22. Milk duct obstruction and mastitis

Health education information from Dr. Jack Newman ~~ Milk duct obstruction and mastitis

Mastitis is caused by infection (usually bacteria) and usually occurs in breastfeeding women. However, this condition can happen to any woman, even if she is not breastfeeding, and even to newborns (male and female). No one knows for sure why some people are more likely to get mastitis. Bacteria may enter the vagina through a lacerated or sore vagina. But people without vaginal lacerations or soreness can also have mastitis, and most people with vaginal lacerations or soreness do not have mastitis. Mastitis is different from blocked milk ducts

It is generally believed that blocked milk ducts are not infections and do not require antibiotic treatment. When the milk ducts are blocked, there will be a painful, swollen lump in the vagina. The skin around the blockage is usually red, but not as red as with mastitis. Unlike mastitis, blocked milk ducts usually do not cause fever, but mastitis may cause fever. Mastitis is usually more painful than blocked milk ducts, but both can be painful. Therefore, it is not easy to distinguish between "mild" mastitis and "severe" milk duct obstruction. It's also possible that blocked milk ducts may develop into mastitis, which becomes more complicated. However, if there is no lump in the vagina, there is no mastitis or blocked milk ducts. In France, doctors call mothers whose vaginal skin is painful, red, hot, and combined with fever but have no lumps on their breasts called lymphangite. Apparently they didn't think the situation warranted antibiotic treatment. I have seen several cases where the mothers recovered without antibiotic treatment. Many mothers with mastitis recover without antibiotic treatment.

As with many breastfeeding problems, incorrect latch on and poor emptying of the breast are the causes of blocked milk ducts and mastitis. Blocked Milk Ducts

Blocked milk ducts usually resolve within 24-48 hours of occurrence and do not require any treatment. When this happens, the baby may become restless when sucking on the affected side because the flow on the affected side becomes smaller. The pressure of the lump may cause other milk ducts to collapse. To unblock blocked milk ducts faster, you can: Continue breastfeeding on the affected side and allow the vagina to empty more smoothly. Latch on as correctly as possible (please refer to the information and videos on latch-on on the nbci.ca website). Use expressed milk. Methods to make the milk flow (please refer to the information related to breast expression on the nbci.ca website). If it is not painful, express with your hands along the blocked milk duct while breastfeeding. When feeding, position your baby with his chin facing the blockage. That is, if the obstruction is in the lower part of the vagina (7 o'clock direction), the football position when feeding the baby is very helpful. Apply hot compress to the affected area. You can use a hot compress bag or hot water bottle, but be careful not to make the temperature too high or for too long, so as not to burn the skin (Translator's note: A heating pack is very useful! Try it). Try to rest. Of course, it is difficult to get a chance to rest when taking care of a newborn. Try taking your baby to bed and feeding him there. Blisters (bleb or blister)

Sometimes, but not always, there will be blisters on the nipple (this is not a white spot) when the milk ducts are blocked. If there is no painful lump, it is difficult to determine whether the milk duct is blocked. This is usually painful and can cause *** pain for a few days afterwards. Some mothers develop blisters due to poor latch on their baby in the first few days after birth. No one knows why some mothers develop blisters weeks after their babies are born. Usually mothers with blisters do not have blocked milk ducts.

If it hurts (and it usually hurts a lot), it can be helpful to break it to give you less pain. You can break it yourself, but only once. If it doesn't work the first time, or you're afraid to do it yourself, see a doctor.

– Heat a sewing needle or pin over a fire. Once cool, prick the blister. – Don’t dig! Only prick the blister from the top or edges. – Try squeezing from behind the blister, and you may be able to squeeze something like toothpaste out of the opening. If the blister is accompanied by a blocked milk duct, this action can open it up. Allowing the baby to suck can also keep the milk ducts clear.

Once the blister is punctured, please apply "Full Effect *** Ointment" for one week after each feeding. This is to prevent infection and also prevent the blisters from coming back. Please refer to the relevant information of All Purpose Nipple Ointment (APNO), which requires a prescription. Ultrasound treatment of blocked milk ducts

Most cases of blocked milk ducts will disappear within 48 hours. If it doesn't go away after more than 48 hours, therapeutic ultrasound is usually effective. Most physical therapy or sports medicine clinics can perform this treatment (in Taiwan, you should probably go to a rehabilitation clinic, which has such equipment). Ultrasound therapists with experience in this technology have better results. Some mothers use the flat side of an electric toothbrush to do their own ultrasound treatment. It has a very significant effect. If the blockage cannot be relieved after two consecutive days of treatment, there is no other way! You need to see a doctor for re-evaluation. Usually one treatment is successful. Ultrasound can also prevent recurrence in the same area.

The dose of ultrasound is 2 watts/cm2 and is used continuously on the affected area for 5 minutes, once a day, with a maximum of two treatments. Lecithin is a food additive that, for some mothers, can prevent blocked breast ducts. The principle of its function is to increase the proportion of polyunsaturated fatty acids in milk and reduce the consistency of milk. It's safe, inexpensive, and works for some moms. The dosage is 1200 mg four times a day. Mastitis

If you are already experiencing symptoms of mastitis (*** painful lump, *** red and sore, fever), try to take a break. Go to bed with your baby. Continue breastfeeding during breaks. Rest is the best way to fight infection.

