Plugged Ducts

Plugged ducts are caused by inadequate removal of milk. They often occur if mom has a really high milk supply or when nursing gets off to a slow start, but there can also be a number of other contributing factors, such as missed feedings, rapid weaning or a pump with an ill-fitting breast shield. Not only do they lower milk supply, but they can also lead to mastitis, since the residual milk is a breeding ground for bacteria. Nipple damage can make this more likely.

Symptoms

• Sore, hard lumps or a swollen area in the breast which remains after the breast has been pumped or the baby has nursed.
• Decreased milk supply.
• Plugged ducts may also be accompanied by a “bleb”, which is a white spot on the nipple—either a spot of dried milk or a milk filled blister, which covers the nipple pore.

Milk which hasn’t been removed becomes more thick and “sticky” so it is difficult to remove by pumping or nursing. It is usually necessary to compress the breast behind the hardened areas to drain the milk.

Treatment

• Heat—Warmth and wetness help to induce letdown and expand the ducts, allowing easier expression of milk. A heating pad before nursing can be helpful.
• Pressure—with counter pressure– from behind the hard areas or working back from the areola toward the blocked ducts—whichever works. Hold until the milk flows and keep holding until it stops. Move your hands and repeat. It can also be helpful while your baby is nursing to use a technique explained by Dr. Jack Newman called
• Breast Compression.
• If your baby is nursing well, increase drainage of blocked areas by pointing baby’s chin toward the plugged area.
• Ultrasound therapy combined with lymphatic drainage massage techniques is extremely effective in clearing stubborn plugged ducts. Two Fairfield county physical therapy centers provide this service, which is usually covered by insurance. A prescription is necessary.
• Ibuprofen (Motrin or Advil)—400-600 mg. for inflammation and pain. Acetaminophen (Tylenol) is helpful for pain if ibuprofen is not tolerated.
• Bleb treatment—warm olive oil compresses applied to the nipple, then using a washcloth or fingernail to loosen the callous of milk that has formed. Antibacterial/antifungal treatment for skin helps reduce the associated skin inflammation.

Prevention and treatment for recurrent plugged ducts

• Change nursing positions—always using the same position or always using a nursing pillow can encourage drainage of only one area and neglect others.
• A bra that continuously compresses some ducts is occasionally a problem.
• Lecithin—1000 mg. three or four times a day can help prevent plugs.
• Correcting oversupply problems which make it difficult to effectively drain the breast is important.