between two feedings. Cold can also help reduce the swelling but it affects the milk flow. If you are not sure whether to choose cold or warmth, ask a breastfeeding consultant to advise you and help you make the right decision.
  • Take a bath or a hot shower.
  • Make sure that your bra is well adjusted… not too tight. A badly fitting bra can block your milk ducts.
  • Massage your breast while feeding without inducing pain. When milk flows, you avoid complications!

2- Stimulate your bloodstream
Taking a bath is a good way to help stimulate your blood circulation. Acupuncture is also a great solution and can even help you increase or decrease your milk production. When you rest, try to lie flat on your back. Regularly move your shoulders in circles and ask your partner to massage your back.

3- Reduce swelling and inflammation
Talk to your pharmacist about the best medication to use in your situation. Cabbage leaves can also help reduce swelling. You can apply it everywhere, except on the nipple. A naturopath could also suggest many natural approaches whether in homeopathy or cataplasms, to help reduce the swelling.

4- Find tools to manage your pain
Some medication like Tylenol can be used. I suggest discussing with your pharmacist. The tips mentioned above can also make you more comfortable.

5- Prevent or fight infection
Occasionally take your temperature to see if you have fever. Mastitis can happen suddenly when milk ducts are blocked or if engorgement is not treated. Make sure that your nipples are in a perfect state! If you notice cracks, ask for help to avoid bacterial infiltration.

A blocked milk duct feels like a worm to the touch. Sometimes a red line appears where it is blocked. The clogged pore can also leave a white spot or a blister on the nipple. It may be caused by an external factor like a finger or the baby’s nose, a badly adjusted bra or safety belt or it may be because of an internal factor such as residual and thicker milk. Usually, the pain is local. Blocked milk ducts can be treated like an engorgement but more precisely as you can generally tell the exact position of the blockage.


Women suffering from mastitis usually have the following symptoms:

  • Redness
  • Heat
  • Fever (sometimes)
  • Pain in one breast (the pain can be very sharp)
  • Significant tensions in the breasts

Women with mastitis may find it difficult to breastfeed because of the pain but also because the areola and the nipple are very tensed. The milk flow is sometimes delayed or downright impossible.

As soon as you present symptoms of mastitis, it would be wise to consult a lactation consultant, a mentor or a nurse who will help you treat this problem quickly. Some women need medication (under prescription) to cure mastitis.

How to react to the first signs of mastitis:

  • Restart your bloodstream.
  • Reduce swelling and inflammation.
  • Find ways to manage the pain.
  • Run your milk, keep breastfeeding and use various nursing positions.
  • Keep checking the state of your nipples to avoid hurting them.

Mastitis is sometimes inflammatory and other times infectious. You cannot easily see which one you are suffering from but when it is bacterial, you must treat the infection with antibiotics.


When you have an abscess, your breast suffers from both inflammation AND infection. In case of abscess, the woman can notice a mass on her breast. It is an accumulation of pus. The mass can be more or less round with small bumps. Redness is significant. Often, the abscess is the consequence of mastitis. If you have an abscess you can keep breastfeeding without being worried because pus cannot get in your milk.  However, it is important to consult and to avoid trying to treat it at home because some women may need drainage or prescription medication.

As you can see, many of those problems are directly related. A neglected engorgement may cause mastitis and lead to an abscess. Never neglect your breasts and remember that pain is not normal when you breastfeed. Many resources are there to guide you and give you the tools you need. Don’t hesitate to consult them to avoid any problems. Breastfeeding is an experience that should be pleasant and positive. You may experience little issues but it should be easily resolved… if you have the right tools!

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