It's been a fantastic week informing the women of our community about all things breasts as World Breastfeeding Week is drawing to a close. I have popped all the educational posts done throughout the week in one handy post to read! A must read for all mums and mums to be, physios, lactation consultants and G.Ps about the role physio and what further management can be offered to help empower, educate and counsel women through breastfeeding.
Get informed with the right information, know the symptoms to look out for and seek professional help for further individualized management.
Mastitis
I'd say most of the women (99%) I have treated with mastitis have said birth is a walk in the park compared to mastitis!!
Mastitis is an 'inflammatory condition of the breast which may or may not be accompanied by infection' WHO
Mastitis can be diagnosed as infective or non- infective mastitis
Non infective mastitis - Symptoms of heat, redness and soreness in an area of the breast present, may arise from milk stasis due to poor removal, sudden changes in the baby’s feeding pattern, trauma and from pressure of clothing or pressure from holding the breast resulting in a blocked duct. The onset is gradual generally unilateral, and the mother feels generally well (no flu-like symptoms)
Infective mastitis is caused by infections either in the outer skin of the breast (nipples) or within the glandular tissue of the breast. If left untreated this may develop to the formation of a breast abscess. Most common bacteria are staphylococcus aureus and coagulase-negative staphylococci but can include e coli, strep or candida.
Risk factors
There are many factors and causes that can predispose a mother to developing mastitis
Stress and fatigue
Positioning and attachment issues
Damaged nipples / nipple pain
Blocked ducts
Ample milk supply
Engorgement or milk stasis
Too rapid weaning
Uneven breast drainage
Distractions that prevent or delay the baby or mother breastfeeding
Illness in mother or baby
Sustained pressure on the breast e.g. poorly fitting bra
Stomach sleeping
History of mastitis with a previous baby
Breast trauma
Type 1 diabetics have an increased incidence of non infective mastitis
Nipple piercings - scar tissue could interfere with milk transfer and contribute to blocked ducts and mastitis
Tongue tie
Breast Swelling
Manual breast pumping
Direct blow to the breast (toddlers alert!)
Abscess
The incidence of breast abscess is < 3 %
A breast abscess can be a complication of mastitis and is usually the result of delayed or inadequate treatment
A breast abscess is a pocket of pus formed in an infected area, this is a protective strategy of the body to localize infection and prevent it from spreading.
Diagnosis will be made by ultrasound imaging, if present treatment will involve draining and antibiotics, whilst trying to continue feeding on the affected side.
Surgical drainage may be necessary if there is a large or multiple abscess presence
After the abscess drainage antibiotics will be prescribed. For severe infections and where there is an abscess present, IV treatment would be considered.
Risk factors include
Previous episodes of mastitis
Mothers who do not breastfeed on the affected breast where mastitis presents
Weaning from the breast too quickly
Blocked Milk Duct
When milk is not removed effectively from the breast, milk stasis can occur leading to a blocked milk duct. Ducts are great milk transporters but not good at holding milk, therefore milk stasis in a duct can lead to a blocked duct. The breast is made up of small ducts which transport milk into larger ducts that eventually converge into one main duct for each lobe, on average there is 9 main ducts per nipple.
A white bump on the nipple may indicate a blocked duct (known as a bleb) or commonly a tender lump on the breast that can be painful, swollen, red...... very hard to distinguish between non-infective mastitis and a blocked duct!
A blocked duct should usually improve within 24 -48 hours regardless of treatment. However, if they do not clear they can lead into mastitis.
General treatment advice for a blocked duct:
Rest
Heat
Massage
Frequent feeds
GENTLE massage - Pleas don't be 'rough or aggressive' to the boobs ladies, this can make things a heck of a lot worse.......gentle massage!
Cold pack after feeding
Baby chin position for feeding
Loose clothing
Ultrasound therapy
Differentiating a Blocked Milk Duct or Cancer
A blocked milk duct comes up usually within hours and is almost always painful (not just tender). This often does not fit the picture of cancer, which does not arise 'overnight' and is usually not tender until well advanced..... inflammatory carcinoma, can appear fairly quickly, though over a few hours would be extremely rare as well
(Jack Newmann 2013)
If a pain free lump has appeared and your breastfeeding routine has not changed head to your G.P for assessment and further management.
Cancer is certainly in the back of every clinician's mind when taking a detailed history and assessing the breast.
Engorgement
A few days postnatal increased milk production occurs leading to swelling of the breasts. Engorgement is defined as the uncomfortable swelling of the breasts. This can make it difficult for baby to latch, resulting in incomplete emptying, inhibition of the let-down reflex and decreased milk supply.
General treatment advice involves
Continue to breast feed
Ensure correct latch of bub
heat prior feeds
GENTLE massage! - prior and during feeds
Lymphatic drainage pump techniques
Manual expression post feed
Cold pack after to reduce pain or swelling
Cold cabbage leaves
Studies have looked at the effectiveness of the above treatments, and unfortunately there is insufficient evidence to justify widespread use, however there is no harm from trialling...... women do swear by some of the recommended treatments, and it's quite achievable to stick cabbage leaves in your bra during the day!
Again, ineffective treatment can lead to mastitis!, so head to the expert's...... lactation consultant for correct management if it does not settle quickly.
Did you know physio can help?
So, we have gone through a few of the major lactating breast issues that can arise postnatal and some of the recommended self-management strategies (heat, cold, loose clothing, gentle massage, lymphatic pumps, frequent feeds and REST)
Individualized assessment and management will always trump generic advice especially if you are struggling to get rid of or experience recurrent engorgement, blocked ducts or mastitis!
Physios can help in the symptom management and quicker resolution of lactating breast problems.
How?
We can help give you individualized advice, education and counselling - this is on the back of a detailed history and breast assessment. Rather than working through your mother's group recommendation ( which will probably be all good advice, but where do you start!)....HELLO STRESS, we will explain the benefits, risks and alternatives of all treatment options.
We can teach you how to perform GENTLE massage to the breast and around the nipple.... there is a specific technique, we want you to maximize the lymphatic system to help with reducing swelling, redness and pain.
Breathing exercising's to utilize the respiratory pump and help with relaxation, reduce STRESS
Specific strapping and supportive garments can be super effective and is supported by lymphoedema therapists to assist with lymphatic drainage
Therapeutic ultrasound - this is the most widely utilized physiotherapy treatment for lactating breast issues. I find it clinically very effective as do the patients. The ultrasound is to treat the breast inflammation, by proving a 'micromassage' to promote reduction of swelling, soothe tender nerve endings and if infection is present help the body's immune system or antibiotics to do their work.
The combination of physio intervention including ultrasound and antibiotics has been shown to be very effective in clearing breast problems and improving the confidence of women to continue feeding.
During breast feeding week I have hoped to improve the awareness among physios, lactation consultants, G.Ps and the mums and mums to be that there are so much more treatment options that can help women achieve their breastfeeding goals.
