Mastitis

1 What is Mastitis?

Mastitis is an infection of female breast tissue, which causes pain, inflammation, and redness, sometimes accompanied by fever with chills.

It occurs most commonly among women who breastfeed (lactation mastitis), and usually 1 in every 10 breastfeeding women may develop mastitis.

It generally occurs within the initial three months of giving birth to a baby (postpartum), but may also occur during the later months of breastfeeding. However, non-breastfeeding women may also develop mastitis.

The condition can prompt a mother to wean her baby before she intends to, but continuing to breastfeed is better for the mother as well as the baby, even while she is on an antibiotic for mastitis.

2 Mastitis symptoms

Generally, lactation mastitis develops only in one breast, and the signs and symptoms appear suddenly, which include:

  • Redness and swelling on your breast, often in wedge-shaped pattern
  • Breast tenderness or feeling of warmth, on touching the skin
  • Generally feeling of being unwell (malaise)
  • Breast lump or hard area
  • Pain or a burning sensation that may be continuous or occur only while breastfeeding
  • White or blood tinged discharge from the nipple
  • Flu-like symptoms such as body aches, chills or fever as high as 101 F (38.3° C) or greater

When to see a doctor

Those suffering from mastitis feel ill with symptoms of flu for several hours before identifying an area of redness or tenderness on the breast.

As soon as you come across these signs and symptoms, it is best to contact your OB/GYN.

Your doctor will perform a physical examination of the affected breast to confirm the diagnosis. Oral antibiotics are prescribed to treat this condition.

If your signs and symptoms still do not improve even after the first two days of antibiotic treatment, consult your doctor immediately to check whether your condition is a result of an underlying or more serious problem.

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3 Causes

Lactation mastitis is often caused by milk stasis or a trapping of milk within the breast.

Breastfeeding is a skill, and incorrect feeding techniques may lead to a build-up of milk in the breast, which is the major cause of mastitis.

Other causes include the following:

  • Block in the milk duct: If your breast does not empty completely at feedings, one of the milk ducts can get blocked causing milk to remain in the breast that leads to infection.
  • Bacteria entering your breast: Bacteria from the surface of your skin or your baby's mouth may gain entry into the milk ducts through a cracked or sore nipple.
  • Stagnant milk in a breast provides a breeding ground for the bacteria. However, the antibacterial properties in your milk help protect your baby against the infection.

4 Mastitis diagnosis

Your doctor will make a diagnosis of mastitis based on a physical examination, taking into account its classic signs and symptoms such as fever, chills, and breast pain.

For mastitis, your first appointment will likely be with your regular obstetrician-gynecologist, family doctor or nurse practitioner.

For problems related to breast-feeding, you may be referred to a lactation consultant.

What you can do to prepare for your appointment:

  • List all your symptoms, even if they seem unrelated to the reason for which you have made an appointment.
  • Review your key personal information, including major stresses or recent life changes.
  • List all medications, vitamins, and supplements you take regularly.
  • Write down questions you want to ask your doctor.

For mastitis, some basic questions to ask include:

  • Will my infection subside on its own or do I need treatment?
  • What self-care measures can be taken at home to relieve my symptoms?
  • How does my condition affect my baby?
  • Should I stop breastfeeding my baby? If I continue to breastfeed, is the medication that I take safely for my baby?
  • How long is the course of the medications?
  • Does the infection recur?
  • How to reduce the risk of recurrence?

Your doctor may ask you questions about:

  • Duration of your symptoms
  • Severity of your breast pain
  • Whether the symptoms occur in one or both the breasts
  • Your breast-feeding technique
  • Whether you had breast infections in the past

Another clear sign is a wedge-shaped portion of redness on the breast that points toward the nipple, which is painful to the touch.

Your doctor will ensure that there is no breast abscess — a complication that occurs when mastitis is left untreated.

In a case of severe mastitis, a culture of your breast milk may be done to determine the best antibiotic for you.

A rare type of breast cancer known as inflammatory breast cancer causes redness and swelling that can be confused with mastitis.

Your doctor may order a diagnostic mammogram. If your signs and symptoms do not subside even after completing a course of antibiotics, a biopsy may be done to preclude breast cancer.

5 Treatment

Mastitis can be treated with the following measures:

  • Antibiotics: Mastitis usually requires a 10- to 14-day course of antibiotics. You may feel well within 24-48 hours of taking antibiotics, but you should complete the antibiotic treatment course to avoid the chances of recurrence.
  • Over-the-counter painkillers: Your doctor may recommend a mild pain reliever such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) to reduce pain and fever
  • Adjustments to your breastfeeding technique: Make sure your baby latches on to your breast properly while feeding and fully empties your breasts. Your doctor may review your breastfeeding technique with you or may refer you to a lactation consultant for help and ongoing support.
  • Self-care measures: Get plenty of rest, drink excess fluids and water to stay well hydrated, continue breastfeeding your baby to help your body fight the breast infection.
  • Avoid wearing tight fitting inner wear until your symptoms go away.
  • If your mastitis doesn't clear up after taking antibiotics, it is important to follow up with your doctor so he or she can decide if you need further testing.