The affected side needs to continue breastfeeding, not to mention the other side. The affected side must be so painful that you cannot breastfeed. Try the side without mastitis first. As long as the pain on the affected side is somewhat relieved, let the baby suck on the affected side. Sometimes squeezing is less painful, but not always. If possible, continue breastfeeding on the affected side. Mothers and babies share bacteria!

Hot compresses can help fight infection. It also helps with the smooth flow of breast milk. Use a hot water bottle or heating pad and remember not to burn yourself.

Fever can help fight infection. Adults always find fever to be a very uncomfortable condition and try their best to reduce it. No need! Fever has no effect on breast milk!

Potatoes (using the method of Bridget Lynch, RM, a community midwife in Toronto), you can apply raw potato slices on the vagina 24 hours after the symptoms begin. This can reduce the pain and redness caused by mastitis. – Slice 6 to 8 raw potatoes lengthwise into thin slices. – Place the potato slices in a large bowl filled with water and bring to room temperature for 15-20 minutes. – Place moist potato slices on the affected area and leave on for 15 to 20 minutes. – Discard the potato slices after 15-20 minutes and replace them with new ones from the bowl. – Repeat these steps two more times, that is, three uses within an hour. – After resting for 20-30 minutes, you can repeat these steps again. Mastitis and Antibiotics

It is generally recommended that antibiotics be avoided whenever possible. Because mastitis may resolve on its own, antibiotics may cause *** or *** Candida infection. Our treatment policy is as follows: If your symptoms of mastitis occur within 24 hours, we will still prescribe antibiotics, but please wait until the following conditions occur – If the condition becomes worse in the next 8-12 hours The worse it gets (more pain, red, swollen lumps getting bigger), start taking antibiotics. – If your symptoms don’t get worse but don’t get better in the next 24 hours, start taking antibiotics. – If symptoms begin to improve within the next 24 hours, symptoms will usually resolve naturally without the need for antibiotics. In this case, it usually takes 2-7 days to recover. Fever usually disappears within 24 hours, pain resolves within 24 to 72 hours, and lumps disappear within 5-7 days. Sometimes it takes more than 7 days for the lump to completely disappear. As long as it gets smaller, that's a good thing.

If mastitis symptoms persist for more than 24 hours and do not improve, antibiotics need to be administered immediately.

If you need antibiotic treatment, take the right antibiotic. Amoxicillin, plain penicillinc, and other antibiotics commonly used to treat mastitis do not kill the bacteria that most commonly causes mastitis (Staphylococcus aureus). Antibiotics that can kill this bacteria include: cephalexin (our usual drug of choice), cloxacillin, dicloxacillin, flucloxacillin, amoxicillin bined with clavulinic acid, clindamycin, and ciprofloxacin. Antibiotics available for community-acquired methicillin-resistant Staphylococcus aures (CA-MRSA): cotrimoxazole and tetracycline.

These antibiotics can be used by breastfeeding mothers without interrupting breastfeeding. There is no need to interrupt breastfeeding due to MRSA infection. In fact, continued breastfeeding can reduce the chance of infection in your baby!

Pain-relieving and antipyretic drugs can help you get through this uncomfortable period (ibuprofen, acetaminopen and others). These drugs, like other drugs, pass into breast milk in very small amounts. Because it does not have anti-inflammatory effects, it may be less effective than other drugs (such as ibuprofen). *** Abscess

*** The treatment of choice for abscesses is no longer surgical. Using ultrasound to locate the abscess and then placing a catheter to drain it has better results. Mothers treated with this method do not need to interrupt breastfeeding and usually recover within 1 week. This treatment is usually performed by a radiologist, not a surgeon.

If your physician is interested, please refer to the following journals: Dieter Ulizsch, MD, Margareta K. G. Nyman, MD, Richard A. Carlson, MD. Breast Abscess in Lactating Women: US-guided Treatment. Radiology, 2004; 232:904-909

For small abscesses, acupuncture and antibiotics are usually sufficient. But you may need to puff a few more times. A lump that doesn't go away

If you have a lump that doesn't go away after a few weeks, see a lactation-friendly doctor. Breastfeeding does not need to be interrupted during the examination and evaluation of the lump (ultrasound, radiography or even biopsy). A lactation-friendly surgeon will not ask you to wean your breasts for a checkup!

Still have questions? Please refer to nbci.ca or drjacknewman If you still can’t find the answer you are looking for, you can e-mail us Let’s get in touch! Blocked duct and mastitis, February 2009○c Written and revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005○c Revised by Jack Newman MD, FRCPC and Edith Kernerman. IBCLC, 2008, 2009○c Thoughts

Dr. Jack Newman is very humorous! Breastfeeding is really instinctive, don’t think too much, just feed it! Using potatoes and an electric toothbrush to treat obstruction by yourself is simple but very practical! Questions Seek medical advice. If the doctor is the first to ask you to wean your breasts, please get out and don’t see this doctor!! We usually use antibiotics too early. I had mastitis once and the medicine never healed. I stopped. The symptoms improved within one afternoon of taking the medicine! The best way is to feed diligently.

If you have a fever, don’t rush to reduce it! This applies to both adults and children!