Blocked milk duct: recognize, treat and prevent

Breastfeeding can be uncomplicated and beautiful. But there are also hurdles on the milky way. If the milk ejection reflex is disturbed, a blocked milk duct can occur. The breast becomes hard, firm and painful. The causes of a blocked milk duct are very diverse. Why does the milk flow get stuck in the first place, what helps against the pressure pain and where can breastfeeding mothers find timely support? 

A blocked milk duct can occur at any time during the entire breastfeeding period. It is important to recognize the onset of a blocked milk duct as early as possible and to act accordingly. 

Pay attention to the following signs: 

• Always take painful, swollen or reddened areas on the breast seriously. 

• Contact your midwife or a breastfeeding and lactation consultant. 

• The treatment of a blocked milk duct depends on the cause. 

• Frequent, unrestricted breastfeeding, rest and stress reduction are important. 

• Stronger massages or manipulations of the breast are not recommended, gentle manual movement of the breast can be helpful 

• An imbalance of the breast microbiome can promote inflammatory processes in the breast. 

• Always seek medical advice if symptoms do not improve after 24 hours or if you develop a high fever. 

The frequency of breastfeeding increases steadily in the first few days. Ten to twelve or more breastfeeding sessions within 24 hours are completely normal. Breastfeed your baby as needed – that is, whenever it shows early signs of wanting to nurse. Breastfeeding on demand also depends on your own needs. 

If your breast feels very heavy or tense, you may gently wake your baby and encourage it to nurse. Frequent breastfeeding gets milk production going well, especially between the second and fourth day after birth. If you breastfeed often enough, you can avoid feelings of tension or pain during this time. 

When milk production begins, there is often an initial swelling of the mammary glands as the body adjusts to increased milk production. Your breast feels full, heavy and warm because more blood and lymph fluid circulate in the glandular tissue. This may also be accompanied by an increased body temperature. These are physiological processes and not a sign of a blocked milk duct. 

Nevertheless, the risk is high during this phase that more serious breastfeeding difficulties will develop. This is especially true if there is pain and injury to your nipples. 

A blocked milk duct usually becomes noticeable through a painful, red and noticeably hardened area on the breast. The redness can be very localized or more widespread. A feeling of illness and increased body temperature are possible additional symptoms. Always take these warning signs seriously and take care of your breast and your well-being in a timely manner. 

Midwives often say: "The breast during the postpartum period is the mirror of the soul." This is actually true, because a blocked milk duct often arises due to stress or emotional strain. If breastfeeding doesn't go as you wish, you may feel overwhelmed. Perhaps the necessary peace during the postpartum period was disturbed or a visit shook your self-confidence. Don't let breastfeeding problems unsettle you – the postpartum period is a particularly sensitive time when you are fully focused on your baby. This sensitivity also makes you more vulnerable, and your body reacts more quickly with discomfort if you are not feeling well. 

Stress and exhaustion can disrupt the important milk ejection reflex, so the milk doesn't flow properly. Hormones like adrenaline, which is released during high stress, can negatively affect breastfeeding. But there are also other causes: Sometimes your baby doesn't drink effectively enough or isn't latched on properly. Maybe a bra strap is pressing on the milk ducts or a small membrane has formed, blocking one of the ducts.  

Longer breaks between feedings, a nursing strike, as well as excessive milk production (hyperlactation) can also lead to a blocked milk duct. If you don't handle pumping your milk correctly, this can also cause a blockage. It's important to find and address the underlying problem. It's best to get support from your midwife or a lactation consultant. 

The most important thing now is that your breast is well emptied and you allow yourself enough rest. Breastfeed your baby frequently and try to get as much bed rest as possible. If necessary, wake your baby in between so you can breastfeed at least every two to three hours. If latching is difficult, have a professional show you the correct technique and keep checking that your baby can drink well. 

