Please Help!

[momoffive]

I need some help. I have had increasing pain in my left breast over the past 2 months. It only hurts after my son has eaten from it. I don't have any lumps and we don't have thrush. I was first thinking that the pain was due to being sucked dry and then making more, but it has increased in strength and now I think something is wrong. The strong pain only lasts about 30 minutes after feeding him, but there is still a dull aching pain that really isn't too noticeable. I'm curious more than anything. If anyone could offer advice or let me know if I need to seek medical advice, I would so appreciate it. Thank You!

[whitnessforhim]

I have no advice other than if it were me I'd probably be calling my Dr.

I hope everything is ok!

[Bumpy]

I don't think you have to feel a lump for a plugged duct, but I may be wrong

[madelsmama]

Sounds like nipple blanching/vasospasm/Raynaud's syndrome of the nipple. Could you check out this link and let us know if this sounds familiar?

http://www.kellymom.com/bf/concerns/mom/nipple-blanching.html

Nipple blanching and vasospasm
By Kelly Bonyata, BS, IBCLC

Nipple blanching (turning white) after a feeding occurs when the blood flow to the nipple is limited or cut off. Blanching is most often related to latch problems. Nipple blanching is often, but not always, associated with pain. Because women may describe shooting, burning breast/nipple pain, this can be mistakenly diagnosed as thrush. If the normal color returns after your baby has finished a feeding and there is no pain, then the blanching is not a problem.

Compression blanching | Vasospasm | Treatment options | Resources

Blanching due to compression
The most common reason for nipple blanching is that that baby is compressing the nipple while nursing. This can be due to:

a shallow latch (the most common problem)
improper sucking
baby clamping down to slow a too-fast let-down
tongue-tie
baby clamping due to allergies
clampdown bite reflex
palate variations, etc.
When blanching is due to baby's compression of the nipple, the nipple is white and often misformed (flattened, creased, pointed, etc.) immediately upon coming out of baby's mouth. There may be a white stripe across the nipple directly after nursing. Pain may not start until a few seconds to a few minutes after nursing, as the circulation returns to the nipple. If you are experiencing pain with the blanching, then finding and remedying the underlying cause will also eliminate the blanching.



Blanching due to vasospasm
Vasospasm, which is more severe, is a sudden constriction/narrowing of a blood vessel (in the nipple, in this case) that is extremely painful. It might occur a short time after nursing or in between nursings. Vasospasm can have various causes:

Vasospasm can be a secondary response to pain or nipple trauma (damaged nipples or thrush). In this case, the nipple(s) turns white shortly after nursing (rather than coming out of baby's mouth white and misformed). Mom might notice a white circle on the face of the nipple a few seconds to a few minutes after breastfeeding. Cold often triggers the vasospasm and/or makes it worse. Unlike blanching due to compression, latch and positioning may be fine if the source of any nipple damage has already been fixed. Healing the nipple trauma or other source of pain should eliminate the vasospasms, although they may persist for a short time after the nipple has healed (previously damaged tissue can remain sensitive for a time).

Raynaud's of the nipple
Vasospasm can also be caused by Raynaud's Phenomenon (more info here), which causes sudden vasospasms in the extremities. When nipple vasospasm is caused by Raynaud's Phenomenon (Raynaud's of the nipple), the nipple turns white, then there is usually a noticeable triphasic color change - from white to blue to red - as blood flow returns. The color change may also be biphasic - from white to blue.

Vasospasm due to Raynaud's is more likely to occur on both sides (rather than just one nipple), lasts for relatively long periods of time (rather than for a few seconds or a few minutes), and can occur during pregnancy and/or at times unrelated to feeding. Vasospasms may also occur in fingers or toes. Cold typically triggers the vasospasm and/or makes it worse. Nipple trauma (and other causes of compression blanching or vasospasm) can exacerbate the problem. Raynaud’s phenomenon may recur with subsequent pregnancies/breastfeeding, so be prepared to seek treatment quickly if you have experienced this in the past.

