Home
> Breastfeeding
> Common Concerns
> Mom
Recurrent Mastitis or Plugged Ducts
By Kelly Bonyata, BS, IBCLC
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.
- 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.
- 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outdated advice to limit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).
- 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.
- 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.
- 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.
- 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).
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.
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.
It is also helpful to make sure that you're getting enough liquids,
and to reduce the amount of saturated fat in your diet.
Some moms with recurrent plugged ducts or mastitis have also had
good luck with the following homeopathic
treatment -- 2 doses Hepar Sulphur and 2 doses of Phytolacca (allow
pellets to dissolve in mouth). The doses are to be taken as follows:
First, take Hepar Sulphur 30C - 3 pellets;
3 hours later, take Phytolacca 30C - 3 pellets;
3 hours later, take Hepar Sulphur 30C - 3 pellets;
3 hours later, take Phytolacca 30C - 3 pellets.
Acupuncture has also been used successfully for recurrent plugged
ducts or mastitis.
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.
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.
Page last modified:
10/10/2005
Written: 7/18/2001
Mastitis and Plugged
Ducts @ 
Lecithin treatment
for recurrent plugged ducts @
Breastfeeding
and breast abscess @
LLL
FAQ: Repeated Cases of Mastitis
Recurrent
mastitis. Question answered by Debbi Donovan, IBCLC
Ultrasound
for persistent mastitis and plugged ducts. Question answered
by Debbi Donovan, IBCLC
Prone
to mastitis - How much milk should I express? Question answered
by Debbi Donovan, IBCLC
Weaning
and repeated mastitis. Question answered by Debbi Donovan, IBCLC
Reasons
for recurrent plugs by Kathy Kuhn, IBCLC
