Plugged duct and milk blister causing painful nursing, down to twice a day!

QUESTION: My problem started about 2 months ago. I had a plugged duct and a milk blister that wouldn't heal. I went to a nursing specialist without much improvement, then to my doctor/nurse. I took a yeast infection pill with no improvement. Then I took penicillin and their was some improvement for about a week. The blister has turned into a crack so that pain of reopening it with each feeding is gone but now I have another problem. I am down to nursing first thing in the morning and last thing at night (because of the pain I have cut down from 4 times a day to just 2). After her morning feeding as the milk comes in I have very sharp pains that last for sometimes 3 to 4 hours. There are lumps near my nipple that can be massaged away but are painful.

This is my second child and with the first I nursed for a year with no problems. I am very frustrated. I called the doctor/nurse this morning and she said, sorry there is nothing more we can do for you.

So the question is should I stop? It makes me very sad. I am not ready but I also cannot deal with the pain anymore.

Thank you for listening. Any help you can give me will be much appreciated.

Dear Lorie,

No, you don't need to stop breastfeeding! You just need to get proper treatment. I believe that what you have is an unresolved yeast infection. Blisters often go along with yeast. Pain ALWAYS does! And still another "clue" you gave me is the pain after your morning feeding. Yeast tends to cause worse pain at the end of the feeding or between feedings. This is not so with other causes of nipple pain. The pains are usually described as sharp, stabbing, stinging, or shooting pains--often deep in the breast. It has been my experience that most health professionals are not really familiar with this. There are even a good number of "lactation specialists" that don't know either how to recognize this or how to treat it.

You can print out some of the information below and share it with your doctor(s) if you'd like. Most physicians that are breastfeeding-friendly say that they have learned the most about breastfeeding from the moms they have worked with. You said you took a "yeast infection pill." Was it diflucan? If so, it normally takes at least two weeks to get rid of yeast in the breast. Quite often, it takes even longer than that! There is a website address below that gives detailed information about dosage, etc. Also many women are now resistant to some anti-yeast medications. So if one doesn't work, it's a good idea to try something else. I know a number of women who have used both diflucan and clotrimazole at the same time with good results.

As you have unfortunately found out, yeast can be extremely painful and difficult to get rid of. I doubt there is anything else than can cause such awful pain for a breastfeeding mother! But help is available, and no mother should have to deal with pain while breastfeeding! Breastfeeding is meant to feel good. If it doesn't, then she needs to get help! If a breastfeeding mom has yeast on her nipples or in her breasts (or both), then it will never go away unless BOTH MOM AND BABY are treated. Babies are often without any symptoms, but you are still passing it back and forth.

Your doctor can give you a prescription for oral nystatin for your baby or you can go to a drugstore and purchase Gentian Violet. Gentian Violet is available over-the-counter and is very inexpensive. It is also very messy--it stains everything it touches purple. Coating the baby's face with Lanolin will help keep it off the face when applying it in the mouth. Most women tell me that, even with the mess, they still prefer it to other medications because it works very quickly--usually within 3-4 days. Dr. Jack Newman, who is a Canadian pediatrician and breastfeeding expert, recommends this as the best course of treatment for breast yeast. You can read what he has to say about both yeast and Gentian Violet by clicking on the blue letters:

http://www.erols.com/cindyrn/6.htm

(Dr. Newman now is saying that, if pain is not gone after 4 days, stop the gentian violet. However, if it is better, but not gone, continue for 7 days.) Diflucan is another medication that is used to treat yeast. It is an oral pill given to both mother and baby. Unlike vaginal yeast, it will not go away after just a couple days. It takes weeks of treatment. It can also be quiet expensive, so unless you have a prescription drug card, it probably won't be feasible. You can read about this also by clicking on the blue letters:

http://www.erols.com/cindyrn/20.htm

Another medication used to clear up yeast in women is clotrimazole. This, too, is available over-the-counter (i.e. Lotrimin or Gyna-Lotrimin.) This should be rubbed into the nipples after each feeding. A small amount is all that is needed--you do not need to "gob" it on. You will have to continue this for a week beyond the point where the pain goes away. With this treatment, it may take a week or more to begin getting relief. Your baby will have to be treated with Nystatin (or Diflucan). Yeast can cause blisters, cracking, bleeding, and open wounds on the nipples. Sometimes, even with treatment, these may be difficult to heal. Any open wound can also allow bacteria into the body, so you can also have a bacterial infection in addition to the yeast. Because of this, Dr. Newman has come up with what he calls an all-purpose nipple ointment. If you have a supportive physician, you might show this to him. A pharmacist can mix it for you. Again, just click on the blue letters:

http://www.bflrc.com/newman/overheads

Many women have also found relief from using cortisone cream. Be extra conscientious about washing your hands during the treatment time. Yeast spreads easily. You also will need to boil on a daily basis any rubber nipples (bottles, pacifiers) you are giving your baby. Good luck! Let me know how things go. Hopefully you and Leah will be a happy nursing couple again soon.

Cher Sealy RN, BSN, IBCLC, LLLL

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