Ashland Health’s resident IBCLC Katie McGee answers questions from real moms about mastitis and plugged ducts

A mother’s instinct is like no other, especially when breastfeeding or pumping isn’t feeling quite right. For first time mothers, this feeling and the associated symptoms can be nerve-wracking, to say the least. In order to give you the best answers and advice possible, we asked our resident IBCLC for some insights on plugged ducts, mastitis, how to tell the difference between the two, and when it’s time to go to the doctor.

Ask the IBCLC: Mastitis and Plugged Ducts

1. What is the difference between a plugged milk duct and mastitis?

A plugged duct is an area of milk that is not draining from the lactating breast. Within this area, milk flow is obstructed. This may feel like a little nodule or engorged section of the breast. A plugged duct usually comes on gradually and affects only one breast, leaving a mother with local symptoms that may include:

  • A small or large lump. This may leave a section of engorgement in the region of the plug
  • The area that is not draining well may feel tender or swollen
  • A more subtle area of tenderness or pain
  • More pain associated before a feeding and often nursing on the affected side may be uncomfortable
  • Decreased milk supply and/or pumping output from the affected breast

Mastitis is an inflammation of the breast that can be caused by obstruction or infection of the breast. It is most common in the first 2-3 weeks, but can occur during any stage in lactation. Mastitis usually comes on quickly and the mother feels more widespread, systemic symptoms than with a plugged duct. Local symptoms are generally the same as with a plugged duct, but symptoms unique to mastitis include:

  • A fever of 101.3 or greater, chills, flu-like symptoms such as aching and malaise
  • Mastitis usually only affects one breast, though it can happen in both
  • Heat, swelling and pain generally more intense than with a plugged duct
  • A segment of the breast may appear red or red streaks may be present
  • Broken skin on the nipple with obvious signs of infection
  • Blood/pus is present in milk
  • Red streaking is present
  • Temperature increases suddenly

2. What are common precursors to these lactation problems?

Milk Stasis (milk staying in instead of coming out through nursing or pumping) is the main cause of both plugged ducts and mastitis. Other plugged duct precursors include: Engorgement, latching problems, ineffective suck or Tongue tie, nipple pain, a sleepy or distracted baby, oversupply, hurried feedings or limiting baby’s time at breast, a blocked nipple pore, pressure on the duct (from fingers, tight bra or clothing, prone sleeping, diaper bag), and inflammation from injury, bacterial or yeast infection. Changes in pattern of removal due to pain, teething, pacifier use, lifestyle change (returning to work or baby suddenly sleeping longer) scheduled feedings, abrupt weaning, supplementing could be the plugged duct culprit, too.

Stress, fatigue, anemia and weakened immunity often precede both plugged ducts and mastitis, and an unresolved plugged duct can easily escalate to mastitis. Sore, cracked, or bleeding nipples offer a point of entry for infection, and a hospital stay increases a mother’s exposure to infectious organisms. Having a history of mastitis is a contributing factor, too.

3. How are mastitis and plugged ducts treated?

Treatment for both are very similar. It is better to aggressively resolve a plugged duct with the goal of avoiding mastitis. Do not decrease or stop nursing or pumping, as this increases potential complications. In fact, extra nursing or pumping generally gets things back to normal within a short time, so nurse frequently and empty the breasts thoroughly. Use heat, a warm compress or a gentle massage before nursing, and loosen your bra and any constrictive clothing to aid milk flow. Rest with your baby conveniently located for easy nursing, and when you are unable to breastfeed, express milk frequently and thoroughly.

Antibiotics are safe with breastfeeding, although not always needed for treating mastitis. Most doctors recommend a 10-14 day oral antibiotic treatment to prevent relapse. Do not discontinue treatment earlier than prescribed. Some mothers choose exclusively natural treatments. A bruised feeling may remain in the area for a few days to a week after a plugged duct or mastitis has resolved, so get extra help around the house so you can take it easy for a couple of days. Stringy or thickened milk may be noticeable as a plugged duct or mastitis is clearing up.

4. How do you prevent mastitis?

Proactively avoid situations that cause milk becoming trapped in your breast. There are precautions mothers can take, but some women just seem to be more prone to mastitis and plugged ducts than others.

5. How can a breast pump help?

Talk to an IBCLC about your personal profile to find out what may have led to this complication and how best to avoid it in the future. A proactive lactation home visit can provide a wealth of understanding about how to avoid this common complication in the first place. A pump observation and assessment may reveal if you are using the right size breastshield (flange) which is important as an improper size may lead to problems. It would also reveal if thorough emptying is occurring with the frequency, length and efficacy of your pump and pumping sessions.

Mothers who have experienced either mastitis or a plugged duct know just how inconvenient, and sometimes alarming, it can be. If you are experiencing any of these symptoms, or if something just doesn’t seem right, call your doctor. It’s better to exhaust all possibilities than let things get worse. If you have more questions or would like to schedule a visit with one of our in-house IBCLCs, contact Ashland Women’s Health today.