#pregnancy #birthrecovery #csection #the_mummy_mot #newborn #breastfeedingjourney #breastfeeding #postnatalsupport #mastitis #womenshealthphysio #pelvichealthphysio #newmum #postnatal #thisgirlcan #postnatalfitness
Breast engorgement & blocked milk ducts present as painful, tight, swelling of the breast as a result of too much milk. They can cause throbbing pain, hard tender lumps & redness. Both can feel better after feeding but a blocked duct may still feel firm under the skin & if left untreated can lead to mastitis.
Mastitis is a bacterial infection (eg from a cracked nipple) or inflammation of the breast. The body thinks the excess milk is a foreign substance & mounts an immune response making you unwell/feverish, you may need antibiotics & in very worst cases an abscess can form needing surgical intervention
Engorgement commonly occurs in the early days of breastfeeding when your milk comes in with increased blood flow to the tissues, or as a response to cluster feeding, but blocked ducts can happen anytime & can result in reduced milk output.
Typical causes are:
Rushed feeding = incomplete emptying
Missed feeds/pumping, bottle feeding between breastfeeds
Poor latch/feeding technique
Wearing too tight clothing
Carrying something heavy on that side compressing the tissues
Nipple bleb- thin white membrane blocking the exit at the nipple,can also be from a poor latch or pump attachment
Talking to a women's health specialist can help treat the symptoms & identify the cause to avoid recurrence. My little girl has always been a great feeder, so I was a bit surprised when I got symptoms of a blocked duct- especially on her 'favourite boob!', it gets regularly drained-or so I thought. She had recently come out of a Pavlik Harness for hip dysplasia which actually positioned her really conveniently for feeding angles. I had noticed her latch didn't feel quite as comfortable but didn't think too much of it. In hindsight her change in body shape meant I needed to adjust our feeding position.
Here are a few other treatments that are typically advised:
Hydration
Rest
Pumping or feeding regularly & completely
Changing position
Anti inflammatories
Massage
Kinesiotaping
Ultrasound
Acupuncture
Warm baths or showers
Cabbage leaves
Warm or cold compresses
Herbal compresses
It is important to say that if your symptoms do not improve or recur you should seek advice from your GP
Hydration- Drinking plenty of water will help keep your milk supply up. More milk means more feeding sessions and more opportunities to clear clogs and discomfort.
Rest- we're always being told to "sleep when the baby sleeps", & hands up I think I've done that once in 5 months, but doing something restful can still be beneficial. Just not rushing round the house getting all the housework done as quickly & silently as possible. A stressed mum is more prone to mastitis.
Feeding/pumping regularly- Typically they say this, but recent evidence suggests that this is not ideal as it will continue to stimulate the milk production. I believe the key thing is to not neglect the breast & to try to use the milk to help clear any blockage. The information suggests to start on the affected side first & feed often & on cue. With a blocked duct it may be necessary to pump between feeds but not with early lactation engorgement. However, if the breast is too full & hard for baby to latch properly it may help to pump a but before feeding to soften the area & lengthen the nipple.
Changing position- different positions work better for different babies, & uneven pressure on the breast may contribute to a blockage. As your baby grows, in length & weight, you may need to alter your go to positions & use more cushions for support rather than holding them. Talking to a breastfeeding specialist can be particularly useful with this.
Anti inflammatories- can be effective, but if in doubt talk to a pharmacist or your GP
Massage- there are various methods out there to gently help mobilise the tissues & aid drainage, reducing pain & swelling. It can also help clear the blockage. This is not about pummelling the boob like a muscle, but light stroking towards the lymph ducts in the arm pit to help swelling. A women's health physio can help with this & teach you how to do it yourself for regular relief. Some form of massage is the most evidence based treatment & is included in most protocols either exclusively or combined with other treatments.
Kinesiotaping- the lift of the skin away from the tissues underneath when the tape is applied is said to aid circulation for reduction in swelling. This is a common approach used to treat other areas of the body but I couldn't actually find research supporting its use for engorgement or blocked ducts. It must not be used on sites of infection ie active mastitis.
