Mastitis and Blocked Ducts

WHAT IS MASTITIS?

Mastitis is an inflammatory condition that affects the breast tissue, often due to a blocked milk duct. Ducts carry milk from deep in the breast to the nipple. These ducts can become blocked or engorged. As a result milk builds up behind the blockage and a firm lump develops in the breast tissue. 

Mastitis is commonly associated with symptoms of: 

• redness 

• pain

• fever 

• headaches

• joint pain 

• feeling generally unwell

• feeling more exhausted than usual

It can occur at any time throughout pregnancy, breastfeeding or weaning, but is most common in the first 3-4 months post birth. Statistics from the Australian Breastfeeding Association highlight that 1 in 5 breastfeeding women are affected by mastitis. 

The inflammation caused by mastitis can progress to an infection so it is important to get treatment early. Early intervention is also crucial to avoid developing serious complications such as a breast abscess.

WHAT CAUSES MASTITIS?

Mastitis can occur as a result of a number of factors:

• Poor attachment to the breasts due to baby positioning 

• Long periods between breastfeeding due to missing or delaying feeds

• Overfull breasts or oversupply of milk

• Overfeeding 

• Overstimulation from regular electric pump use 

• Nipple damage including cracked skin

• Weaning baby from breastfeeding too quickly 

• Tight or restrictive clothing, or items that over-compress the breast tissue

• Compromised immunity due to illness or poor sleep 

• Previous episodes of mastitis

Mastitis is not always preventable but can be effectively treated if signs and symptoms are noticed and assessed early. 

IF I HAVE MASTITIS, WHAT CAN I DO?

The best course of action if you think you have mastitis is to continue feeding your baby normally. Mastitis will not affect your baby and your milk is perfectly safe for breastfeeding. Maintaining milk flow can actually be beneficial for reducing inflammation in the breast tissue. 

Don’t stop the flow 

• Continue breastfeeding as normal - try not to skip or increase feeds

• Warm the breast gently before feeding to stimulate milk flow - use a warm cloth or gel pack. Avoid using heat at other times as it may aggravate inflammation. 

• Make sure your baby is positioned well and has a good latch to ensure they are removing milk easily 

• If you are unable to breastfeed, express breast to increase comfort, only mimicking the frequency and volume of your baby's physiological needs

• Feed in varying positions - using a reclined or sidelying position can help manage breast swelling 

Use both sides 

• Start each feed with the alternate breast

• Avoid overfeeding or over expressing from the affected breast

Reduce pain and swelling 

• Use cold packs post feeding to reduce discomfort and swelling 

• Use pain relief such as NSAIDs, which are typically more effective as mastitis is an inflammatory condition 

• Avoid wearing a bra at home - this reduces the compressive forces on the breast

• Ensure your bra is well fitting - check for any areas of redness when removing the bra for overly tight straps

• Treat and manage nipple damage

Seek help from a Physiotherapist 

• Therapeutic ultrasound  - see more information below 

• Breastfeeding education and advice

• Stretches and taping

• Lymphatic drainage 

Consider engaging with a lactation consultant for further advice around attachment, nipple damage, feeding regimes, and optimising all of the above. 

If your symptoms do not improve or continue to worsen seek advice from your GP. Some cases of mastitis are infectious and may require antibiotics in conjunction with the above.

HOW DOES PHYSIO HELP?

Physiotherapists can administer therapeutic ultrasound to the affected breast. At Fortis, our physiotherapist Ashleigh can complete a thorough history and examination to determine the best treatment based on your symptoms. 

Therapeutic ultrasound is effective for infective and non-infective mastitis as well as blocked ducts. It has been shown to increase circulation and lymphatic drainage within the breast tissue, reducing swelling and tenderness. An improvement in pain and lump size is often seen in 1-3 ultrasound sessions. 

Physiotherapists will also often use lymphatic drainage massage as a technique to reduce the effects of mastitis. Lymphatic drainage techniques aim to unblock the milk ducts and lymphatic channels, helping loosen any blockages and improve milk flow. It can also be effective for the fascial structures of the breast, allowing the lymphatic ducts to drain away from the breast allowing more space for milk flow and expression.

We can also provide advice and education on breastfeeding positions, self management strategies and apply taping to the breast to help stimulate milk flow. 

HOW DOES THERAPEUTIC ULTRASOUND WORK?

Therapeutic ultrasound is a quick, effective, non pharmacological treatment which produces micro massage and heat at a cellular level. Sound waves produced by the ultrasound machine create vibrations in the breast tissue which in turn provide a micro massage and a heat response. This is effective in unclogging affected ducts, encouraging breast drainage and accelerating tissue healing.

Ultrasound therapy is applied to the affected breast tissue through an ultrasound probe, which is moved around the breast for 5-15 minutes depending on the size of the affected area. You may feel a gentle compression of the tissue and a gentle warmth underneath the probe, neither of which will cause any pain. 

FINAL THOUGHTS

Mastitis can be a common yet challenging condition for breastfeeding women, but with early intervention and treatment, it is manageable. Physiotherapy can offer beneficial treatment protocols for mastitis and provide you with tools to reduce the risk of recurrence. If you are struggling with mastitis or have any questions about management please don't hesitate to contact our clinic on 02 6247 7033 or jump online and book an appointment with Ashleigh. 

REFERENCES

1. Australian Breastfeeding Association. (2017). Mastitis. Retrieved from ABA Website

2. Amir, L. H., Forster, D., & McLachlan, H. (2007). Incidence of mastitis in the neonatal period in a cohort of primiparous women in Melbourne, Australia. International Breastfeeding Journal, 2(1), 12.

3. Spencer, J. P. (2008). Management of mastitis in breastfeeding women. American Family Physician, 78(6), 727–731.

4. Fetherston, C. (1997). Characteristics of lactation mastitis in a Western Australian cohort. Breastfeeding Review, 5(2), 5–11.

5. World Health Organization. (2000). Mastitis: Causes and management. Geneva: WHO.

6. Foxman, B., D’Arcy, H., Gillespie, B., Bobo, J. K., & Schwartz, K. (2002). Lactation mastitis: Occurrence and medical management among 946 breastfeeding women in the United States. American Journal of Epidemiology, 155(2), 103–114.

7. Amir, L. H. (2014). Breastfeeding management of the mother–infant dyad in a resource-limited setting. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(1), 93–105.

8. Walker, M. (2013). Breastfeeding management for the clinician: Using the evidence. Jones & Bartlett Publishers.

9. Dodd, V. (2013). Therapeutic ultrasound in soft tissue lesions. Physiotherapy, 69(3), 112–116.

10. Barbosa-Cesnik, C., Schwartz, K., & Foxman, B. (2003). Lactation mastitis. JAMA, 289(13), 1609–1612.

11. Australian Government Department of Health. (2019). Clinical Practice Guidelines: Mastitis and Breast Abscess. 

12. Lawrence, R. A., & Lawrence, R. M. (2010). Breastfeeding: A guide for the medical profession. Elsevier Health Sciences.

13. Riordan, J., & Wambach, K. (2010). Breastfeeding and human lactation. Jones & Bartlett Publishers.

14. World Health Organization. (2009). Infant and young child feeding: Model chapter for textbooks for medical students and allied health professionals. Geneva: WHO.

Lavigne, V., & Gleberzon, B. J. (2012). Ultrasound as a treatment of mammary blocked duct among 25 postpartum lactating women: a retrospective case series. Journal of Chiropractic Medicine, 11(3), 170–178.