Per Anderson et al, "Because the breast pain associated with Raynaud’s phenomenon is so severe and throbbing, it is often mistaken for Candida albicans [yeast] infection. It is not unusual for mothers who have Raynaud’s phenomenon of the nipple to be treated inappropriately and often repeatedly for C albicans infections with topical or systemic antifungal agents."

Keep in mind that Raynaud's is not caused by breastfeeding (anyone might have it) -- it simply has the potential to affect breastfeeding. For example, any person might have inverted nipples, which might or might not affect a mother's breastfeeding relationship (as this can make latching or sore nipples more of a challenge in the beginning). Raynaud's works the same way - anyone might have it coming into breastfeeding, and it might (or might not) affect the breastfeeding relationship if the vasospasms are triggered by bad latch, a sudden temperature change as baby unlatches, etc.

Some maternal medications have been associated with vasospasm, including oral contraceptives. Fibromyalgia, rheumatologic diseases (eg, systemic lupus erythematosus or rheumatoid arthritis), endocrine diseases (eg, hypothyroidism or carcinoid), and prior breast surgery have also been associated with Raynaud’s phenomenon. Some sources indicate that the antifungal medication fluconazole may be associated with vasospasm, although the manufacturer does not report this as a known complication of fluconazole use. Other sources feel that vasospasms experienced by mothers taking fluconazole are a result of nipple pain/trauma due to thrush (and not due to the medication used to treat the thrush).



Treatment options for vasospasm
Avoid cold. Apply dry heat to the breast when needed (this relaxes the "cramping" blood vessels). Some mothers benefit from keeping the entire body warm (warm clothing, warm room, wrap up in a blanket, etc.)
Cover the nipple as soon as possible after baby comes off the breast. Some moms say that it is helpful use a wool breast pad or a soft cloth diaper.
Apply dry heat immediately after breastfeeding. A rice sock can be useful as a source of dry heat: Fill a sock or a cloth bag with uncooked rice and microwave 45 seconds (or until desired warmth is achieved); hold the rice sock against the nipple (over the cloth or mom's shirt) until blood flow resumes.
Avoid caffeine, nicotine and other vasoconstrictive drugs, as they can precipitate symptoms.
Ibuprofen.
Dietary supplementation with calcium/magnesium.
Dietary supplementation with vitamin B6.
Low dose oral nifedipine.
See links below for additional details

[ima062002]

How does your nipple look like after such a feed? White as if the blood had been drawn from it?

[ima062002]

Oh Cheryl, you beat me to it :).

[madelsmama]

Patricia, :), great minds, ya know?

momoffive, I read in another thread that you have OALD. This could be the cause of the blanching (baby clamps down on the nipple to try to slow the flow). Are you block nursing?

[momoffive]

Nipple blanching sounds like us! I have block nursed and it has slowed my supply. He also has allergies and has been put on a low dose of Benadryl. My nipple does look flattened and has a white crease line when it is released. How do I fix this?

[madelsmama]

What kind of block nursing are you doing?

Do you feel that it is under control?

Talk more about the allergies and benadryl...

[momoffive]

I am offering one breast every 3 hours. I'm not sure it is working. I still spray milk if he releases during a let-down and the opposite breast leaks. I have been doing this for a week now.

As for ds's allergies, he itches. Eyes, ears, nose, even his head. He has been prescribed 1/4 tsp every 4 hours, but I don't give him that much that often.

He is also teething. I don't know if that has anything to do with it.

[madelsmama]

You could give the block nursing a few more days. Another way to do block nursing is to nurse from the same side for two full feeds before switching sides.

Either way, getting the OALD under control is the key to getting relief from the blanching.

If he seem allergic to something, it could be a protein in your milk (from something you're eating). Have you considered eliminating dairy, egg, tree nuts, peanuts, shellfish, etc?

[momoffive]

I'm so afraid of losing my supply. With the block nursing that was suggested, the second feeding on the left breast, ds doesn't get hardly anything. He is able to get 2 full feedings for the right breast. I'm curious if the blanching is left untreated does it have any long term damaging effects? Or will I just be in pain while I continue to bf and then after weaning, I'll be fine?