Did we mention it hurts?
Mastitis is caused by an inflammation of the mammary glands inside the breast. It can affect one or both breast glands, and typically creates a hard, sore spot in the gland locations. Worse, it spooks many women, who are not accustomed to pain in that area of the body, and may presume it is cancer.
While the typical cause of mastitis is an infection or a blocked milk duct, pain in the breast is potentially a sign of other serious issues and should be checked by a medical professional.
TWO TYPES
Mastitis comes in infectious and noninfectious flavors. The noninfectious is caused by a condition called milk stasis, which is, as the name implies, simply when the breast milk stays within the breast tissue because of a blocked duct or breastfeeding issue. If untreated, the milk can eventually become infected by bacteria, leading to infectious mastitis.
One of the strange things about the condition is the lack of scientific consensus on how many women get it. Approximately 10 percent of United States mothers get mastitis while breastfeeding, according to Centers for Disease Control research. But there are other studies that differ on that number.
Some studies claim as little as three percent of nursing mothers get the condition while others claim 33 percent may become affected. What is clear is that the condition can appear anywhere from three months to two years after childbirth, and in rare cases, it may affect women who are not currently lactating.
The painful condition usually leads to the cessation of breastfeeding, but women can continue to safely breastfeed during mastitis.
SYMPTOMS
Mastitis usually develops rapidly in most patients, and typically only in one breast. Symptoms include sore nipples; an area of the breast turning red; the affected area becoming sore to the touch; the area becoming hot when touched; and the afflicted having a burning sensation that may be present only when breastfeeding, or may be there all the time. There may also be anxiety, stress, chills, a high body temperature, general aches and pains, extreme fatigue, shivering, and sometimes a general feeling of malaise.
When mastitis develops because of milk stasis, it may be caused by the infant not being able to properly latch on to the breast for feeding, or because the infant has difficulties sucking the milk. This may be the result of a structural issue, such as a cleft palate. It could also be because the infant is not being frequently fed. The milk ducts could be blocked because of compression caused by prior wearing of tight clothing.
The breast tissue becomes inflamed by cytokines, which are special proteins in milk that the immune system uses and then passes on to the infant. With mastitis, the mother’s immune system attacks the cytokines thinking that they represent an infection, causing the area to become inflamed.
While bacteria do not thrive in human milk, they can develop if the milk ducts are blocked and it stagnates. It is possible that bacteria enter the breast area through skin breaks or through the infant’s mouth during breastfeeding, but there is no conclusive evidence on this. One reason for the belief is that women who are not lactating can develop infectious mastitis.
The non-lactating women who develop the condition are usually regular smokers who are in their 20s to early 30s. The smoking link is key, as researchers believe that the habit may somehow damage the breast’s milk ducts, making smokers more prone to infection. Another potential avenue for infection is nipple piercing, which provides an avenue for infection to enter the breast tissue.
DIAGNOSIS AND TREATMENT
A doctor will conduct a physical examination to identify mastitis, focusing on the symptoms that are presented. In some cases, a small sample of breast milk is needed to determine the presence of bacteria and the type of bacteria. This is necessary to determine the most effective treatment.
If the suspected cause of mastitis is improper breastfeeding, the doctor may observe a feeding to see whether poor latching is the issue.
There is a rare form of breast cancer called inflammatory breast cancer that has similar symptoms to mastitis, namely redness and swelling. If the doctor suspects inflammatory breast cancer is the issue, a breast tissue biopsy may be performed.
If the problem is diagnosed as noninfectious mastitis, treatment usually involves some simple steps. The mother will be advised to drink plenty of liquids and get rest. Over-the-counter painkillers like acetaminophen will be prescribed. Although some of the drug may get into the breast milk, the small levels are safe for the baby. Aspirin should not be used as a substitute for acetaminophen.
DRAIN, DRAIN, GO AWAY
In the case of a mastitis diagnosis, the mother’s milk will have to be more frequently drained, either by breastfeeding more or by squeezing out the milk when the breasts feel full. The sore breast should be the first one used when feeding, as it will be drained by a hungry infant. Any leftover milk in either breast should be expelled after feeding.
In some cases, it may help the mother to be coached on breastfeeding by a nurse, doctor, midwife or social worker. This can ensure that the infant and mother are properly positioned when feeding and that the infant is attaching properly. Mothers should experiment with different feeding positions to find one that is most effective in draining the breast milk.
In some cases, warming the breast area with a heating pad before feeding can make lactation easier. A pre-lactation stroking of the breast area can also help. Loose-fitting clothing should be worn while breast-feeding; at least until the mastitis condition is gone.
Cases of infectious mastitis are usually treated with the above techniques plus an antibiotic. While the antibiotic is necessary to knock down the bacteria infection, it can be passed along to the infant through the milk, and may cause restlessness and runny stools in the child. Those symptoms will vanish when the treatment is complete.
Once the mother has had a case of mastitis, they are more susceptible to getting the condition again, usually because treatment started late for the symptoms. There is also the issue of potentially collecting pus in the breast. In this instance, the abscess will need to be surgically drained.