Contemplating causes and solutions for painful nipples

Breastfeeding shouldn’t hurt. Or at least that is what all the books say. The reality is that most women will experience some discomfort and painful nipples in the beginning, which mostly will pass in a few days as they get used to the sensation and learn how to get it right.

For some women breastfeeding is agony, and nipple pain is a common reason why women stop breastfeeding. And this should not be the case.

There are five common causes and solutions for painful nipples while breastfeeding:

1. Poor positioning and latching – suspect if you have pain in the early days of breastfeeding that lasts throughout a feed and results in cracked and bleeding nipples.
2. Nipple thrush – suspect if you have burning, itching pain that started after you’ve been comfortably breastfeeding for a period of time.
3. Raynaud’s syndrome – suspect if your nipples blanch white after a feed and first turn blue and red before returning to normal colour
4. Mammary constriction syndrome – suspect if you also have sore neck and shoulder muscles, or have stabbing pains into the breast, or have pain that remains despite trying everything else
5. Incorrect expressing – you guessed it; suspects if you experience pain during expressing.

Let’s look, at these in more detail:

1. Poor positioning and latching

The number one cause of nipple pain is a baby not latching correctly. During a good latch baby should pull the nipple and part of the areola deep into the mouth, and then compress the nipple between the back of the tongue and the soft palate to get out milk. The tongue should come out over the lower gums and ‘cup’ the breast. If the nipple is not pulled in deep enough into the mouth he will compress the nipple between the tongue and the gums or the hard front palate, which can be excruciating.

In the early days of breastfeeding it’s quite common to experience some pain during the first few sucks, as baby is pulling the nipple in properly. If the pain goes away and the feeding continues without pain from there on it usually means that baby is getting it right. You may need some assistance getting the initial latch right though.

Signs and symptoms of a poor latch:

• Pain while baby is sucking that continues throughout the feed – this can be a biting or a rubbing sensation
• Cracked or bleeding nipples
• A nipple squeezed into a lipstick shape after a feed
• You may see hollows in baby’s cheeks during sucking, or hear sucking noises

Solutions:

• Seek help early, as this is not a problem that is going to fix itself
• Make sure that you position baby correctly – baby’s body should be turned towards you (tummy to mommy), and baby should be held tightly against you. Point the nipple to the nose so that baby has to extend his neck a little bit and come up with his chin first.
• Try feeding in laid-back positions as this typically yields a deeper latch
• Apply breastmilk to your nipple, or alternatively a 100% lanolin ointment.
• Rinse your nipples with a saltwater solution (5ml of salt in 250ml of water) after feeds to prevent infection
• Avoid other lotions and potions without seeking professional assistance

2. Thrush 

Nipple thrush or Candida is a fungal infection on your nipples. It should be suspected when you experience painful nipples after a period of comfortable breastfeeding. If you’ve had cracked and sore nipples for a few weeks Candida can enter those wounds and can become the reason why you continue to struggle. If you tend to generally struggle with Candida infections you should especially be aware.

Signs and symptoms of nipple thrush:

• Pain during feed that continues for a period after you have stopped feeding
• You may experience a burning sensation on the nipples
• Your nipples may itch
• Sometimes they can be bright red/pink
• Shooting pains into the breast
• Occasionally one may see white fungus growing on the nipple
• Expressing breastmilk will also be painful
• Baby may have oral thrush or a Candida nappy rash

Solutions:

• Wash your hands before touching your nipples – Candida often spreads from a vaginal infection
• Remember that candida thrives in dark, warm moist environments; air your nipples during the day and try to expose them to a few minutes of sunshine (don’t shock the neighbours!)
• Lower your sugar intake as this leads to Candida growth
• Be sure that you are properly sterilising nipple shields, dummies and breastpump equipment as this may be where the Candida is growing
• Change your breast pads frequently
• Wash your bra’s and shirts in hot water and hang them in the sun
• Apply coconut oil to your painful nipples, alternating with Daktarin gel which is a gel used to treat oral thrush in babies
• You will need to treat baby as well, as Candida will also be in his mouth and you will keep re-infecting each other.
• Improvement of symptoms may only come after a few days
• Continue treating your nipples and baby’s mouth for two weeks to ensure that it doesn’t come back
• If these tips don’t help you may need to see a doctor for a prescription of oral thrush medications

READ THIS: Five basic tips for breastfeeding

3. Raynaud’s Syndrome 

In Raynaud’s syndrome the blood vessels in the nipples contract and cut of blood supply to the area during feeding. There are various reasons for this. It is more common in women also suffering from winter’s hands and feet, and may be triggered by cold.

Signs and symptoms of Raynaud’s Syndrome:

• Severe and throbbing pain during and after feeds, that may take relatively long to go away (not just a few seconds or minutes)
• The pain may have started in pregnancy already
• Pain may also occur in-between feedings
• Nipple blanching (turning white) after a feed, as the blood flow to the area is limited. Remember that the most common cause of blanching is still a poor latch
• The nipple may first turn blue or purple before returning to normal colour

Solutions:

• Avoid cold; in fact, keep your whole body warm if it’s cold outside
• Apply a warm cloth to the breast as soon as baby comes of, or in-between feeds whenever you experience pain
• Gently massage the nipple with olive oil to improve supply
• Avoid caffeine, nicotine and cold/flu medications containing pseudoephedrine
• Consider dietary supplementation with fish oils and with calcium/magnesium
• Your doctor can prescribe nifedipine for 2-3 weeks, which often sorts the problem completely

4. Mammary Constriction Syndrome 

This is a common cause of painful nipples that has been discovered fairly recently. Sometimes a mother sits in an uncomfortable position feeding for long periods. Other times she may tense up when she needs to latch baby because her nipples may be sore because of other reasons. Whichever way, this creates tension in the muscles of her neck, shoulders and chest wall. The effect is similar to Raynaud’s Syndrome – a narrowing of blood vessels that reduces blood flow and oxygen to the nipples, but this time due to tense muscles!

Signs and symptoms of mammary constriction syndrome:

• Nipple pain that can be confused with either a thrush infection or with Raynaud’s Syndrome. However, none of the treatment tips for these conditions will help
• Be especially on the lookout for stabbing pains into the breasts
• You may also experience tense and painful shoulders and neck muscles

Treatment:

• Be sure to position yourself comfortably before bringing baby to your breast for latching
• Be sure not to hunch forward during feeding
• Avoid lifting heavy bags or car seats
• Do pectoral muscle massage, a technique described by Dr Jack Newman. It involves rubbing the chest muscles (not your breast) quite vigorously for about 45-60 seconds on the affected side. There are four places to massage: 1) above the breast against the chest wall; 2) between her breasts just to the side of the breast bone; 3) under the breast against her rib cage; 4) on the side of her body, beside her breast, against the rib cage. One of these four areas is likely to be the ideal spot for her to relieve her pain.

5. Incorrect expressing 

If you express with a flange that is too small for your nipple this will cause bruising and trauma to the nipple while you are expressing. This is a surprisingly common cause of nipple pain as many women do not even realise that there are different flange sizes available.

READ MORE: How to find the perfect flange for pumping

Also, be sure not to set your breastpump’s suction levels too high. A good tip is to increase suction until it becomes painful, and to then dial it 1-2 settings lower. This level will differ from mother to mother. You don’t need to express on the strongest setting to get out enough breast milk.

If despite all of the above you still experience pain, don’t lose hope. Seek assistance from a lactation consultant as solving painful nipples can be tricky and you may well not be able to do it on your own.