Severe breast pain: Chronic mastitis?

I am experiencing severe pain after nursing my four month old. I was treated for early mastitis, but the pain remains. My baby was evaluated and he does not have thrush. My Ob/Gyn says that there is nothing he can do for me. I was told to control the pain with Tylenol and to use warm water compresses. I'm not ready to wean him yet, but I am getting very very tired and frustrated with the pain.

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

There are many causes of breast pain during lactation. Often the first thing that comes to mind is mastitis. You said that you had been treated for "early mastitis," but that your physician now refuses to treat you with anything other than tylenol and hot compresses. Whenever you experience pain, it is a message that something is wrong. It's not a good idea to ignore your body's messages.

Tylenol is a pain reliever and will only help you to deal with the discomfort. It does not get to the source of your problem. If your physician is unwilling to take another look into your case, I believe you should seek a second opinion.

With mastitis, you will have one area of your breast that is quite sore. There may be no other symptoms. If mastitis is suspected, ask your Health Care Provider to culture your milk and your baby's throat. This will tell them specifically what type of pathogen they are dealing with, and will help to assure proper treatment. Antibiotics, if necessary, should be given for a period of at least 14 days. Some women are helped by long-term, low-dose antibiotic therapy (over a period of two to three months.)

"Chronic" mastitis can actually be an undiagnosed breast abscess. Is the area firm and very tender? Abscesses are very rare, but if an abscess is suspected, diagnosis can be made in your physician's office by aspiration. Antibiotics alone will not resolve an abscess. An abscess will probably require surgical drainage, along with appropriate antibiotic therapy (determined by culturing the drainage), warm soaks and regular and complete emptying of the breasts.

Other possibilities to look into when experiencing breast pain:

  • Thrush with ductal involvement -- Your baby may not show any symptoms of thrush. Are you experiencing any nipple pain? Do you have a history of vaginal yeast infections? Have you been treated with antibiotics? If you answer yes to any of these, thrush may be present.
  • Back pain/muscle strain -- Can occur from poor positioning. Sit up straight or lean back slightly to feed your baby. Use a low footstool (or even a phone book) to elevate your knees a bit. Your back can become strained if you lean over your baby while nursing.
  • Large breasts -- Trying a different style of supportive bra, or supporting the breasts with a rolled up baby blanket or cloth diaper during the feed may help to relieve the pain.
  • Fibrocystic breast changes -- Usually are worse premenstrually.
  • Breast tissue injury caused by improper pumping - Can result from using a bicycle-horn pump (never recommended!), continuous suction pump, or using a suction that is too strong.

Continuing breast pain has a negative impact on the nursing relationship. It is very important that it be properly evaluated and treated, not only for your comfort, and to preserve breastfeeding, but to rule out any underlying medical condition.

Wishing you health!

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