Chronic Nipple/Breast pain

by Leticia
(Guadalupe, Ca)

I have a breastfeeding issue. My baby is 4 months old, solely breastfed. It doesn't seem urgent enough to see Dr and I don't qualify for WIC to seek a consultant. About 6 weeks ago when my baby started sleeping through the night, I think I had a plugged duct? It was hurting to nurse on the left side all day. At night before bed I noticed both breasts were empty except the inside of my left breast. It was hard and painful to the touch. No fever. No chills. Just hard tender lump. I tried to unclog it from recommendations online and the tender lump went away after 3 days. However it was still painful to nurse on that side. 1 week later the lump returned and it was painful and swollen again. The lump went away again, however, its been 6 weeks and its still painful to nurse on the left breast. No tender lump but it still hurts when I touch it and my breast hurts all day long. Sometimes I get sharp shooting pains deep inside my breast. My nipple hurts bad and I don't have any nipple trauma. I dont have chills or fever indicating an infection. Any clues as to what may be causing it? Would you recommend I see my Dr?

Answer from the lactation consultant
I am so sorry you have experienced painful breastfeeding.
It does sound consistent with a plugged duct. And the symptoms you describe sound like those consistent with vasospasms. It is residual nerve pain from the plug or possible infection. I have several recommendations.
1. I would see your doctor and have your breastmilk tested for infection. It is possible you have a residual bacterial infection that needs to be treated. Make sure he/she also evaluates you for thrush as well. Or you could see a lactation consultant. The hospital where you delivered should give you a referral to a lactation consultant or to a la leche league leader.
2. YOu can try applying cold compresses to the breast before and immediately after the feedings. Cold works most of the time but I have seen moms who benefit from heat, so you can try both. A good way to apply a compress is to fill a disposable baby diaper with cold or warm water and apply it to the breast. NO leaking, kinda neat, huh?
3. Avoid caffeine as it usually contributes to the nerve pain
4. Medications: ibuprofen usually helps the pain. Supplements of B6, calcium and magnesium could help. If your doctor feels these are truly vasospasms he/she could prescribe a drug called procardia which works to relax blood vessels.
5. If you feel the plugged duct has not truly resolved, then you can take a supplement called lecithin to help resolve and prevent future plugged ducts.

All this being said, I would highly recommend you have a physical exam by a board certified lactation consultant who can guide you along your recovery.

I am NOT a medical doctor and am NOT diagnosing your condition. These are simply recommendations based on your description. If you want a diagnosis please see your doctor.

Liz Pevytoe, RN, IBCLC