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Blocked ducts or mastitis? How to tell the difference

You’ve finally gotten the hang of breastfeeding and—oh no, is that a lump?

If you’ve felt a lump or soreness on your breast you’ll want to know the difference between mastitis and a blocked duct and you’ll want to seek treatment early.

The difference between mastitis and blocked ducts

A blocked duct

A blocked duct is where milk flow is obstructed in an area of the breast.

Symptoms can include:

  • Reddened area of the breast which becomes tender, hard and painful.
  • There can, occasionally, be tenderness or pain without an obvious lump.
  • Occasionally a low-grade fever (less than 38.5 degrees Celsius) can be present.

Common causes:

  • poor attachment.
  • tight or poorly fitted clothing.
  • only sleeping on one side (which causes pressure on the breast).
  • holding your breast tightly during feeding or expressing.
  • white spot on your nipple.
  • stress and fatigue.
  • anaemia.

Side effects:

  • Milk supply from the affected breast may temporarily decrease. This is normal. Extra feeds or expressing breast milk will return your supply to normal.
  • You may see strings of thick or fatty-looking breast milk.
  • After the blocked duct has resolved, the area can feel bruised or look reddened for a week or so.

Mastitis

Mastitis is an inflammation of the breast that can be caused by a blocked duct, infection or allergy. Symptoms can include:

  • Reddened area of the breast which becomes tender, hard and painful.
  • There can, occasionally, be tenderness or pain without an obvious lump.
  • Fever of 38.5 degrees Celsius or higher.
  • In most cases, the pain/heat/swelling is more intense than it is with a blocked duct.
  • There can be red streaks that extend away from the affected area.
  • Often rapid onset of flu-like symptoms, such as joint aches and pains, extreme tiredness.

Common causes:

  • delayed treatment of a blocked duct.
  • previous mastitis.
  • damage to the nipple.
  • oversupply of breastmilk.
  • poor attachment.
  • poor general health.
  • poor hygiene (eg. not changing breast pads, not washing hands after changing nappies and touching baby’s sticky eyes etc).
  • anaemia.

Side effects:

  • Milk supply from the affected breast may temporarily decrease. This is normal. Extra feeds or expressing breast milk will return your supply to normal.
  • You may see strings of thick or fatty-looking breast milk.
  • After the blocked duct has resolved, the area can feel bruised or look reddened for a week or so.
  • If your baby is breastfeeding they may fuss due to a change in the taste of breast milk. It may taste salty due to increased sodium and chloride content.
  • Occasionally your breast milk might contain blood or pus.

How to manage blocked ducts and mastitis

It is important to start treatment at the first sign of mastitis. If your doctor has prescribed antibiotics it is important to take these as instructed and finish the entire course.

If needed you can take pain medications such as paracetamol or ibuprofen as they are both safe during breastfeeding.

If you have mastitis or a block duct you should

  • Breastfeed or express every two hours (or as often as possible) and empty your breasts well (especially the affected breast).
  • Feed from the affected breast first. If it is too comfortable start on the other side and switch after letdown.
  • Try feeding while learning forward so gravity may help to drain the breast
  • If you can still feel a lump after breastfeeding, express until the breast feels drained.
  • Massage over the affected area while expressing
  • Rest.
  • Drink enough fluids and eat nutritious foods.
  • Use heat and massage before breastfeeding or expressing.
  • Apply warm compresses to your breast (warm pack of face washer rinsed under hot water).
  • Massage the breast in a warm shower or try to hand express.
  • Loosen your bra or restrictive clothing before feeding or expressing.

How to reduce the risk of reoccurring mastitis and blocked ducts

  • Do not wear bras, or other clothing, that are too tight.
  • Try not to sleep on your stomach.
  • Do not go for long periods without breastfeeding or expressing.
  • Rest when you can.
  • Drink adequate fluids.
  • Make sure you have correct attachment (seek help from a lactation consultant or midwife if you’re unsure).
  • Ensure the breast pump is positioned correctly, if you are expressing.
  • Regularly examine your breasts for lumps and massage these while feeding or expressing.
  • This is not the time to wean. You need to drain your breast frequently (via feeding and/or expressing) to avoid a breast abscess.

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Mater patients can access support from the Mater Mothers Parenting Support Centre. For more information or to make a booking, please contact the centre on 07 3163 2229 or visit matermothers.org.au/parenting-support-centre.

About Mater lactation consultants

Mater's team of lactation consultants understand every aspect of breastfeeding from milk supply to correct latch technique. They are trained to help mothers start and continue breastfeeding with success.

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