Treatments for Raynaud's Phenomenon (blanching of the nipple)
Raynaud's phenomenon is due to spasm of blood vessels preventing
blood from getting to a particular area of the body. It occurs in
response to a drop in temperature. Most commonly, Raynaud's
phenomenon will occur in the fingers, typically when someone goes
outside from a warm house on a cool day. The fingers will turn white
and the lack of blood getting to the tips of the fingers will cause
pain. Raynaud's phenomenon occurs more commonly in women than men,
and is often associated with illnesses such as rheumatoid arthritis.
Raynaud's phenomenon can also occur in nipples. In fact, it is much
more common than generally believed. It can occur along with any cause
of sore nipples, but it may also, on occasion, occur without any other
kind of nipple pain at all.
Typically, Raynaud's phenomenon occurs after the feeding is over,
once the baby is already off the breast. Presumably, the outside air
is cooler than the inside of the baby's mouth. When the baby comes
off the breast, the nipple is its usual color, but soon, within
minutes or even seconds, the nipple will start to turn white. Mothers
generally describe a burning pain when the nipple turns white. After
turning white for a while, the nipple may actually turn back to its
normal color (as blood starts to flow back to the nipple), and the
mother will notice a throbbing pain. The nipple may go back and forth
between colors (and types of pain) for several minutes or even an hour
or two.
The treatment for Raynaud's phenomenon is to fix the original cause
of the pain (poor latch, Candida etc). Almost always, as the nipple
soreness from another cause is getting better, so will the pain from
Raynaud's phenomenon get better, but more slowly. Fixing the
original cause of the pain (improving the latch, treating Candida
etc) should be the focus of treatment. However, some mothers no longer
have pain during the feeding, or never had it at all. Indeed, some
start having Raynaud's phenomenon during the pregnancy. If the pain
is mild, there may be no reason to treat, and reassurance is all that
is necessary. However, in some cases it is worth treating, especially
if severe, and especially if the pain during the feeding does not
improve, as severe restriction of blood supply to the nipple may delay
healing.
The first choice for treatment is:
-
Vitamin B6. This has shown to work by
trial and error, but it does seem to work. There is no scientific
evidence that it works, but it does nevertheless. It is safe and
will do no harm. The dose is 150 mg/day once a day for four days,
followed by 25 mg/day once a day. The mother continues it until
she is pain free for a few weeks. It can be restarted if
necessary.
If vitamin B6 does not work within a few days, it
probably won't. It is then useful to try:
-
Nifedipine. This is a drug used for
hypertension. One 30 mg tablet of the slow release formulation
once a day often takes away the pain of Raynaud's phenomenon.
After two weeks, stop the medication. If pain returns (about 10%
of mothers), start it again. After two weeks, stop the medication.
If pain returns (a very small number of mothers), start it again.
Very few mothers I am aware of took more than three courses. Side
effects are uncommon, but headache does occur.
This article may be copied and
distributed
without further permission
 About the
Author
JACK NEWMAN
graduated from the University of Toronto medical school as a pediatrician in 1970. He
started the first hospital-based breastfeeding clinic in Canada in 1984 at Toronto's
Hospital for Sick Children. He has been a consultant with UNICEF for the Baby Friendly
Hospital Initiative in Africa, and has published articles on the subject of breastfeeding
in Scientific American and several medical journals. Dr. Newman has practiced as a
physician in Canada, New Zealand, and South Africa.
If you would like to contact Dr. Newman, you can mail him at: newman@globalserve.net
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