Ultrasound- is one of the most commonly advertised treatments for these conditions. The sound waves vibrate the tissues, which helps to soften & loosen the blockage. They also promote circulation in the swollen tissues via acoustic streaming to 'flush' it out. Although people often report subjective relief following ultrasound I couldn't find supporting research (since the 1980s). It may be that the gentle massage with the probe & cool gel is soothing rather than the actual sound waves? That said, I do still use it as a treatment for certain conditions, particularly very tender areas.
Acupuncture- is an effective treatment for pain relief & treating imbalances in the body. I found mixed results in the research but no negative. Acupuncture was found to be as effective as more conventional treatments & may result in reduced abscess size in mastitis
(Treatments for breast engorgement during lactation.
Zakarija-Grkovic I, et al. Cochrane Database Syst Rev. 2020)
Hot baths/Showers- heat softens the blockage to help clear it & help milk flow ( i found using a hot pack helped with colostrum harvesting so I can see this helping here too). Heat dilates blood vessels which can help flush inflammation. If you don't have a bath it is suggested that you fill a bowl with warm water & Epsom salts & lean over it submerging the breast. Using the shower head you could also gently massage with the water jets. Also relaxing in the bath may help the stressed mums! Nothing to lose trying this one!
Cabbage leaves- its not just an old wives tale! There is some research that suggests putting chilled cabbage leaves on the breast reduces pain & swelling. Now this may just actually be the cold, but cabbage leaves apparently contain mustard oil which is a home remedy for anti-inflammatory treatment. Boh Boi Wong et al. actually found cabbage leaves more effective than gel packs (Application of cabbage leaves compared to gel packs for mothers with breast engorgement: Randomised controlled trial Boh Boi Wong et al. Int J Nurs Stud. 2017 Nov.) This isn't exactly undeniable proof, but it may work for some women.
Warm or cold compresses- the warm benefits are as above but with direct application, which is handy to be able to keep doing things- if you must (she says while typing, carrying the baby & with a warm pack in her bra). Cold compresses are effective for pain relief & reducing swelling between feeds. But best not done immediately before a feed as the cold constricts the vessels.
Herbal compresses- this is quite a broad title really, so first thing to say is make sure whatever you're using isn't toxic to you or the baby if ingested, & not going to cause skin irritation.
However I did find a couple of studies looking at Herbal compress remedies, one with Hollyhocks- which I didn't know were medicinal, they've always been a gardening frustration for me managing rust (any gardeners out there will know what I mean).
In general the studies found herbal compresses may be more effective than heat alone, but the studies also combined treatment with other modalities.
As with every research topic, more research is needed to be conclusive as to the best treatment approach. All of these listed here are safe to try, but as I mentioned before, if your symptoms persist, you become unwell, or the condition recurs, seek medical help.
https://lansinoh.co.uk/blogs/breastfeeding/engorgement-blocked-ducts-and-mastitis
The effectiveness of cabbage leaf application (treatment) on pain and hardness in breast engorgement and its effect on the duration of breastfeeding
Boh Boi et al. JBI Libr Syst Rev. 2012.
The Effect of Hollyhock (Althaea officinalis L) Leaf Compresses Combined With Warm and Cold Compress on Breast Engorgement in Lactating Women: A Randomized Clinical Trial Shahla Khosravan et al. J Evid Based Complementary Altern Med. 2017 Jan.
Effect of Herbal Compresses for Maternal Breast Engorgement at Postpartum: A Randomized Controlled Trial Sukwadee Ketsuwan et al. Breastfeed Med. 2018 Jun.
Comparison of the Effect of Kinesio Taping and Manual Lymphatic Drainage on Breast Engorgement in Postpartum Women: A Randomized-Controlled Trial Hanife Doğan et al. Breastfeed Med. 2021 Jan.
Treatments for breast engorgement during lactation Lindeka Mangesi et al. Cochrane Database Syst Rev. 2016.