Plugged Duct or Yeast?

I am pretty sure I have a clogged milk duct, and I've tried all the things suggested -- warm compresses, gentle massage, pain killers, etc. There appears to be a whitish cyst on the middle of my nipple and the pain when I nurse is so excruciating it makes me cry. This is the third time this has happened since Ali was born.

The first time, I actually had visible cracks toward the base of the areola, so that may have been something different. We were both treated for thrush and I rented a double pump. She was around 8 weeks at the time, and somehow, we survived. Then about 2 months ago, I got very sore nipples and the pain went away on its own after several days.

The present condition has been going on for around 4 days. I really hate to give up on nursing because I believe strongly in its beneficial impact on the baby and would prefer not to have to prepare formula. I nursed my son for 8 months with few problems and had hoped to nurse Ali at least a full year. Three bouts of painful episodes like this, however, make me wonder if I am going to have persistent and chronic problems. I did visit a lactation consultant the first time and she didn't see any problems with the hold or latching on. Ali has been to the pediatrician recently and has no signs of thrush.

I don't feel I'm getting much support or assistance from my OB. What should I do? It seems like my breast (the right one -- which is where most of my milk is -- the left one is fine) is not emptying even after she nurses, and when I pump, I'm not getting as much as I normally would. Could a doctor do something to unclog the duct? I nurse lying down and using the cradle hold (I've never been comfortable with the football hold). The baby seems fine and I'm not worried that she's being effected by this, but I'm in agony. She is on solids (fruit, cereal and veggies) and her weight is fine. Should I give up?




 

Dear Tracey,

What you are describing does not sound at all like a plugged duct. Plugged ducts are very uncomfortable, but they are never excruciating. It sounds to me like you have a very stubborn case of unresolved yeast. Nothing causes such exquisite pain for a breastfeeding mother. The "whitish cyst" you describe is often seen with yeast. Yeast is very stubborn, as you have found out, and often very difficult to treat. What medication did you use for yourself and for how long did you use it? It is generally recommended now that anti-yeast medications be used for at least one week after the pain is gone. But many women are resistant to one or more medications, so you may need to try another.

Has anyone told you about gentian violet? It is very inexpensive, available over-the-counter, and works quicker than any other anti-fungal. Unfortunately, it is called gentian violet because it is a purple dye. It stains everything it touches, including any clothing that it gets on, and also skin. But many women have told me it was worth it because it works so quickly--within several days.

There is information at the following website about gentian violet and also diflucan, which is a prescription systemic medication for treating yeast. http://www.erols.com/cindyrn/drjack0.htm Remember that babies can be re-infected by toys or rubber nipples. It is important to boil anything that goes into your baby's mouth (besides your own nipples!) while you are treating for yeast. Hand washing is also very important. Many women have been helped by making dietary changes. Reducing the amount of sugar you eat can help. Adding acidophilus to your diet can also be very helpful. You should be able to get information about this from any good health food store. Acidophilus tablets reestablish the good bacteria that keep the yeast populations down in and on our bodies. This is probably the best natural way to resist yeast.

You mentioned that you are not getting as much milk out as you used to. That is also to be expected with yeast. The reason is that you are in pain. The letdown reflex is inhibited by many things, including fear, fatigue, anxiety, and pain. As you get rid of the yeast, your supply will go back up. It is important to understand that babies can be asymptomatic and still be passing the yeast back and forth with you. Both of you have to be treated simultaneously.

Cher Sealy, RN, BSN, IBCLC, LLLL





 

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