Engorgement and mastitis are complications associated with breast feeding. Mastitis associated with breast feeding is also called lactational mastitis.

Breast feeding, like parenting, is not always uncomplicated, especially in the first few weeks after birth. It can be easy to forget at this time that, like all new skills, breast feeding can take a while to learn and become really good at.

Not all women experience true engorgement or mastitis; however, if you do it may really test your commitment to breast feeding. At times you may feel that it is not worth it, and that breast feeding is just not for you.

It is strongly advised if you are experiencing difficulties with breast feeding, such as engorgement or mastitis, that you seek the advice of a midwife, lactation consultant, community child health nurse, the Australian Breastfeeding Association or your doctor.

Engorgement

Breast engorgement happens when there is a build-up of milk and fluid in the breasts. The blood vessels in the breasts also become congested (too full).

Engorgement symptoms

When your breast(s) are engorged, they become:

  • firm or hard;
  • swollen; and
  • painful.

Engorgement can result in your nipples not protruding as much as usual, and your baby may not be able to latch on properly.

Causes of engorgement

Breast engorgement can happen if:

  • you are making more milk than your baby needs;
  • breast feeding your baby does not adequately drain your breasts; or
  • your baby misses a feed or is feeding infrequently.

Engorgement tends to happen more often in the weeks just after your baby is born, when a breastfeeding routine is still being established.

Treatment for engorgement

Engorgement can be treated with self-care measures and pain relievers if needed. A lactation consultant, midwife or your doctor can give advice on how to manage engorgement.

  • Breast feed your baby on demand until they have had enough. Let your baby finish the first breast before starting on the second.
  • Put your baby to the more painful breast first. Try using one side for each feed rather than offering both breasts. If your baby is still hungry offer the other breast.
  • Stand in a warm shower for 5 minutes before feeding. It is soothing and comfortable, and may help with milk flow during the feed. Alternatively, apply a warm compress to your breast before feeding.
  • Although is it generally not a good idea to express excess milk by hand, expressing a little in the shower before feeding can make it easier for a very new baby to ‘latch on’ correctly.
  • Take your bra off before breast feeding. Apply a cold pack after feeding to help relieve symptoms.
  • If necessary, express breast milk after feeds.
  • Avoid giving your baby any other fluids.
  • If your breasts are very painful, ask your doctor or breast feeding advisor about pain relief. You may feel reluctant to take pain-relievers, however, remember that being in pain makes establishing a healthy, satisfying breast feeding pattern much more difficult.

Remember, there is no greater relief for engorged breasts than an enthusiastically feeding baby.

Mastitis

Mastitis is inflammation of the breast tissue, particularly the milk ducts and glands, in a breast feeding woman.

In the 6 months after giving birth, mastitis affects about 20 per cent of breast feeding women in Australia. Mastitis is most common in the first 6 to 8 weeks after giving birth to your baby. It also sometimes happens when you decide to stop breast feeding (wean your baby).

Symptoms of mastitis

Mastitis symptoms (which often come on suddenly) can include:

  • a sore breast that feels warm and tender to touch;
  • breast swelling, firmness or engorgement;
  • sharp or shooting pain in the breast that is worse with breast feeding;
  • tender, red lump(s) in the breast (from a blocked milk duct);
  • ‘shiny’ or red skin on the breast (often in a wedge shape) or red streaks on the breast;
  • feeling generally unwell with ‘flu-like symptoms (aches and pains, headaches, sweating);
  • feeling tearful and tired; and
  • fever.

Causes of mastitis

Mastitis can be caused by blocked milk ducts when the breasts are too full and the milk is not draining properly. A blocked milk duct can cause the development of a tender breast lump. Mastitis can also be due to a cracked nipple.

Bacteria may get into the breast tissue, causing infection in the blocked milk ducts.

