Recurrent Mastitis or Plugged Ducts

By Kelly Bonyata, BS, IBCLC

Risk factors for recurrent plugged ducts or mastitis

Most mothers do not have repeated bouts of mastitis or plugged ducts, but when there is a history it’s always a good idea to look at additional risk factors. Make sure that you are aware of the symptoms of plugged ducts and mastitis so you can start treatment immediately. See Mastitis and Plugged Ducts for more information.

Risk factor: Inadequate treatment of previous mastitis

• A major risk factor for recurring mastitis is failure to completely recover from a previous bout of mastitis due to slow treatment, incorrect treatment (wrong antibiotic, for example), or treatment that was not long enough. Has the treatment of previous bouts of mastitis been delayed, inadequate or incomplete? If you were treated for a previous bout of mastitis, did you take a complete course of antibiotics? Have you had repeated prescriptions for the same antibiotic? Amoxil is often ineffective against the bacteria that causes mastitis. Some of the drugs “of choice” for treating this are Keflex, Dicloxacillin, and Erythromycin. Treatment should continue for 10-14 days. See the links below for additional information.
• In addition, some moms get recurrent plugged ducts due to inflammation from an ongoing subclinical case of mastitis.
• A related risk factor is a previous plugged duct. The duct can be deformed (“stretched out” a bit) at the location of a previous plug, which can put that particular area more at risk for plugging in the future. To reduce this risk, be vigilant about keeping the milk flowing well after a plugged duct is resolved.

Risk factor: Poor milk drainage

• Are latch-on and positioning optimal? Problems with either can affect milk drainage, and whenever the milk flow is hindered you are at risk for plugged ducts and mastitis. Always go back to the basics when you are having problems.
• Are you supporting the breast from underneath? This is not always needed, particularly after the first few weeks. However, if you are having problems with plugged ducts or mastitis, lifting the breast from underneath can increase milk drainage.
• Are you interrupting feedings or cutting them short (due to outdated advice to limit nursing duration, a busy schedule, taking care of other children or family members, etc.)? This can lead to a backup of milk in the breast and thus increases the risk for engorgement, plugged ducts, or mastitis.
• Do you press down on the top or side of your breast to make extra breathing space for baby? This should not be necessary (baby’s nose is designed so baby can breathe while nursing) and can cause plugged ducts and/or sore nipples.
• Look for anything that results in consistent pressure on the breast tissue — this can block milk flow and lead to plugged ducts. See if you can associate any of the following things with the location of the plug(s): Are you sleeping on one side or on your stomach a lot? Do you carry a heavy purse or bag on one side? Are you carrying the baby in a front carrier or sling? Do you wear an underwire bra that presses in one area? Are you wearing any type of bra that does not fit well? Do you wear a sleep bra that stays pushed up or to the side for much of the time at night? Are you wearing constrictive clothes?
• Are you having problems with oversupply or engorgement? Do you feel that you have too much milk? Does your baby choke, gag, strangle when nursing because of a fast milk flow? Do you leak a lot? Remedying the oversupply will help to reduce your risk for plugged ducts and mastitis.
• Do you use a nipple shield? Use of a nipple shield can result in poor milk drainage from the breast.
• Sometimes moms who pump often (to replace missed nursings) are more prone to plugged ducts because a breastpump simply cannot drain the breast as effectively as the baby. You might try slightly moving the breastshields around to different quadrants of the breast so that these areas will be softened more efficiently.
• Any kind of exercise that involves repetitive motions of the upper arm may lead to plugged ducts or mastitis.
• Have your breasts been operated on, scarred, bumped, handled roughly, or otherwise injured? Any breast surgery can cause scarring and/or pressure on milk ducts. Other things that can cause plugged ducts/mastitis are an anatomical problem or variation in a particular duct, breast lumps or cysts, past injuries. In any of these cases, mastitis will recur in the same area of the breast. Recurring mastitis in the same location is one of the warning signs of a breast tumor (but this is rare cause of recurring mastitis).

Risk factor: Nipple problems

• Look for dried milk secretions on the nipple. If you notice this, apply a warm cloth to the nipple until the dried milk peels off and then try to express some milk. Sometimes this can cause a plugged duct because the duct cannot empty well through the nipple.
• Have you had any nipple damage? Sore, cracked, or bleeding nipples can offer a point of entry for bacteria. Secondary staph infections may be responsible for delayed healing.
• Milk blisters can cause repeated plugged ducts.
• Secondary infections such as thrush (yeast/fungal infection) can cause inflammation within the milk ducts which increases the risk of plugged ducts or mastitis. Moms who are experiencing recurrent plugged ducts or mastitis due to thrush may benefit from taking an anti-inflammatory medication (like ibuprofen) to reduce the inflammation.