6 Prevention

To start off with a good breastfeeding relationship with your infant, and to prevent problems such as mastitis, consider meeting a lactation consultant.

A lactation consultant is able to give you tips and invaluable advice regarding proper breastfeeding techniques.

If you are breastfeeding, you can minimize your risk of developing mastitis by following these measures to stop milk build-up in your breasts:

  • Allow your baby to complete feeding on one breast before changing on to the other breast.
  • Let your baby feed frequently, especially when your breasts feel full
  • Make sure your baby attaches on to your breasts properly during feeding
  • Do not take your baby off your breast until she finishes feeding
  • Avoid taking a long break between two feeds
  • Avoid pressure on your breasts from tight fitting clothes

7 Coping with mastitis

Lifestyle modifications are necessary in order to cope with mastitis.

Breastfeeding may be continued even if you have mastitis as it helps improve your infection. You can breastfeed as often and as long as your baby feels hungry, this can relieve your discomfort.

Take a good amount of rest, preferably lie down in the bed along with your baby as it can encourage frequent feedings. Avoid milk overflow in your breast (engorgement) for a prolonged period.

Change your breastfeeding positions every time you feed your baby. Drink excess amounts of fluids. Apply warm compresses on the breast or take a warm shower just before breastfeeding, if you have difficulty in emptying your breast.

If you experience pain while your baby feeds on the infected breast or your infant does not like to feed on that breast, try expressing the milk by hands or using a breast pump.

8 Risks and complications

Certain specific risk factors that increase your risk of developing mastitis include:

  • Breastfeeding during the initial few weeks following childbirth
  • Sore or cracked nipples but mastitis can develop even without broken skin
  • Breastfeeding using only a single position, which may not fully empty your breast
  • Wearing a tight fitting bra or using a seatbelt or carrying a heavy bag that puts pressure on your breast, which may restrict the milk flow
  • Becoming over-stressed or tired
  • The previous episode of mastitis while breastfeeding
  • Poor nutrition

If mastitis is not treated properly or is associated with a blocked duct, an abscess may form in your breast. An abscess is usually treated through surgical drainage.

9 How to overcome mastitis effectively

Though early diagnosis and timely treatment help to cure mastitis effectively, one has to take precautions to cure it without any delay or prevent it from occurring in the first place.

Having a baby can be one of the most emotionally fulfilling experiences. Life takes a dramatic turn with the arrival of your little one. If you have a newborn, your first priority is to feed your baby. If you have decided that bonding and providing essential nutrients is for you, then you need to know how to prevent or rid yourself of mastitis. Nothing should get in the way of a mother's ability to breastfeed her baby. Education is the best way to overcome mastitis effectively.

10 How to avoid mastitis

Mastitis is highly infectious and not only makes the woman suffer, but also causes acute pain in and around the nipples and develops clogs in the ducts.

There are certain precautions needed to be taken to avoid the mastitis disease or infection.

Nursing mothers should avoid wearing bras, which could develop clots more often. The bra fits around the skin tightly and stops the movement of milk flow in the breast completely. The pressure on breasts should be reduced to a minimum.

Nursing mothers should never sleep on the stomach, which is also another cause of clots. Always sleep on your side or back, which keeps milk flow even and reduces the chance of creating the clogs. It makes it easy to feed milk to the baby.

Always feed the baby on a regular schedule, which helps in continued flow of the milk. The milk is produced daily and it needs to be given without disruption. It also helps to massage the breasts before feeding the baby. Massage helps in avoiding the clots to happen in the ducts. If you keep massaging the breast, you are less likely to have a problem relating to clogging or getting infections.

Have good posture and better position while feeding the baby. You can make use of a feeding pillow which is easily available and is helpful for both mother and baby while feeding milk. Feeding the baby in a good position makes it easier for mother and baby, and the baby gets milk with constant flow.

11 Warning signs

There are certain indications that nursing mothers should be aware of while feeding the baby.

There are many indicators of a possible case of mastitis that every breastfeeding mom should be wary of. These are just a few:

  • At the beginning, there will be a tingling sensation in the nipple but slowly it develops into pain. The pain in the nipple is the first indication of mastitis. But remember that not every breast pain indicates this disease.
  • The disease can make the suckling area sore and red in color. The area around duct starts developing clogs which show smaller red spots and which are extremely painful to the touch. It can even be difficult to carry a baby in your arms due to the pain. A medium sized lump can be observed or felt with touch.
  • The nursing mother may feel weak, tired, and lethargic.

12 Tips to reduce the effects of mastitis

The mother should rest and sleep well. Try not to be too active during the day.

To enhance the immune system, take Echinacea and Vitamin C to fight the infection.

Always consult your physician if the pain persists and you continuously feel uncomfortable.

Use a warm wet compress on the painful area.

Keep feeding your baby while taking mastitis treatment medication.

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