Mastitis

Mastitis commonly occurs with breastfeeding. This blog talks about contributing factors and how best to treat it.

You may have read my blog on Breast Feeding and heard that I suffered from mastitis, a couple of times. The infection was caused by cracked nipples when we were having trouble breast feeding. Not a fun time. It makes me cringe thinking about the pain when she latched on to feed!

Mastitis is an inflammation of breast tissue that can lead to infection. Initially there will be redness over the breast but can lead to flu like symptoms such as a raised temperature, aches, tiredness. Mastitis can be caused as in my situation, if your baby is not latching on correctly and either not draining your breast milk ducts or creating open breast tissue from cracking the nipples with poor latching. Other causes of mastitis are from not feeding frequently enough, stopping breast feeding too suddenly, a tight bra, or a baby with tongue tie who can not latch on properly.

Misaki did not have any tongue tie but my friend’s baby did. It was a subtle posterior tongue tie though so was initially missed when inspected by the lactation consultant and midwives. As I said tongue tie can make latching on difficult which has its effects on the breast but also for the baby getting painful and, distressing for all, wind from poor latching and potentially lack of weight gain. This is also something to investigate if poor latching/ wind or weight gain is a problem. Please see my friend’s emotional and heart felt blog on Tongue Tie in future blogs.

Another cause of poor latching is torticollis (twisted neck), which is stiffness in a babies neck that results from their neck being in awkward positions in utero. Physiotherapists can give advice on stretches and positioning to correct torticollis and those that are trained like Mummyotherapy physiotherapists can gently correct torticollis muscle or spine stiffness with techniques that are as light as touching the skin. Please see our blog on Torticollis for more information on this.

“another cause of poor latching (and mastitis) is torticollis...”

To prevent mastitis it is important to breast feed regularly, feed from both breasts, as often as your baby needs. It is important to completely empty one breast before moving to the next one. If old milk is regularly left behind it hardens which can lead to the blocked ducts. It doesn't matter if your babe doesn't completely empty the second breast. Just start on that breast at the next feed. If your breasts still feel full you could express a bit but you don’t want to express too much otherwise your breasts will likely produce too much milk for your babies needs and could create an increased chance of mastitis.

If your ducts feel blocked (raised hard bits on breasts), attend to them promptly by putting heat packs on them or having a hot shower and gently massaging along the duct towards the nipple. There are new theories however that blocked ducts may be a lymphatic issue, thus we should be massaging towards the lymphatic duct in the armpit. More research is needed in regards to this but I found gentle non directional circular massage in the shower helpful at breaking up my lumps. People are regularly told to do this too firmly though, potentially causing the breast more pain and damage. A Women’s Health Physiotherapist can advise you how best to do this. Many would advise to use heat and massage just before/ during a feed to make sure you are not overstimulating supply. Please also see a lactation consultant or your midwife if the hospital offers these postnatal services to check that your baby is latching on well. 

If you are unfortunate enough to develop mastitis it is important to keep breast feeding. Your milk is perfectly fine for your baby to drink and they say your baby is the best ‘tool’ to drain your breasts of milk. I didn’t agree with this in the early stages when Misaki was not latching on well and felt the breast pump was more effective. Anyway, use the breast pump if you have one as well as your baby breast feeding as you want to get that milk unblocked and flowing as quickly as possible.

Take Paracetamol if you have a temperature, hot breasts or pain. It will not harm your baby. As above, heat and massage done properly is useful to unblock the ducts but then apply ice to reduce inflammation and make sure you drink plenty of water and rest as much as you can. I went to see my hospital midwives and they asked my Obstetrician to prescribe antibiotics for the infection. The antibiotics will do no harm to your baby but do transfer to your breast milk and may give them a tummy ache. Antibiotics should only be taken if there is an infection. If you can attack the infection promptly, the quicker you will recover.

"..treat blocked ducts, redness and swelling of mastitis.. with therapeutic ultrasound"

“...treat blocked ducts, redness and swelling of mastitis... with therapeutic ultrasound”

Another very effective way to treat blocked ducts and the pain, redness and swelling of mastitis is to go to your Women’s Health Physiotherapist for therapeutic ultrasound. Ultrasound will treat the pain, redness and swelling in one or a maximum of 3 sessions. Even though there is no conclusive evidence to its efficacy, it seems to work! Various settings can be used to treat superficial or deep blockages and acute (inflammatory) or chronic (non inflammatory) blockages. The high frequency of the ultrasound vibrates and loosens up the hardened tissue and increases blood flow to help reduce inflammation and increase milk flow. It will not treat the infection though so if there is a true infection antibiotics will be required.

Physiotherapists can also advise you on breastfeeding positions to encourage milk flow (through gravity) and massage techniques as I mentioned previously.

Blocked ducts and mastitis with lactating women is quite common. It is important to attend to the symptoms promptly and effectively to prevent symptoms from getting worse. There are techniques that you can try at home but seek prompt medical attention from your Doctor or Women’s Health Physiotherapist if symptoms don’t clear quickly.

Summary

Blocked ducts which can lead to Mastitis if not treated promptly can be caused by poor latching, not feeding frequently or stopping breastfeeding too quickly.

Depending on whether you have blocked ducts or inflammation or infection will determine whether you should use hot or cold to assist recovery. Your physio can help with this.

Massaging the breast may be good or bad depending on the condition and is often done wrong. Talk to your physio about this.

Therapeutic ultrasound from your physiotherapist can treat blocked ducts, redness and pain.

Melli Tilbrook is a Physiotherapist based at Adelaide Physiotherapy and Pilates Studio, Beulah Park.