Lynnette Hafken, MA, IBCLC
text (fastest response) or call: (240) 888-2123
email: [email protected]
If you have not already, please review Positioning & Latch, since most causes of nipple pain can be attributed to a latch issue. However, there are other causes that should be explored if you continue to have pain:
- Nipple damage
- Dermatosis (skin lesions like eczema)
- Vasospasm/Raynaud's phenomenon
- Allodynia/functional pain
Damage to Nipples/Areolas
Shallow or dysfunctional latch, or injury from breast pump use, can cause pain and skin damage. When the skin is damaged, inflammation is caused, and infection can set in. Redness, swelling, blisters, and cracks can result. Infection can further complicate the situation, causing more pain and preventing healing.
After having learned to position and latch your baby properly, continued pain might be caused by something your baby is doing while feeding. Babies can have a dysfunctional suck, maladaptive behavior such as biting/clamping, having trouble with the speed of milk flow, or difficulties grasping the breast. Here are some common conditions:
- Breast too full for baby to latch deeply
- Tongue tie and other oral anomalies (like palate shape)
- Neurological immaturity
- Fast letdown
- "Oroboobular disproportion" (small mouth, big nipple)
- Clavicle fractures
- Nasal congestion
Breast pumps can also cause nipple soreness or trauma. Make sure you are:
- Centering your nipple in the flange (cone-shaped part)
- Using the correct sized flange or insert
- Lubricating your nipples with nipple ointment if they are sore, injured, or dry
- Using the strongest comfortable level of suction (reduce the strength if your nipples feel sore)
- Do not pump longer than 20 minutes at a time; usually 15 is plenty.
Trying a different pump may be necessary if these methods fail.
Eczema and psoriasis can affect nipples and the surrounding skin. An emollient can be used to keep the skin supple and reduce discomfort due to dryness. Additional medical help may be required. Contact dermatitis can result from irritants such as fragrances, rough clothing, nipple ointments, and allergic reactions (some mothers react to residues of solid food in their babies' mouths).
If the skin becomes broken or fissured, infection can set in, which would also need to be treated. See your doctor if you notice weeping, yellow crusting, blisters, or swelling.
Allodynia/Functional Nipple Pain
The Academy of Breastfeeding Medicine uses this term for “the sensation of pain in response to a stimulus, such as light touch, which would not normally elicit pain.” There is little known about the physical source of this pain, but the ABM states that it sometimes co-occurs with other chronic pain conditions such as irritable bowel syndrome (IBS), fibromyalgia, interstitial cystitis, migraines, temporomandibular joint disorders (TMJ), and pain with intercourse—or just by itself.
Research shows that people with chronic pain who are also experiencing depression, anxiety, or other distressing psychological symptoms have a less effective response to treatment; so although you are experiencing real physical pain that no one should imply is “all in your head,” treatment for psychological symptoms can improve your physical response to treatment.
Vasospasm presents with blanching or purple color changes
of the nipple accompanied by sharp, shooting, or burning
pain.38,39 (II-3, II-3) Women may report pain after breastfeeding, on getting out of a warm shower, or in the setting of cold
temperatures, such as in the frozen food section of the grocery
store. Symptoms may be bilateral or unilateral in the setting of
current or past nipple trauma. Some mothers report a history of
cold hands and feet, such as needing to wear socks to sleep or
gloves in mild weather, or a formal diagnosis of Raynaud’s
syndrome. Women with a history of connective tissue disorders
such as rheumatoid arthritis or prior diagnosis of Raynaud’s
phenomenon are at risk for vasospasm of the nipple.