- How do I know if I have mastitis or a plugged duct?
- Common (and not-so-common) side effects of plugged ducts or mastitis
- What are the usual causes of plugged ducts or mastitis?
- What is the usual treatment for plugged ducts and mastitis?
- Does mastitis always require antibiotics?
- References and additional information
How do I know if I have a plugged duct or mastitis?
PLUGGED DUCT
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A plugged (or blocked) duct is an area of the breast where milk flow is obstructed. The nipple pore may be blocked (see Milk Blister), or the obstruction may be further back in the ductal system. A plugged duct usually comes on gradually and affects only one breast. |
Local symptoms
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Mom will usually notice a hard lump or wedge-shaped area of engorgement in the vicinity of the plug that may feel tender, hot, swollen or look reddened. Occasionally mom will only notice localized tenderness or pain, without an obvious lump or area of engorgement. The location of the plug may shift.A plugged duct will typically feel more painful before a feeding and less tender afterward, and the plugged area will usually feel less lumpy or smaller after nursing. Nursing on the affected side may be painful, particularly at letdown. |
Systemic symptoms
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There are usually no systemic symptoms for a plugged duct, but a low fever (less than 101.3°F / 38.5°C) may be present. |
MASTITIS
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Per Maureen Minchin (Breastfeeding Matters, Chapter 6), mastitis is an inflammation of the breast that can be caused by obstruction, infection and/or allergy. The incidence of postpartum mastitis in Western women is 20%; mastitis is not nearly so common in countries where breastfeeding is the norm and frequent breastfeeding is typical. Mastitis is most common in the first 2-3 weeks, but can occur at any stage of lactation. Mastitis may come on abruptly, and usually affects only one breast. |
Local symptoms
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Local symptoms are the same as for a plugged duct, but the pain/heat/swelling is usually more intense. There may be red streaks extending outward from the affected area. |
Systemic symptoms
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Typical mastitis symptoms include a fever of 101.3°F (38.5°C) or greater, chills, flu-like aching, malaise and systemic illness. |
Common (and not-so-common) side effects of plugged ducts or mastitis
Plugged duct
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MastitisSide effects may be the same as for a plugged duct, plus:
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What are the usual causes of plugged ducts or mastitis?
Plugged duct | Mastitis |
Milk stasis / restricted milk flow… may be due to:
Stress, fatigue, anemia, weakened immunity |
Milk stasis (usually primary cause)
Infection
Stress, fatigue, anemia, weakened immunity |
What is the usual treatment for plugged ducts and mastitis?
It’s always best to treat a plug immediately and aggressively to avoid escalating into mastitis.
CAUTION: Do NOT decrease or stop nursingwhen you have a plugged duct or mastitis,as this increases risk of complications (including abscess). |
GENERAL SUPPORTIVE MEASURES | |
Plugged Duct
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Mastitis
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MEDICATION * | |
Plugged duct | Mastitis |
Analgesia
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Analgesia
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Antibiotic?
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Antibiotic?
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* Consult your health care provider for guidance in your specific situation. The medication information is taken from the references listed below and is provided for educational purposes only. |
Does mastitis always require antibiotics?
No, mastitis does not always require antibiotics.
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Mastitis is an inflammation of the breast that is most commonly caused by milk stasis (obstruction of milk flow) rather than infection. Non-infectious mastitis can usually be resolved without the use of antibiotics. However, per the World Health Organization document Mastitis: Causes and Management, “Without effective removal of milk, non-infectious mastitis was likely to progress to infectious mastitis, and infectious mastitis to the formation of an abscess.”
Per the Academy of Breastfeeding Medicine’s Clinical Protocol for Mastitis:
“If symptoms of mastitis are mild and have been present for less than 24 hours, conservative management (effective milk removal and supportive measures) may be sufficient. If symptoms are not improving within 12-24 hours or if the woman is acutely ill, antibiotics should be started.”
If a mom with mastitis has no obvious risk factors for infection (as noted in the box below), it is likely that the mastitis is non-infectious and, if properly treated, will resolve without antibiotics.
When you have mastitis… Talk to your DR about starting antibiotics immediately if:
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Follow-up
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As always, consult your own health care provider to determine how this information applies to your specific circumstances.
References and additional information
@
- How do you treat a milk blister?
- Non-antibiotic treatment of mastitis
- Recurrent Mastitis or Plugged Ducts
- Lecithin treatment for recurrent plugged ducts
- Breastfeeding and breast abscess
@ other websites
- Academy of Breastfeeding Medicine. Clinical Protocol Number 4 – Mastitis (March 2014).
- Newman J. Blocked Ducts and Mastitis. Revised February 2009.
- World Health Organization. Mastitis: Causes and Management (PDF version) (WHO/FCH/CAH/00.13). Geneva: World Health Organization, 2000.
- Mastitis from La Leche League, Intl
- Mastitis and Breastfeeding from The Breastfeeding Network Trust (Scotland)
- Blocked Duct/Mastitis by Carolyn Lawlor-Smith, BMBS, IBCLC, FRACGP and Laureen Lawlor-Smith, BMBS, IBCLC
Amir LH. Mastitis: Are we overprescribing Antibiotics? Current Therapeutics 2000 (April); 41:24-28.
Amir LH. Management of Mastitis. Current Therapeutics 2000 (April); 41:29.
Fetherston C. Mastitis in lactating women: physiology or pathology? Breastfeed Rev 2001 Mar;9(1):5-12.
Fetherston C. Risk factors for lactation mastitis. J Hum Lact 1998 Jun;14(2):101-9.
Foxman B, D’Arcy H, Gillespie B, Bobo JK, Schwartz K. Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol. 2002 Jan 15;155(2):103-14.
Kinlay JR, O’Connell DL, Kinlay S. Risk factors for mastitis in breastfeeding women: results of a prospective cohort study. Aust N Z J Public Health. 2001 Apr;25(2):115-20.
Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. Philadelphia, Pennsylvania: Mosby, 2005, p. 299-301, 562-570, 1068-1071.
Livingstone VH, Willis CE, Berkowitz J. Staphylococcus aureus and sore nipples. Can Fam Physician. 1996 Apr;42:654-9.
Mohrbacher N, Stock J. Breastfeeding Answers Made Simple, Amarillo, Texas: Hale Publishing, 2010, p. 682-683.
Prentice A, Prentice AM, Lamb WH. Mastitis in rural Gambian mothers and the protection of the breast by milk antimicrobial factors. Trans R Soc Trop Med Hyg. 1985;79(1):90-5.
Riordan J. Breastfeeding and Human Lactation, 3rd ed. Boston and London: Jones and Bartlett, 2005, p. 248-253.
Riordan JM, Nichols FH. A descriptive study of lactation mastitis in long-term breastfeeding women. J Hum Lact. 1990 Jun;6(2):53-8.
Smith A, Heads J. Breast Pathology. In: Walker M, ed. Core Curriculum for Lactation Consultant Practice. Boston: Jones and Bartlett, 2002, p. 180-190.
Walker M. Breastfeeding Management for the Clinician: Using the Evidence. Boston: Jones and Bartlett, 2006, p. 388-394.