Engorgement, Clogged Ducts, and Mastitis

Breast Feeding Mama Talk Staff

Engorgement is that feeling when your breasts are rock solid and probably painful and tender.  Typically it happens either when your milk comes in or baby is not eating as usual for whatever reason (for example, you left baby for the afternoon with their grandma and you did not pump to replace the feedings).  With the second option the answer for it is quite simple, to pump or hand express so your breasts are emptied similar as to if the baby was eating.  The first option can be a little more difficult.  Although you can hand express or pump a little, it is important to remember that whatever the amount you express, your breasts will make again.  As this is a period of learning how much baby needs and your supply is regulating, dealing with engorgement by milk expression can make the cycle continue, with too much milk being made that is not being consumed by the baby (this is potentially dangerous as we will discuss later on).  The ways to deal with pain and discomfort from engorgement are:

  • Getting baby to breastfeed to effectively drain the breasts of milk
  • Warm/cold compresses, whichever gives most relief
  • Warm shower where you express only enough to give a little relief (or alternatively you could pump out enough to give relief)
  • Tylenol or ibuprofen to help with pain
  • Cabbage leave compresses will help to dry you up a little (However caution with this remedy as overuse of this product will cause you to dry up too much)

If the engorgement is not relieved or you continuously express too much and the body continues making more milk, it could lead to an oversupply.  This is dangerous because an oversupply can lead to milk stasis and clogged ducts.

  • When milk is not effectively evacuated from the breasts and stays in a singular space for too long.  This can lead to clogged ducts and the growth of microorganisms, which can lead to mastitis (discussed below)

  • Clogged Ducts: area of the breast where milk flow is obstructed, this typically only affects one breast, and is perceived as: a wedge shape area of engorgement (which may feel painful, warm too touch, swollen and be red in colour).

- How to deal with clogged ducts:

  • Breast massage
  • getting baby to breastfeed on the affected side and make sure the breast is being drained effectively (aim for every two hours at least, and remember if baby is not breastfeeding effectively to pump/hand express as appropriate)
  • Resting as much as possible
  • Adequate fluid intake
  • Adequate caloric intake
  • Warm compresses before feeding and cold compresses between feedings (this will help with pain/inflammation)
  • Hot shower combined with massage of the breast tissue
  • Again pain medication such as Tylenol or Ibuprofen are safe to take while breastfeeding and may help with the potential pain

- Other risk factors for milk stasis/clogged ducts besides engorgement: ineffective milk removal (due to latching troubles, nipple pain/cracked nipples, sleepy baby, etc.), skipped feedings (such as the scenario above or overuse of a pacifier, baby starting to sleep longer at night, supplementation and sudden weaning), stress, fatigue, and a weakened immune system.

There is a potential with clogged ducts for microorganisms to grow and this could lead to a breast infection or mastitis.  Symptoms of mastitis include:

  • Similar symptoms in the breasts as a clogged duct

AND added to that is

  • Flu like symptoms (fever, chills, aching etc. which are all signs of systemic illness)

Mastitis is most common in the first 2-3 weeks (as your supply is regulating, etc. as we discussed above), and other risk factors include: cracked nipples (which can cause a portal of entry for bacteria), hospital stay (due to increased risk of exposure to bacteria that could cause harm), previous history of mastitis, weakened immune system, stress and fatigue.

It is very important if this happens to seek medical attention, as potentially, you will need a round of antibiotics to help control the infection (but do not worry there are many safe breastfeeding antibiotics available!)  The antibiotics are an important step because if mastitis is not taken care of, it can lead to an abscess in the breast.  Other remedies for mastitis include what is listed above for clogged ducts.  Lastly, as an aside, if you are taking antibiotics it is important to remember that there is a potential for thrush so a probiotic might be a good idea to invest in as a preventative measure.

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