Factors that can contribute to the development of mastitis include:

  • the baby not latching on or positioning on the breast correctly;
  • the baby having tongue-tie or another problem resulting in difficulties with breast feeding;
  • wearing a tight-fitting bra or tight clothing (which can increase the risk of blocked ducts);
  • breast engorgement;
  • stress and exhaustion;
  • returning to work; and
  • having previously had mastitis.

Treatment for mastitis

Treatment for mastitis involves antibiotic treatment plus breast feeding advice to help effectively drain the breast, as well as self-care measures.

  • Antibiotics may be prescribed to cure the infection. Untreated, severe mastitis can lead to a breast abscess. Most antibiotics used to treat mastitis are safe to use while breast feeding your baby.
  • It is very important that you have time to rest and spend time feeding your baby. Seek help and support from your partner and family.
  • Breast feed on demand, starting with the sore breast. It is quite safe to feed your baby from the affected breast. Breast feeding helps treat the mastitis and relieve symptoms by draining the milk. The aim should be to empty your breast as much as possible with each feed.
  • Make sure the baby is latched on correctly (mouth covering not just the nipple but also almost the entire areola, the dark circle of skin around the nipple) and drains the breast well.
  • Wear loose fitting clothes. Make sure that your bra that is not too tight and it does not dig in anywhere (obstructing the flow of milk). It may be more comfortable to take off your bra while breast feeding.
  • You may need to gently express some breast milk if your breast is not drained after breast feeding.
  • Apply warmth to the sore area just before feeding, by taking a shower or applying a warm hot water bottle wrapped in a towel or a wheat bag.
  • If you have a breast lump that is due to a blocked duct, gently massage towards the nipple while breast feeding to help drain the duct.
  • A cold pack applied after breast feeding may help relieve breast pain.
  • Drink plenty of fluids (especially if you have a fever).
  • Paracetamol can be taken regularly (as directed) if necessary for pain and fever. Non-steroidal anti-inflammatory drugs (NSAIDs) can also be used. These pain relievers are safe to use while breast feeding.

Women with mastitis need plenty of support plus advice on breast feeding. Breast feeding tips can help resolve breast feeding problems and help recovery from mastitis.

For women who decide to stop breast feeding, it is recommended that you wean your baby gradually after the mastitis has settled. Stopping breast feeding suddenly can make the symptoms worse and may increase the risk of developing complications, such as a breast abscess.

Recovery from mastitis

Most women with mastitis feel better after 2 to 3 days of treatment. If you continue to have symptoms after 48 hours of treatment, you should see your doctor. You should also seek medical help if you develop a tender breast lump that is not relieved by breast feeding.

Support for breast feeding women

Many women who develop engorgement and mastitis are already feeling tired and run-down after the birth of their baby. Developing mastitis can trigger strong emotions, and depression and anxiety have also been associated with episodes of mastitis.

Support is available from your doctor, midwife, lactation consultant or community nurse. The Australian Breastfeeding Association can also provide support. They have a National Breastfeeding Helpline (1800 686 268) that is available 7 days a week and also provide an email counselling service.

Last Reviewed: 11/07/2016

myDr



References

1. Australian Breastfeeding Association. Engorgement (updated Oct 2014). https://www.breastfeeding.asn.au/bf-info/common-concerns%E2%80%93mum/engorgement (accessed Jun 2016).
2. Mastitis (published November 2014). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2016 MAr. http://online.tg.org.au/complete/ (accessed Jun 2016).
3. Cusack L, Brennan M. Lactational mastitis and breast abscess. Australian Family Physician 2011; 40 (12): 976-99. http://www.racgp.org.au/afp/2011/december/lactational-mastitis-and-breast-abscess/ (accessed Jun 2016).
4. MayoClinic. Mastitis (updated 12 Jun 2015). http://www.mayoclinic.org/diseases-conditions/mastitis/basics/definition/con-20026633 (accessed Jun 2016).
5.BMJ Best Practice. Mastitis and breast abscess (updated 3 Sep 2015). http://bestpractice.bmj.com/best-practice/monograph/1084.html (accessed Jun 2016).