Risk factor: Mother’s overall health

• • Have you been very tired or busy, worried or stressed? Many times mothers who have recurring bouts of mastitis are not getting enough rest or are trying to do too much. Mastitis is often the body’s way of telling Mom to “slow down.”
  • Have you been ill? Might you be anemic? Lowered resistance to infection or anemia can cause or contribute to recurrent plugged ducts. A blood test for anemia is a good idea when there is a history of repeated mastitis. Increasing foods containing natural sources of iron (or supplemental vitamins with iron) and a Vitamin C supplement may be helpful.
  • Are bouts associated with hormonal changes (ovulation or menstruation)?
  • Do you have food allergies? According to La Leche League’s Breastfeeding Answer Book, food allergies occasionally result in plugged ducts that occur either premenstrually or before ovulation:

In her book Breastfeeding Matters, Maureen Minchin theorizes that if a mom has allergies, recurring mastitis/plugged ducts might be caused by the “complex immune responses” that occur when she is exposed to an allergen. In a group of food-intolerant women, Minchin observed that their plugged ducts, “which rarely progressed to overt infection and which often recurred either premenstrually or before ovulation,” were “often accompanied by other symptoms of allergy intolerance.”

• Do you smoke? Smoking can lower your resistance to infections.

Risk factor: Mother’s diet

• Are you eating regularly, and eating plenty of fresh food and vegetables? This will help to increase your resistance to infection.
• Are you drinking to satisfy thirst? Lack of sufficient fluids can contribute to plugged ducts. Make sure you are drinking something each time you sit down to nurse or pump.
• Too much saturated fat in the diet can be a problem. Reduce animal fats / limit your fat to polyunsaturated fats and take one tablespoon of lecithin (a dietary supplement available at most pharmacies, health foods stores, etc.) Adding lecithin to the diets of moms with recurrent plugged ducts has been shown to be very effective.
• Either too much salt or too little salt in the diet has been linked to this problem.

Risk factor: Baby’s health

• Has your baby been ill? Occasionally, baby can have the bacteria in the back of his throat and be reinfecting mom with mastitis. This can be determined by swabbing the baby’s throat. If the culture is positive, then baby should be treated along with mom. A culture of your milk can also help your health care provider better determine the best treatment (antibiotic-wise).

Treatments for recurrent plugged ducts or mastitis

These treatments should be used in addition to your efforts to find and remedy the source of the problem. Keep in mind that if the source of your recurrent plugged ducts or mastitis is something fixable (for example: oversupply, infrequent nursing, too tight bra, etc.), then solving the underlying problem is the most effective thing you can do.

Treatments: Dietary supplements and diet

A Vitamin C supplement can be helpful for any mom suffering with recurrent plugged ducts or mastitis.

Many moms have found that taking lecithin (a dietary supplement) can help to resolve and prevent recurrent plugged ducts.

Several studies have shown that probiotic supplements (certain Lactobacillus strains) are effective in treating infectious mastitis and also resulted in a lower occurrence of repeat mastitis.

It is also helpful to make sure that you’re getting enough liquids, and to reduce the amount of saturated fat in your diet.

Treatments: Therapeutic breast massage

Daily breast massage may help to improve milk drainage and prevent plugged ducts and mastitis. See Breastfeeding Medicine of Northeast Ohio’s video for a demonstration of the basics of therapeutic breast massage.

Treatments: Long-term, low-dose antibiotics

If you follow the complete course of treatment with an appropriate antibiotic and the mastitis continues to recur, Dr. Ruth Lawrence (Breastfeeding: A Guide for the Medical Profession, page 281) suggests long-term, low-dose antibiotics for 2-3 months or even the duration of lactation. This type of treatment has broken the cycle of repeated mastitis for some women. If this treatment is chosen, it’s also a good idea to have an antifungal medication prescribed along with the antibiotic and/or to supplement the mother’s diet with acidophilus to lessen the risk of thrush.

Treatments: Time

If you are relatively early postpartum and your recurrent plugs/mastitis seem to be tied to an overabundant milk supply, a little more time may be the best remedy. Hormonal changes occur by about 12 weeks (give or take a bit) that make milk supply more stable and you may notice less of a tendency to get the plugs.

 

References and additional information

Mastitis and Plugged Ducts @

Lecithin treatment for recurrent plugged ducts @

Breastfeeding and breast abscess @

LLL FAQ: Repeated Cases of Mastitis