When Breastfeeding Hurts - how to trouble shoot and stop the pain

Are you curling your toes in pain at each breastfeed? Are you becoming anxious and dreading every feed? It’s normal to feel some nipple tenderness in the early days, a bit like breaking in a new pair of shoes – your nipples have never worked this hard before - but breastfeeding isn’t meant to be really painful.

If your nipples are burning, stinging or even bleeding, call in an expert such as a lactation consultant or see your doctor for a diagnosis. It’s important to treat cracked nipples as bacteria can enter the cracks and may lead to mastitis.

Preventing sore nipples

• One of the major causes of nipple pain can be a poor latch at the breast - often made worse by interventions such as pushing your baby to the breast and feeding holds that interfere with your baby's natural ability to seek and latch at the breast.
•  Nipple soreness can be related to dryness and cracked skin from inappropriate treatment (such as using soap), a lack of skin suppleness or nipples that are not especially ‘stretchy’. Some experts recommend massaging your nipples with a nipple balm  before the birth, to increase suppleness.
•  After your baby is born, it’s usually better to avoid creams, as these may encourage the growth of Candida Albicans (thrush) or bacteria – there is also information suggesting that some bugs can become resistant to antibiotic based creams so in some cases, creams may prolong wound healing.  
•  Many mothers swear by breast milk to keep nipples healthy and research shows that this is even more effective than applying lanolin.- squeeze out a little breast milk after feeds and massage your nipples, then air dry your nipples.
•  Make sure your bras aren’t squashing your nipples flat – some bras apply pressure that pushes your nipples inwards and moisture in the resulting crevices can be a breeding ground for bacteria, often resulting in a ‘ring’ of nipple damage around the base of the nipple.
•  Vitamin supplements can help healing and boost your immune system – try a good pregnancy/breastfeeding multivitamin containing zinc and vitamin E and take evening primrose, omega 3 oils (found naturally in oily fish such as salmon, tuna and sardines or flaxseed) and vitamin C and D.

  Let's look at the causes of nipple pain - and what will help

Often one look can tell us what’s causing nipple pain and what you can do to fix it and make breastfeeding the relaxing, natural experience it is meant to be:

Squashed nipples- check baby's latch

If your nipples are squashed after a feed, this usually means there is a problem with your baby’s latch or suck. Changing your baby’s position at the breast can help but it’s important to check if there is an underlying problem such as atongue tie: sometimes the little membrane called the frenulum which joins the middle of the tongue to the floor of the mouth is too tight and ‘ties’ or restricts movement of your baby’s tongue so that attaching and sucking effectively is difficult.

This can cause pinching as your baby feeds and after a feed, your nipples can look like the pointy end of a lipstick or they may have a graze or crack across your areola.

Get a professional to check a feed and assess your baby’s mouth – they need to feel inside your baby’s mouth, not just see that he can poke his tongue out. A tongue tie can be revised easily by a doctor or dentist or some IBCLC Lactation Consultants, and you will be able to breastfeed immediately after the procedure.  You may be surprised how quickly breastfeeding becomes pain free.

Nipples turn white – nipple vasospasm

Nipple vasospasm is caused by poor peripheral circulation. You may notice that your nipples look white after a feed, when they are exposed to cool air after a shower or if you treat sore breasts with cool-packs. They may also turn purple before they return to their normal colour.

As you feed, vasospasm will cause a stinging , stabbing pain, and as circulation to your nipples returns and they regain their normal colour, you will feel an intense burning feeling. Some asthma medications, decongestants, caffeine, cigarette smoking (even two cigarettes a day can affect your circulation), a condition called Raynauds’s phenomenon or poor attachment to the breast may be contributing factors to vasospasm. Vasospasm can be avoided or treated by:

• Exercising to increase circulation
• Keeping yourself warm (for example, breastfeeding in a warm room)
• Applying heat packs to your breasts before and after feeds (cool packs are nor appropriate if you have vasospasm)
• Taking supplements of magnesium and a six week course of evening primrose or fish oil. There is also a prescription medication (Nefidipine) – discuss this with your doctor.

‘White spot’ – milk blister or ‘bleb’.

You may notice a small painful white lump or blister on the tip of your nipple. This tends to occur when skin grows over one of the nipple pores, causing milk to block up behind the skin and thicken.

These spots often open and clear during a feed, but if not, you can help the blister open and clear by soaking your nipple area in warm water or applying a warm wet compress before feeding. If this doesn’t work, you will need to open the nipple pore with a sterile needle ( if you aren’t comfortable doing this yourself see your doctor). It can often be easier to do this after your baby has sucked a little. Once you have opened the blister, remove the thickened milk by expressing or continuing to feed your baby.

Red, shiny, stinging nipples – nipple thrush (Candida Albicans)

Nipple Thrush is a fungal infection. It’s most likely to occur if you or your baby are treated with antibiotics (which can kill natural gut bacteria), as well as during summer and in hot humid climates (which encourage yeast growth). Nipple thrush can also occur if you have vaginal thrush or if you or your partner has tinea.

Your first symptoms of nipple thrush may be excruciating, shiny red nipples or a burning pain deep in your breasts. If your baby is affected (you can transfer thrush between baby’s mouth and your nipples), he may suddenly have difficulty latching on or he may fuss unusually while breastfeeding.

Look inside your baby’s mouth : thrush produces a white cheesy substance on the insides of his cheeks and/or tongue and you won’t be able to wipe it away. In the early stages, thrush may not be obvious inside your baby’s mouth – your red stinging nipples will be the first sign and your baby may develop a red angry looking nappy rash. 

If you suspect thrush see your health care provider as soon as possible. Your doctor can make a diagnosis (symptoms of nipple thrush can be similar to symptoms of a bacterial infection) and prescribe medication and an antifungal cream such as Kenacomb which is antifungal and antibiotic. You will need to treat baby’s mouth too as infection can be passed back and forth from baby to you and vice versa. Meanwhile, there are some environmental precautions you can take to reduce/alleviate thrush:

•  To prevent reinfection, apply antifungal cream to your nipples, wash bras frequently, use disposable nursing pads and boil all dummies, teats and toys that come in contact with your baby’s mouth. Insist that everybody who handles your baby washes their hands first.
•  Reduce thrush in your body by eliminating refined sugar, alcohol and yeast from your diet (use yeast –free breads and avoid products such as vegemite). Increase your intake of plain yoghurt containing live cultures and try foods as kefir , sauerkraut and kombucha or take a probiotic supplement to increase the ‘good’ bacteria that control yeast in your gut.
•  Keep your nipples dry (avoid creams other than those advised for the treatment of thrush)and expose them to sunshine when possible.
•  Make sure any family members who have a fungal infection such as tinea are also treated; they will need to adhere to the diet too.