Blocked ducts and mastitis

What are the differences between blocked ducts and mastitis?

Blocked duct

A blocked duct is an area or segment of the breast where milk flow is obstructed causing a tender lump or spot in the breast.

Local symptoms:

• Reddened area or segment of the breast which becomes tender, hard and painful
• Occasionally there can be localised tenderness or pain without an obvious lump

Systemic symptoms:

Occasionally a low grade fever may be present—less than 38.5 degrees celsius.

Mastitis

Mastitis is an inflammation of the breast that can be caused by obstruction, infection or allergy.

Local symptoms:

• Reddened area or segment of the breast which becomes tender, hard and painful
• Occasionally there can be localised tenderness or pain without an obvious lump
• Usually more intense pain/heat/swelling than a blocked duct
• There may be red streaks extending outward from the affected area

Systemic symptoms:

• Fever of 38.5 degrees Celsius or greater
• Flu-like symptoms—joint aches and pains, lethargy. Often rapid onset of symptoms.

Side effects of blocked ducts and mastitis

Blocked duct

• Your milk supply from the affected breast may decrease temporarily. This is normal—extra feeding or expressing will return your supply to normal
• You may express strings of thickened or fatty looking milk
• After a blocked duct has resolved, it is common for the affected area to feel bruised or remain reddened for a week or so afterwards

Mastitis

• Milk supply from the affected breast may decrease temporarily. This is normal—extra feeding or expressing will return supply to normal
• You may express strings of thickened or fatty looking milk
• After the mastitis has resolved, it is common for the affected area to feel bruised or remain reddened for a week or so afterwards
• Your breast milk may taste salty due to increased sodium and chloride content. If your baby is breastfeeding they may fuss due to this change in taste. If your baby is being tube fed they will not notice any difference
• Your breast milk may occasionally contain blood or pus

Common causes of blocked ducts and mastitis

Blocked duct

Milk stasis (restricted milk flow) due to:

• Poor attachment or restricted feeding or expressing
• Tight or ill-fitting clothing
• Consistently sleeping on one side causing pressure on the breast
• Holding your breast tightly during feeding or expressing
• White spot on your nipple occluding nipple pore
• Stress and fatigue
• Anaemia

Mastitis

Milk stasis (restricted milk flow) due to:

• Delayed treatment of a blocked duct
• Previous mastitis
• Damaged nipples
• Oversupply
• Poor attachment during breastfeeds
• Poor general health
• Poor hygiene—not changing your breast pads or washing your hands after changing nappies; contact with your baby’s sticky eyes; and before handling your baby
• Anaemia

Breastfeeding management (the same for both blocked ducts and mastitis)

General management

• Breastfeed or express every two hours, or as frequently as possible, and empty your breasts well. Aim to keep the affected breast as well drained as possible
• Rest
• Eat nutritious foods and drink adequate fluids
• Before breastfeeding or expressing—use heat and massage
• Apply warm compresses to your breast—such as a warm pack or face washer rinsed in warm water
• If expressing is becoming difficult and you feel very full and uncomfortable, try filling a bowl with warm water and add a handful of Epsom’s salts—one handful of salts per two litres of water—and submerge the affected breast in the water. If this is too difficult, try soaking a washer in the solution and apply to the affected breast. Rinse with fresh water prior to feeding or expressing to remove the salty taste
• Massage the affected breast in a warm shower or try to hand express while under the warm water
• Loosen your bra and any other constrictive clothing prior to feeding or expressing

While breastfeeding or expressing

• Feed on the affected breast first. If the breast is too painful, start on the comfortable side then switch back to the affected breast after let-down. If your baby is not yet breastfeeding continue to express and massage the breast over the blocked area down towards the nipple
• Try feeding or expressing while leaning forward so gravity may aid in draining the breast

After breastfeeding or expressing

• If your baby has fed on the affected breast and a lump can still be felt, express after the feed until the breast feels well drained. Massage over the affected area while expressing
• Apply a cold pack to the breast for 10 minutes after feeding or expressing to help reduce pain and inflammation

Pain medication

Take regular pain relieving medication if required—an anti-inflammatory such as ibuprofen (Nurofen) is preferred. If you are unable to take this type of medication take paracetamol as directed on the box.

Antibiotics

• Antibiotics are not needed to treat a blocked duct
• However, if you have been unable to relieve the symptoms of a blocked duct after 12 to 24 hours or if you develop a fever, you should see your GP, as soon as possible, for further management
• If antibiotics are required it is still safe to continue breastfeeding or expressing milk for your baby
• Consider taking a probiotic to reduce the risk of thrush

To avoid further problems

• Do not wear bras, or other clothing, that are too tight

• Avoid sleeping on your stomach

• Do not go for long periods without either breastfeeding or expressing

• Rest when you are able

• Drink adequate fluids

• Ensure correct attachment

• Ensure the breast pump is positioned correctly, if you are expressing

• Regularly examine your breasts for lumps and massage these while feeding or expressing

• This is not the time to wean. You need to keep your breasts empty at this time in order to avoid a breast abscess

References Ramsay DT, Kent JC and Hartmann PE. Anatomy of the lactating human breast redefined with ultrasound imaging. J. Anat. 2005; 206: 525–34.

Find out more about Mater Mothers' Hospital here