Mastitis – a common condition affecting new mums. I’m sure many of you will have heard about it, but may not know exactly what it is, or that physiotherapy can help. Well, fear not! Today’s blog will take you through the ins and outs of mastitis and what you can do about it!

What is mastitis?

Mastitis means inflammation of the breast. Mastitis can occur either as a result of a blocked milk duct that hasn’t cleared, or as a result of a bacterial infection. When a milk duct is blocked, some of the milk banked up behind the blocked duct can be forced into nearby breast tissue, causing the tissue to become inflamed. Alternatively, mastitis may also occur because of an introduction of bacteria through a damaged or cracked nipple, leading to an infection.

A red, painful or hard lump is usually the first sign of a blockage. Mastitis can feel like you have the flu; you may feel hot and have body aches and pains.

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Signs and Symptoms of Mastitis

Early symptoms of mastitis can make you feels as if you are getting the flu. You may begin to get shivers and aches. Sometimes, there are no early signs and mothers get mastitis “out of the blue”.

Following are some other symptoms that may be warning signs of mastitis:

  • tender or painful breasts
  • a hot or read area of breast tissue
  • a hard, palpable lump in the breast
  • a swollen section of the breast
  • the skin may appear tight and shiny, and be streaked with red
  • high temperature (over 38oC)
  • body chills
  • flu-like symptoms

How does mastitis develop?

Factors that predispose a woman to blocked milk ducts, which can lead to mastitis include:

  • poor drainage of the breast – this can be caused by poor attachment of the baby at the breast, or limiting the baby’s time at the breast
  • engorgement of the breast due to missed feeds or delaying feeds – milk stasis (stagnant milk sitting in the breast rather than flowing through and emptying) can then lead to inflammation
  • a tight or ill-fitting bra or consistently lying in one position during sleep – this can cause compression of the milk ducts and can affect milk flow (the milk ducts are very sensitive and collapse under pressure quite easily)
  • holding the breast too tightly during feeding
  • trauma to the breast such as a kick from a toddler or pressure from a seat belt
  • nipple trauma caused by incorrect attachment of the baby during feeds – this can allow bacteria to enter the breast tissue and cause infection
  • poor physical health

What can I do if I think I have mastitis?

It is important to start treatment at the first signs of mastitis.

Drain the breast often, but gently:

  • feed often from the affected breast – commonly women will avoid feeding once they have mastitis but this can make the symptoms worse
  • this is not the time to wean – your breasts need to be kept as empty as possible to help clear the blockage. Your baby’s sucking is the best way to do this

Your breast milk is safe for your baby even if you have mastitis, so continue to breastfeed or express from the affected breast.

Apply warmth to the breast before feeding or expressing to help with your milk flow and drainage. You could have a warm shower or use a heat pack, well-covered hot water bottle, warm hand towel or a face washer wrung out in hot water.

Gently massage any breast lumps towards the nipple while feeding or expressing to help improve drainage. When you are not feeding, massage away from the nipple and towards the armpit to help remove inflammatory fluid. Also remember that we mentioned before that milk ducts are very fragile, so ensure the massage is extremely gentle.

Change feeding positions to help shift the blockage.

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Continue to breastfeed or express your sore breast until it feels more comfortable. Check that your baby is getting the milk – that is, the let-down reflex is working soon after they begin to suck. Make sure your baby is attached well and that you are relaxed and comfortable. This will assist in bringing about the “let down” reflex.

Apply cold to the breast after a feed or expressing to help reduce swelling and relieve pain. You could use an ice pack wrapped in a wet towel or cold cabbage leaves.

Medications such as paracetamol or ibuprofen are safe to take while breastfeeding and may help with the pain and inflammation. Not all patients with mastitis will require antibiotics – not all mastitis conditions are infective, some are just inflammatory. However, if you do require antibiotics, it is safe to continue breastfeeding whilst taking them.

Drink plenty of water throughout the day. Staying hydrated will help to flush any blockages.

Rest as much as possible – don’t be afraid to ask your partner, family or friends for help with household tasks.

If symptoms do not resolve, seek professional advice. If you have tried all of the above strategies over 12 to 24 hours and things are not improving, or it’s only been a few hours and you are feeling very unwell, make an urgent appointment with your doctor as you may need antibiotics.

Where can I get help?

A physiotherapist can help with settling pain and inflammation. Some physiotherapists are trained to use ultrasound therapy and manual lymphatic drainage to reduce inflammation and help to clear blockages. Luckily, Laura at Revive is one of those physiotherapists! We can also teach you to self-massage and provide advice on feeding positions and expressing if necessary.

If your symptoms point to infective mastitis, your doctor will provide you with antibiotics, and can refer you for further investigations if they suspect you may be experiencing other complications.

A lactation consultant can provide advice on positioning for both the mother and baby, as well as assessing whether your baby has any latching or attachment issues that may be contributing.

Early treatment will mean you get better faster, you will feel less ill and you will be at less risk of a breast abscess or other complications.

What can I do to prevent mastitis developing?

  • Breastfeed as often as your baby needs (normally 8-12 times in 24 hours for a new baby).
  • Try not to delay or skip feeds. Wake your baby for a feed if your breasts become too full. If your baby doesn’t want to feed, you may need to express a small amount of milk.
  • See a lactation consultant or maternal and child health nurse to make sure your baby is attaching and feeding well at your breast.
  • Offer both breasts at each feed. If your baby only feeds from one breast, make sure to offer the alternate breast at the next feed.
  • Express a small amount of milk after feeds if your breasts still feel full – express only until your breasts feel comfortable.
  • Avoid pressure on your breasts from tight clothes or fingers when feeding.
  • Stay hydrated.
  • Try to get some rest during the day when your baby is asleep.

Remember, that if you have tried all of this advice and things are not improving, book in with a healthcare professional ASAP.