Mastitis: What to do when your breasts are painfully inflamed

Mastitis is a painful infection of the breast that affects up to 30% of breastfeeding women. The infection can cause pain, swelling, and sometimes fever, making breastfeeding a challenging experience. Mastitis can also occur in women who aren't nursing. Understanding the causes, symptoms, and ways to prevent mastitis can help women navigate this difficult, but treatable, challenge.

What causes mastitis?

Mastitis can occur if milk hasn't properly drained from the breast during breastfeeding. Some factors that can lead to improper draining of milk include:

• missed feedings
• a poor latch
• bras that are too tight or constrictive.

As milk pools in the breast, milk ducts (thin tubes that carry milk from the breast to the nipples) can become blocked, creating an ideal environment for bacteria to grow and cause infection. (Bacteria can enter the breast through small cracks in the nipple or through the milk ducts.) Bacterial infections that result from these conditions can cause breast tissue to become inflamed. This is called lactational mastitis.

Lactational mastitis is the most common form of mastitis. But less common types of mastitis can occur in women who are not breastfeeding. Periductal mastitis is a benign condition that causes inflammation of breast tissue surrounding milk ducts behind the nipple. The cause of periductal mastitis is not clear.

Mastitis symptoms

Mastitis symptoms can come on very suddenly. Lactational mastitis is most likely to occur during the first three weeks after giving birth.

Symptoms can occur in one breast or both breasts and may include:

• breast pain
• breast swelling
• a breast that feels warm or hot to the touch
• redness of the skin of the breast
• hard, sore lump in the breast
• flulike symptoms such as fever, chills, body aches, and fatigue
• yellowish discharge from the nipple
• skin changes like pink or red areas on the breast, which may look triangular or wedge-shaped.

Home remedies to relieve symptoms

Several home remedies and measures can help to relieve symptoms of lactational mastitis.

One of the most important things you can do is to frequently and fully empty the affected breast or breasts. Unless you do this, milk will continue to build up and infection may worsen. To help empty the breast(s), you should try breastfeeding more often. Starting on the sore breast can help. To help with pain and ease the flow of milk, you can apply heat like a warm compress, or take a warm shower before nursing.

You can also try massaging the painful area toward the nipple during feeding or pumping to help relieve symptoms. After feeding, you can hand express or use a pump to fully drain the milk. Using a cold compress after breastfeeding may help reduce pain and swelling.

Keep in mind that rest, hydration, and proper nutrition are key to recovery. Ask your doctor before taking nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin) to help relieve pain while you are breastfeeding.

Wearing a supportive but nonrestrictive bra is also important for comfort and healing.

Medical treatments for mastitis

During the first 12 to 24 hours, conservative care like rest, heat, cold, and continued breastfeeding can help significantly in relieving symptoms of lactational mastitis. If symptoms don't improve within 24 hours, contact your doctor, who may prescribe antibiotics.

Your doctor can advise you on how best to manage your pain. This is important because pain can interfere with milk flow. Ibuprofen is often preferred over acetaminophen (Tylenol) because it reduces both pain and inflammation. Up to 1,600 milligrams (mg) per day of ibuprofen is considered safe during breastfeeding, but talk to your doctor about your individual circumstances.

Most people with lactational mastitis recover with proper treatment. Up to a third of women may experience a recurrent bout of mastitis.

Periductal mastitis is usually treated with antibiotics.

Preventing mastitis: Tips for breastfeeding

Here are some tips to help prevent mastitis while breastfeeding:

• Feed your baby on demand to avoid going too long between feedings. This ensures your milk production matches your baby's needs and helps prevent milk from pooling in the breast.
• Avoid pumping more than necessary; this can lead to an oversupply of milk.
• Make sure your baby is well positioned and has a good latch to help them effectively take in milk. A lactation consultant can provide help and support. Or contact your doctor's office to ask about other resources.
• Try different breastfeeding positions to find what's most comfortable for you.