What is the difference between mastitis vs. clogged ducts?

What is the difference between mastitis vs. clogged ducts?

A common concern with breastfeeding is understanding the difference between mastitis vs. clogged ducts.   Thinking about all the potential problems that come with breastfeeding can be overwhelming. The great news is that most women will go through their whole nursing journey without any issues. Occasionally problems arise and it is important to be aware of what some of those issues can be, how to fix them, and when to call for help. Knowing how to prevent and treat both clogged ducts and mastitis will help your breastfeeding journey go more smoothly.  

What is a clogged duct?

A clogged (blocked or plugged) duct is when on the of the many milk ducts in the breast are obstructed and the milk flow is stopped or slowed. Sometimes the duct can be in the nipple causing a nipple bleb or milk blister but in most cases, it is more further back into the breast tissues. The symptoms of a clogged duct come on gradually, and typically affect just one breast.  

What is mastitis?

From the book Breastfeeding Matters, "mastitis is an inflammation in the breast that can be caused by obstruction, infection, or an allergy." Mastitis can happen at any time during lactation, and it is most common during the first month of breastfeeding and during weaning. Studies show this is especially true in cultures where breastfeeding is not seen as the "normal" way to feed a baby, and parents are encouraged to limit the time or amount their baby breastfeeds.  

What are the symptoms of mastitis vs. clogged ducts?

When the breast has a clogged milk duct, there may be a hard lump or a very sensitive wedge-like spot in the area where the clog is located. You may experience:  

  • swelling
  • slight engorgement
  • skin that is warm to the touch
  • soreness or tenderness in the area of the clog. 
Your breast may feel more painful with feedings and let downs, and less painful after nursing or emptying the breast. The lump may feel smaller after feeds, and the location of the clog might shift as the blockage is being moved out.   When mastitis is the issue, your symptoms may be similar to having a clogged duct, but they will be more intense, especially if the clogged duct is the reason for the mastitis. Because the symptoms are so similar, it is important to start treating the clog as soon as you notice it.   

How do you know if it's mastitis?

The symptoms that distinguish mastitis from a clogged duct are the sudden onset of flu-like symptoms:  

  • fever
  • body aches
  • chills  
The breasts may also be very warm to the touch and have red streaking. While mastitis can happen in both breasts, often it affects only one breast.  

What causes the clogged duct or mastitis?

Clogged ducts and mastitis can have similar origins, and clogged ducts can also lead to mastitis if not relieved quickly. They can both be caused by:  

  • Consistent engorgement or inadequate milk removal
  • Limiting the baby’s time at the breast (if you schedule feeds or follow rigid infant schedules) 
  • Incorrectly-fitting pump flanges
  • Use of nipple shields
  • Extreme oversupply of milk
  • Overuse of pacifier (leading to long stretches between feeds)
  • Returning to work or abrupt weaning - Wearing binding clothes/ tight bras/ too-small bras/ underwire bras.

Clogged ducts may turn to mastitis when you have:

  • Cracked or bleeding nipples  
  • A bacterial infection  
  • Past history of mastitis or other infection  
  • Stress, a weakened immune system, or anemia   
  • Untreated clogged ducts.  

Are there side effects of having mastitis or clogged ducts?

In both situations, you may notice that the flow or output is diminished on the affected breast, which happens because of inflammation and the decreased movement of the milk. Normally this issue is temporary, and supply can be increased again by maintaining frequent emptying through nursing, pumping, or both.   When the clogged duct is released there may be "strings," thickened milk, or fatty looking milk. While this may appear alarming, it is normal and not harmful to your baby.   When the breast has mastitis, your milk may look clumpy or "gelatin-like." This milk is also fine for your baby. Babies nursing directly may spit this out, or your breastmilk may be saltier in taste than normal, and your baby may reject that side temporarily. This is also normal, and once the infection is cleared the infant should go back to nursing normally. If the infection is bad you may notice mucus, pus, or blood in the expressed milk. Check with your pediatrician if you are concerned.   

How do you treat mastitis or clogged ducts?

The most important thing to remember through the treatment of mastitis or clogged ducts is that direct breastfeeding is the best way to solve the problem. As long as breastfeeding isn't too painful, it is strongly recommended that you continue nursing. Your baby is a great tool to help move the milk out faster, and continuous stimulation helps to maintain milk supply as well as boost supply more quickly if there is a decline.   When treating mastitis or clogged ducts, a good mantra to remember is: “heat, massage, rest, empty the breast!”   - Continue to nurse frequently. The more often you are able to efficiently remove milk, the better. If nursing is too painful, pump instead. - Use heat before nursing and pumping and massage your breast while the baby is nursing or while pumping (or both). - Some parents report some relief when doing an Epsom salt soak before nursing, and massaging the breast while soaking. - Be sure to wear loose bras and clothing to further discourage clogged ducts. - Try dangle feeding, so that gravity in combination with your nursing baby can loosen up the clog (to dangle feed: lie your baby on their back, crouch over them on all fours, lean down over them and dangle your nipple in their mouth to nurse). - Make sure to pump and/or hand express after nursing. - Get some rest. Ask for help with your baby so that you can relax and sleep as much as possible to help the healing process.  

Can I use medication to treat mastitis or clogged ducts?

Yes, you can use a pain reliever to help treat the symptoms, but keep in mind that the underlying issue is not resolved until the clog is gone or the mastitis has subsided.   - Ibuprofen or acetaminophen is okay to take for the fever and aches. - Antibiotics may be necessary if the issue persists longer than 24 hours. Reach out to your lactation consultant (IBCLC) and health care professional to see if an antibiotic treatment is right for you. - Sometimes probiotics can be helpful with clearing mastitis. Particularly if you are prescribed antibiotics, you should take a probiotic, but wait at least two hours after taking the antibiotics to take the probiotic. - Call your doctor IMMEDIATELY if mastitis is in BOTH breasts, or if the baby is less than 2 weeks of age, there is blood and pus in the milk, there is nipple damage that involves broken skin, you see red streaking on the breast, and/or your temperature increases suddenly. You'll also want to work with a lactation consultant to make sure the infant’s latch and positioning is not the initial cause of the mastitis.  

When do I need to see a lactation consultant?

You should make an appointment with a lactation consultant if there is pain with feedings, if you feel like the baby does not do a good job at emptying the breast, or if the breast does not feel softer after a feed. If you are having misshapen nipples (nipples that look pinched or like a new tube of lipstick), or if your nipples are cracked and bleeding, you should reach out ASAP. Your lactation consultant can help you with better latching techniques and can give you a treatment plan to help heal your nipples BEFORE clogged ducts and mastitis set in. If you are having pain with feeds in general, make an appointment with a lactation consultant so that the issue can be diagnosed and treated. Breastfeeding should not be painful.   Lactation consultant appointments with an IBCLC are covered through insurance or reimbursed through the Affordable Care Act. You can look for a lactation consultant in your area here: www.uslca.org/find-an-ibclc   References: https://pubmed.ncbi.nlm.nih.gov/9775842/
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