Pain in both Nipples
Consider improving attachment even if there is medical basis for pain
Pain in one Nipple
There is a greater probability of pain being due to attachment but also consider the following. (Click on the links below which are relevant to your condition)
When is the pain strongest ?
At the start of a feed
Consider attachment difficulties which needs to be assessed by specialist practitioner as soon as possible.
At the end of a feed
If the nipple turns white at tip after breastfeeds and pain is immediately at end of feed when blood returns (or may become red and itchy), Vasospasm is the likely cause.
This is due to restricted circulation from compression of the nipple by the baby squashing it between his tongue and the roof of his mouth during a feed. It can be relieved by help with attachment by a specialist breastfeeding practitioner. Vasospasm can occur in both breasts but does not respond to medication which is unnecessary.
At the end of a feed and the site of pain can be pin-pointed?
If you can point to a discrete white spot [beneath thin layer of skin on the nipple] as the origin of the pain and pain occurs after breastfeeds, likely to be due to a white spot. Symptoms may return periodically.
The skin overgrowth can be removed by rubbing with a clean, moist washcloth or may require removal by a healthcare professional using a sterile needle. Antibiotic cream may be required if a significant wound results. Squeezing just behind the blister may extrude some toothpaste-like material through the now opened blister.
Is the nipple damaged?
Use moist wound healing within wound [avoid applying cream to whole nipple] to stop scab formation which will deepen the wound. Attachment needs to be assessed by specialist practitioner as soon as possible
Is the pain severe and worsening?
If there is a red/lumpy area on the breast, and you are experiencing shaking, and raised temperature is not resolving or is increasing despite frequent drainage it is likely that you have mastitis. See GP for Prescription of antibiotics plus an anti-inflammatory drug (eg ibuprofen) .
Is there a red area on the breast?
Consider abscess if it has not resolved following frequent, effective drainage and a course of antibiotics and the skin looks like orange peel. A milk sample should be taken to ascertain the micro-organism involved in the infection to inform choice of antibiotic. An ultra sound investigation may be required to diagnose an abscess. Drainage of pus by needle aspiration or surgical drainage together with appropriate antibiotic. Abscess formation is a rare complication of infectious mastitis and may involve MRSA. You may benefit from emotional support from a specialist breastfeeding practitioner