Breastfeed in the position that is most comfortable for you. Acrobatic breastfeeding positions, such as kneeling over your baby on all fours, have not proven to be helpful and are also unsafe. Additional pumping can actually worsen the blocked duct situation. A breast pump should only be used with proper indication and professional guidance. 

Many women find cooling the affected breast pleasant. Even though there is no evidence for cold applications in inflammatory breast diseases, experience shows that these improve well-being for many breastfeeding women. Please note the following: Cooling too much could reduce blood flow to the breast so much that milk transfer is impaired. 

The recommendation is to cool after breastfeeding so that the breast is warmed up again by the next feeding. Only use cool compresses from the refrigerator for this, but not ice-cold ice packs from the freezer. If you do use an ice pack, wrap it in a towel first so that the temperature is comfortable and not too cold. 

A tried and tested home remedy for cooling during inflammatory processes is a quark compress. Apply the quark from the refrigerator directly to the affected area or put it on a kitchen towel, which is then folded into a pad with the quark inside. Place the resulting elongated pad on the breast, leaving out the nipple. This application is uncomplicated and may prevent unpleasant manipulation of the breast from applying and washing off the quark. 

Cabbage leaf compresses are also a well-known home remedy. For this, a leaf of organic white cabbage, previously kept in the refrigerator, is rolled out with a rolling pin. This is supposed to release the anti-inflammatory ingredients from the cabbage. Then a hole is cut in the leaf as a space for the nipple. The cabbage leaf is now placed on the breast and left there until the cooling sensation noticeably decreases. The leaves can also be placed in a nursing bra or a bustier. 

There is no scientific evidence for these measures. But in the experience of midwives, moderate cooling has proven effective in relieving symptoms for breastfeeding women. 

You still often hear the recommendation to massage the area swollen by a blocked milk duct to resolve the blockage. Many also believe that you can thoroughly empty the breast this way. However, this is based on incorrect assumptions about a blocked milk duct and can actually make the situation much worse. 

Therefore, you should definitely avoid such manipulation of the breast. Even vibration massages with special devices or an electric toothbrush should be used with great caution. They can increase the pressure in the milk ducts and thus further intensify inflammatory processes. 

Very gentle, more stroking hand movements before breastfeeding to trigger the milk ejection reflex, on the other hand, can be quite helpful. It can also be helpful to gently move the breast with your hands again and again. To do this, grasp it with your whole hand, gently lift it, and carefully move it in circles in all directions. With any touch of the breast, make sure it feels comfortable for you. This applies not only to a blocked milk duct. 

In addition to all these measures, it may also be necessary to take a painkiller. There are effective and breastfeeding-compatible analgesics. Get professional advice on which pain medication and dosage is right for you. 

A blocked milk duct can develop into mastitis, which is an inflammation of the breast. Sore nipples can also cause mastitis if bacteria enter the body through the open area. That’s why good hygiene is important: Wash your hands thoroughly and change damp nursing pads regularly. 

An imbalance, known as dysbiosis of the breast microbiome, can also promote inflammatory processes in the breast. According to current research, there is evidence that taking certain lactobacilli (Lactobacillus fermentum, Lactobacillus salivarius, and Ligilactobacillus salivarius) to strengthen the microbiome has a positive effect on the recovery from subacute mastitis.  

Mastitis usually needs to be treated with medication or antibiotics. If the symptoms associated with a blocked milk duct do not improve within 24 hours or if you develop a high fever, be sure to seek medical advice. In the worst case, untreated breast inflammation can lead to pus accumulating in the glandular tissue, which must be removed surgically. 

All of this is usually accompanied by significantly reduced well-being and a severe feeling of illness. This is especially stressful during the baby period. So take particularly good care of yourself and your body during breastfeeding. Complaints that are noticed early can usually be treated well and quickly. 

In addition to inflammatory breast diseases such as a blocked milk duct and mastitis, there are other reasons such as cysts that can lead to changes or discomfort in the breast. Always have any abnormalities in your breast checked by your gynecologist, whether you are breastfeeding or not.