Mastitis: Causes, signs, symptoms and treatment options breastfeeding mums should know

Mastitis is an infection of the breastfeeding mother's breast tissue. Typically, this infection is caused by bacteria entering the milk duct through a break or crack in the nipple. It can also occur if the plugged or blocked milk duct isn't treated accordingly.

Discover the causes, symptoms, treatment, and impact of mastitis on breastfeeding. Expand your knowledge on this condition for a better understanding of its complexities.

While mastitis can occur in women who are not breastfeeding and even in men, it often happens to those who are nursing. 

It usually affects only one breast at a time but if a mum has had it before, there is a big chance that she will have it again. This problem is most common in the first two to three weeks but can occur in any stage of lactation.

You may have a lot of questions about this condition, like, "How do I know if I have mastitis?" or "When to go to the hospital?" Arming yourself with the right knowledge is important. This is so you understand that you do not need to stop breastfeeding while you have the condition, and in fact, continuing so can be better for you and your baby.

What is the main cause of mastitis?

Mastitis can be both painful and frustrating. Understanding its main cause is essential for prevention and effective management. Let's delve into the primary culprit behind this condition:

• Inadequate breast milk removal

Proper and frequent removal of breast milk is crucial for maintaining healthy lactation. Incomplete emptying of the breasts can lead to a buildup of milk, causing engorgement and increasing the risk of mastitis.

• Milk stagnation or blocked milk ducts

Blocked milk ducts, often caused by milk not flowing freely, can create a favourable environment for bacterial growth. The stagnation of milk can occur due to factors such as tight-fitting bras, poor latch or positioning during breastfeeding, or infrequent nursing or pumping.

• Bacterial infection

Mastitis can occur when bacteria, usually from the baby's mouth or the mother's skin, enter the breast tissue through cracks or nipple damage. These bacteria can multiply and cause inflammation and infection.

• Weakened immune system

A weakened immune system can make breastfeeding women more susceptible to mastitis. Factors such as fatigue, stress, poor nutrition, or underlying health conditions can compromise the immune response and increase the likelihood of developing mastitis.

• Engorgement or oversupply of milk

When breasts become overly full and engorged, it can put pressure on the milk ducts, leading to blocked ducts and mastitis. An oversupply of milk can contribute to engorgement and increase the risk of mastitis as well.

Mastitis symptoms

How do I know if I have mastitis?

Mastitis is pretty obvious when it occurs. This is because there is a significant change in breast appearance and considerable pain is felt on the affected breast/s.

Here are some mastitis symptoms to watch out for:

• Hard, swollen breasts

• Warm, reddened and tender breasts

• Presence of red streaks over the breast

• Fever and chills (of 38.5 degrees or higher)

• Fatigue and flu-like body aches

• Headaches

• Expressed milk may look gelatin-like or stringy

• Milk may also include mucous pus or blood

• Milk may taste saltier due to the increased sodium

• Nausea or vomiting

• Pus coming out of the nipple

• Pain when breastfeeding

Can you breastfeed with mastitis

Yes, it is generally safe and encouraged to continue breastfeeding when you have mastitis. In fact, breastfeeding can help alleviate the symptoms and aid in the healing process.

Although it may be uncomfortable or painful, it's important to empty the affected breast frequently to prevent milk stasis and promote milk flow. Breastfeeding also helps maintain milk supply and prevent complications like abscess formation.

However, if you find it too painful to nurse directly, you can try different breastfeeding positions, express milk, or use a breast pump to empty the breast. Consulting with a lactation consultant or healthcare professional can provide guidance and support in managing mastitis while continuing to breastfeed.

Treatment for mastitis

While it is a scary thing to experience, mothers should not fret. Mastitis is a very curable infection, and the treatment will not affect breast milk or breast tissue. 

You can do the following for mastitis treatment:

1. Antibiotics

The most commonly prescribed medication for mastitis is antibiotics. Safe for both the breastfeeding mummy and baby, antibiotics like Augmentin or amoxicillin can help kill the mastitis-causing bacteria and eliminate pus from inside the breast tissue.

 It is recommended that mums with mastitis go for between 10 to 14-day courses. Antibiotics should be prescribed by a doctor.

2. Pain relievers

When you have mastitis, fever can be one of the symptoms. Take fever medication (antipyretics) if you have a fever. Ibuprofen or panadol can help to reduce numerous symptoms of mastitis such as fever, swelling, and pain. 

Just like antibiotics, it is important to note that any medicine should only be taken when prescribed by the doctor.

3. Drainage via an incision

If the swelling of the breasts won't go away immediately, the doctor can make a small incision on the breast in order to manually drain the pus. This treatment is very effective and provides almost instant relief.

4. Supportive measures

Mastitis-infected mothers should get a lot of bed rest, especially when they are experiencing fever and fatigue. Warm compress with breast massage helps get the swelling down while encouraging milk letdown.

Do also increase fluid intake and get adequate nutrition. If possible do also get help around the house during this stressful period.

How to prevent mastitis and manage the condition

Even with this infection, mummies should never decrease or stop breastfeeding. It may be uncomfortable or painful, but it is the only way to prevent plugged ducts and relieve engorgement of the breast.

Aim to nurse every two hours.

If you are concerned about the health of your baby, express a few drops of milk out from the infected breast before suckling. When actual breastfeeding is not possible, pump the breasts to drain them of milk completely.

1. Before nursing

Use heat and gentle massage before breastfeeding. Use a warm compress and take a very warm shower, as heat helps to improve milk flow. When in the shower, apply soap to your breasts and a wide-tooth comb.

Comb your breast gently toward the nipple with the wide-tooth comb to improve circulation. 

You may see the affected part turning red; this means that this method is working. Combing improves blood circulation and helps the milk flow out more easily. Loosen your bra and wear comfortable clothing that will not restrict your milk supply.

2. While nursing

Nurse on the affected breast first. If it's too painful then nurse from the affected breast immediately after let-down. Find a good position to feed and make sure you have a good latch.

Ensure the position you choose allows you to massage your affected area. Massage gently but firmly from the plugged area toward the nipple. Do also nurse while leaning over the baby (dangle feeding) to maximise the use of gravity and the baby's suckling to help.

3. After nursing

Use a cold compress or cold cabbage leaves between feedings for any inflammation.

As for how to prevent mastitis, here are things you can do:

• Moisturise the nipple to prevent cracking and irritation.
• Breastfeed frequently.
• Use a breast pump and make sure the parts fit properly.
• Make sure your baby is latched properly.
• Wean gently and slowly, not suddenly.

How do I know it's cleared?

When mastitis is cleared, you will feel your breast go back to normal. There will be no hardened lumpy area and your breast will be softer. It will still have some residual soreness but that will ease off.

How to stop breastfeeding without getting mastitis

If you've come to the decision that you want to stop breastfeeding, there are ways you can do so while preventing mastitis. In the same vein, you may want to know how to reduce your milk supply without getting mastitis.

You can do it by phasing it out gently. Aside from giving you and the baby time to get used to the idea, gradual stopping will also prevent problems. These include having engorged breasts, being overfull, and mastitis. 

Start by dropping one feed at a time. You know your baby best, so you can decide which of the feeds to drop. If your baby finds comfort in night feeding, you may want to drop that last. 

One way how to reduce your milk supply without getting mastitis is NOT to bind your breasts. Breast binding may cause clogged ducts and lead to mastitis.

In addition, ensure you maintain taking good care of your breast tissue. This is to avoid bacteria from entering via cuts and sores, which can lead to infection.

If during weaning you develop a symptom of mastitis like fever, call your doctor to know if you'll need antibiotics or other types of treatment.

Need help? Don’t fret!

If you have mastitis, knowing when to go to the hospital is important to get your concerns addressed. If you have symptoms that worry you, do not hesitate to call your doctor.  You may also refer to a lactation consultant, who can offer you more personalised advice according to your and your baby's situation.

This article was first published in theAsianparent.